Redness and Swelling in Infants' Toenails: Causes and Solutions

Redness and swelling of the infant's (big toe) nail fold?

My seven-month-old brother has redness and swelling in the nail fold of his right big toe (compared to the left foot).
He enjoys being supported under his armpits to stand and often kicks his legs, which seems to worsen the redness and swelling in the nail fold afterward.
Can infants also get ingrown toenails? Is it possible for him to have paronychia? How should we respond? Thanks.

Xinshou PaPa, 30~39 year old female. Ask Date: 2007/04/07

Dr. Chen Rongtai reply Pediatrics

The letter mentions that the younger brother is seven months old and that the nail fold of his right big toe appears red and swollen.
Paronychia can be classified into acute and chronic types.
Acute paronychia is usually caused by infections from Staphylococcus and pyogenic Streptococcus.
Symptoms include rapidly developing pain, redness, and swelling at the proximal and lateral nail folds, along with the presence of pus, often occurring after minor trauma to the tissue near the nail (such as improper nail growth direction).
Chronic paronychia is not caused by bacterial, fungal, or yeast infections, but rather results from chronic inflammation of the proximal nail fold.
Paronychia is common in children who have habits of thumb-sucking or nail-biting, as well as in adults who frequently come into contact with water and cleaning agents.
To determine if it is indeed paronychia, a thorough examination and diagnosis by a specialist is recommended.
-- Nantou Hospital wishes you good health and all the best.

Reply Date: 2007/04/07

More Info

When it comes to redness and swelling in an infant's toenail area, particularly in the nail fold (the area surrounding the toenail), there are several potential causes to consider. Given that your baby is seven months old and has been experiencing persistent redness and swelling in the right big toe, it is essential to evaluate the situation carefully.

Possible Causes
1. Ingrown Toenail: One of the most common issues that can lead to redness and swelling around the toenail is an ingrown toenail. This occurs when the edge of the toenail grows into the surrounding skin, causing pain, redness, and swelling. Infants can develop ingrown toenails, especially if their toenails are cut too short or if they are wearing tight-fitting footwear.

2. Nail Fold Infection (Paronychia): This condition occurs when bacteria or fungi infect the skin around the toenail. It can result in redness, swelling, and sometimes pus formation. This is more common in infants who may have frequent exposure to moisture or irritants.

3. Trauma: If your baby is standing and moving around, there is a possibility that the toenail area has experienced some trauma, leading to inflammation and swelling. Infants are often unsteady on their feet, and minor injuries can happen easily.

4. Fungal Infections: Although less common in infants, fungal infections can also cause redness and swelling around the toenails. This is typically accompanied by other symptoms such as discoloration or thickening of the nail.

5. Allergic Reaction: If your baby has come into contact with an irritant or allergen, it could result in localized redness and swelling. This could be due to a new soap, lotion, or even a reaction to certain fabrics.

Solutions and Recommendations
1. Observation: Monitor the affected toe closely. Look for signs of improvement or worsening. If the redness and swelling persist or worsen, it is essential to seek medical attention.

2. Proper Nail Care: Ensure that the toenails are trimmed straight across and not too short. Avoid rounding the edges, as this can increase the risk of ingrown toenails.

3. Soaking: If you suspect an infection or ingrown toenail, soaking the affected toe in warm, soapy water for about 10-15 minutes a few times a day can help reduce swelling and promote healing.

4. Avoid Tight Footwear: Ensure that your baby is wearing properly fitting footwear that does not constrict the toes. This is particularly important as they begin to stand and walk.

5. Consult a Pediatrician: If the redness and swelling do not improve with home care, or if you notice pus, increased pain, or fever, it is crucial to consult a pediatrician. They may need to examine the toe and possibly prescribe antibiotics or antifungal medications if an infection is present.

6. Preventive Measures: To prevent future occurrences, keep your baby's feet clean and dry, and avoid exposing them to irritants. If your baby is prone to nail issues, regular check-ups with a pediatrician or a podiatrist may be beneficial.

In summary, while it is possible for infants to experience issues like ingrown toenails or infections, careful observation and proper nail care can often mitigate these problems. If you have concerns about your baby's toe, especially if there are signs of infection or significant discomfort, do not hesitate to seek professional medical advice.

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