Impetigo in Babies

When to get help

Aged 11 months or younger: see a GP. The NHS sends children aged 12 months and over to a pharmacist, who can prescribe the same medicines as a GP, but names babies of 11 months or younger as a GP case. It also notes that babies and people with a weakened immune system may need antibiotic tablets to stop the infection causing more serious problems.

See a GP too if you are breastfeeding and the sores are on your breasts, if symptoms have changed or worsened after treatment, or if impetigo has come back within the past year. Impetigo is very infectious, so check with the surgery before going in — they may suggest a phone consultation first.

Seek urgent advice — NHS 111 in the UK (phone rather than online for a child under 5), GP out-of-hours in Ireland, your paediatrician in the US or Canada, healthdirect on 1800 022 222 in Australia, Healthline on 0800 611 116 in New Zealand — if your baby develops a temperature at or above the age thresholds of 38°C (100.4°F) under three months or 39°C (102.2°F) from three to six months, becomes generally unwell, or if the redness spreads into the surrounding skin and becomes hot and swollen. A pharmacist or GP will check whether symptoms are caused by a more serious skin infection such as cellulitis.

Call emergency services — 999, 112, 911, 000 or 111 depending on your country — for the universal baby red flags, including a rash that does not fade under a pressed glass, difficulty breathing, a first seizure, or a baby who is floppy or cannot be roused.

What it looks like

The NHS describes it starting as red sores or blisters — with the caveat that redness may be harder to see on brown and black skin. The sores or blisters burst quickly and often leave crusty, golden-brown patches. Those patches can look a bit like cornflakes stuck to the skin, can get bigger and spread to other parts of the body, and can be itchy and sometimes painful.

The commonest sites are the face, particularly around the nose and mouth, and the hands. The CDC adds arms and legs, and says sores usually appear about ten days after exposure to group A strep bacteria, forming a crusty yellow or honey-coloured scab that then heals without leaving a scar.

There is a second form, bullous impetigo, in which yellow liquid oozes from the blisters and hardens to leave a scaly border around a scab.

Things that look like it

The NHS lists the near-misses: blisters on the lips or around the mouth are more likely cold sores; itchy, dry, cracked or sore skin is more likely atopic eczema; itchy blisters may be chickenpox or, in adults, shingles. The distinguishing feature of impetigo is the golden crust rather than the blister.

Worth knowing in the other direction too: impetigo often follows something that broke the skin first. The NHS notes it usually infects skin that is already damaged, such as a cut, scratch or insect bite, or skin affected by eczema or scabies. In a baby with chickenpox, scratched spots that turn crusty and golden are a classic route in.

Treatment

A pharmacist or GP may prescribe hydrogen peroxide cream, or antibiotic cream or tablets. The CDC notes that healthcare providers treat impetigo with antibiotics. The NHS adds an instruction that is easy to ignore once things look better: do not stop using cream or taking antibiotic tablets early, even if the impetigo starts to clear up.

With treatment, impetigo often gets better in a few days.

The 48-hour rule

The NHS gives two clear points at which impetigo stops being contagious:

• 48 hours after starting hydrogen peroxide cream or antibiotics prescribed by a pharmacist or GP;
• when the patches dry out and crust over, if you do not get treatment.

That is the basis of the nursery and childcare rule: stay away from work, school or nursery until no longer contagious. UKHSA guidance for education and childcare settings uses the same threshold.

Stopping it spreading

Impetigo spreads easily to other parts of your baby's body and to other people through skin contact, and via things like towels and bedding. The NHS advice:

• wash affected areas with soap and water and dry them thoroughly;
• wash your hands frequently, particularly before and after applying cream;
• wash flannels, towels, sheets and pillowcases at a high temperature;
• wash toys with detergent and warm water;
• do not touch or scratch the sores, blisters or crusts — this also helps stop scarring;
• do not share flannels, towels, sheets or pillowcases;
• avoid close contact with people who have diabetes or a weakened immune system.

For a baby, the practical version of "do not scratch" is short fingernails, scratch mitts or socks on the hands at night, and long sleeves over affected areas on the arms.

When it keeps coming back

A GP may take a swab from the skin to check for the bacteria, and may also swab inside the nose, which is where the bacteria commonly live between episodes. Treatment can then include an antiseptic body wash, a nasal ointment, or both, to clear the carriage and stop the cycle. That is worth asking about if this is the second or third round rather than accepting another tube of cream.

Rare complications

The CDC notes that very rarely, complications can include post-streptococcal glomerulonephritis, a kidney problem, and rheumatic fever, which affects the heart, joints, brain and skin. These are uncommon, and the reason to mention them at all is that they are the reason treatment is recommended rather than waiting it out — particularly in a baby.

Preventing the next one

Keep cuts, scratches and insect bites clean by washing with warm water and soap, and treat skin conditions such as eczema properly. The CDC also lists poor hand and body washing among risk factors, and notes impetigo is more common in hot, humid weather. Well-controlled eczema is the single biggest preventive lever for most babies who get it repeatedly.