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Healthy
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IMPETIGO
Rashes and skin irritations are quite common in children. Rashes or other outbreaks may indicate allergic reactions, diseases, or simply irritations, but sometimes they are a sign of skin infection. Skin infections in children may be bacterial, viral, or fungal. The most common type found among preschool children is a bacterial infection called impetigo.
What is Impetigo?
Impetigo may occur when bacteria enter the skin, usually through a break in the skin from an insect bite, a cut or scrape; a chronic runny nose that is irritated by the fluid from the nose or the continual wiping of the skin; or diaper rash. Impetigo also can be a complication of chicken pox lesions. (Another reason why all children more than 12 months of age should receive the chicken pox vaccine.)
Once the bacteria invade the area, they begin to multiply. By traveling beneath the skin in the body's lymphatic system, these bacteria can invade nearby skin areas. That is why impetigo infection appears in clusters. The infection usually is superficial and is more common in warm climates or warm months.
The skin affected by impetigo will become red and may be raised. Small bumps develop that may become blisters or pimples. The skin then breaks down and sores develop. Depending upon the specific bacteria responsible, these sores may develop thin yellowish crusts about an inch in diameter. The infection may also cause blisters, or fluid-filled sacs, which may be localized or widespread on the skin. The symptoms develop over several days, causing itching, tenderness, and/or pain. The skin generally begins a healing process, and the open sores develop scabs, usually draining clear fluid or pus.
Serious complications are rare, but possible. The sores can become very red, tender, warm, and swollen, and red streaks may be seen along the skin from the area. This means the infection is invading the tissues, and the child should be seen by a physician immediately.
Treatment
Treatment consists of cleaning the area, gently removing the scabs with soap and water, and using antibiotics to treat the bacteria. The parent should be careful not to rub the area too hard because the skin easily can be damaged even further. If a topical ointment is prescribed, parents should apply it as directed, usually three or four times per day, and covered.
Because the bacteria are so easily spread, it may not be advisable for caregivers to be involved in the child's treatment. Changing bandages or applying ointment in the childcare setting can provide an opportunity for bacteria to spread to the caregiver and/or to other children.
Unfortunately, topical ointments often are not enough, so oral antibiotics also may be prescribed by the child's physician. These antibiotics usually are taken for five to seven days. The skin should heal totally in about seven days, sometimes causing a little scaring or skin discoloration that usually disappears.
Preventing the Spread
Impetigo can be spread very easily. The bacteria in the open sore can spread when the child scratches the area. Bacteria get under the fingernails, another skin area is scratched, and the bacteria are then reintroduced into the body at another location. To discourage scratching, cut the child's fingernails short and cover the sores with the prescribed ointment and a bandage. Thorough and frequent hand washing also helps prevent spread of the infection.
Impetigo is usually caused by strep and staph bacteria, which are commonly carried in children's throats and noses. The most common source for the spread of infections is the nose, where the secretions or droplets are spread by the contaminated hand and mouth. The bacteria also can live on other objects. Most toddlers touch and mouth everything in reach, and, therefore, deposit bacteria for others to pick up. Bacteria also can be spread to other children, caregivers, or family members by sharing tissues, wash cloths, or towels.
The most effective way to prevent the spread of impetigo, or any infection, is by the simple act of hand washing with soap and water. (The waterless soap preparations are not as effective, and should not replace regular hand washing.) Thorough hand washing by both the child and the caregiver is essential after blowing or wiping the nose, toileting, or changing diapers.
Bacteria do not usually penetrate unbroken skin, so it is important to keep skin healthy. Help prevent skin irritation and infection by cleaning wounds thoroughly with soap and water, then covering with a bandage and by wiping noses with soft tissues and putting ointment on irritated skin under noses. Impetigo is often associated with diaper rash or irritation, so change diapers frequently to avoid urine irritation. Children with compromised immune systems or circulation are at increased risk. Therefore, keep their skin lesions especially clean and watch closely for signs of infection.
Should impetigo be listed in your policy on illness and admission to the childcare program? In Caring for our Children, the American Academy of Pediatrics and the American Public Health Association recommend that children with impetigo be sent home and excluded from admission until 24 hours after treatment has been initiated. When a case of impetigo is present in the home or center, caregivers should watch for signs of infection in other children and staff. Check with your program's health consultant or physician to determine how you should write and enforce your policy.
By JAMES M. POOLE, MD FAAP, The committee on Early Childhood, Adoption and Dependent Care of American Academy of Pediatrics
Internet Resources
The Pennsylvania Chapter of the American Academy of Pediatrics has available a fact sheet on impetigo. Visit their web site; www.paaap.org/ecels/fact/impetig.
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