Ingrown Toenails

Dear Lisa,

Hello.
My daughter is 20 months old. Few months ago I noticed that her toe nails on her big toes look ingrown. During her routine exam I mentioned it to her doctor. She said that there is nothing to worry about, just put some Vaseline around the baby’s nails and let them grow. I’ve been doing so. However, it doesn’t seem to help. The toe nails grow out, but then break off very close to the skin, which makes it even worse. Is there anything else I could use? I myself have that problem, but it developed when I was in my late teens, and now it doesn’t bother me at all. I worry that her toe nails will get even worse. I really appreciate your advice.

Thank you.

“Ingrown Toenails”

Dear “Ingrown Toenails”,

Ingrown Toenails occur when the nail curves while it grows and embeds into the skin at the corner of the nail. The big toe tends to be the toe that is prone to this problem. It seems that you are concerned that your daughter developed this condition at such a young age, but actually Ingrown Toenails are not uncommon in young children at all. Children can develop Ingrown Toenails during their first year of life.

Some health care professionals believe that restrictive clothing such as tight fitting feetie pajamas or tight socks contribute to the problem. (1) In order to prevent and treat Ingrown Toenails parents should avoid dressing their children in tight fitting footwear. Dressing children in pajamas without attached feet many times rectifies the problem.

The condition usually resolves if a child's nails are cared for properly. (1) Proper nail care includes trimming the nail straight across with a clean clipper or pair of scissors. It is not recommended to cut the nails on a diagonal on the outer edges. Applying gentle pressure on the nail margin after a child comes out of the bath also may help. If this is done on a regular basis, this will eventually lift the nail plate above the adjoining skin.(1)

Ingrown Toenails can become infected therefore it is important to monitor your child’s toe nail for signs and symptoms of an infection. Signs of infection include swelling, redness, induration, warmth and pain. It is important to remember that young children are not be able to communicate pain. Instead they may become irritable, walk with a limp or refuse to let their parents put shoes on their feet.

Pus is another sign of an infected Ingrown Toenail. If gentle pressure is applied to an infected Ingrown Toenail, pus may seep out of the corner where the nail meets the skin. If colored pus is noted with this maneuver, the child should be evaluated by a health care professional.

The treatment for an infection of an Ingrown Toenail includes soaking the toe in warm salt water, applying warm compresses and applying an antibiotic ointment. Warm compresses should be applied for 15 minutes, three to four times per day. In some cases, on oral antibiotic may be needed in order to eradicate the infection. If your child has an Ingrown Toenail and develops signs of an infection an evaluation by a health care professional is necessary.

Typically these non-invasive measures are all that is needed to resolve the problem. It is very rare that a young child requires more aggressive treatment. (1) If chronic or recurrent problems occur an evaluation by a Podiatrist may be needed, but in most childhood cases, this is not necessary.

References:
(1)Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc. 1990:32.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice For Parents with Infants