Fingernail/Toenail Infection - Fungal

This is a medical condition where your child has a fungal infection in their fingernails or toenails.

The medical term for this is onychomycosis.

It is less common in children than adults.

This can cause the nail to look discolored, thickened, and sometimes it may have a smell.

• At first it may look like a bruise, so parents often think it was due to an injury or when playing.

• Or it may look like your child has a stain on their foot.

Fungal infections often come from moist areas or damp environments.

Potential causes or risk factors are:  

• Sucking on fingers or toes.

  • This exposes the nails to constant moisture

• Having mold in your house.

• Hand-me-down shoes that have fungus in them.

• Playing in wet areas like mud, grass, or sandboxes if barefoot or with shoes that allow water to soak in.

• Having eczema, atopic dermatitis or dry skin, as fungus can get in the cracks.

• Having a fungal infection before, like thrush, candidal diaper rash, or athlete’s foot.

• If the nails are cut to where they are jagged or have rough edges, this may allow fungus.

• Wearing shoes that make your child’s feet really sweaty.

• Having a family history of nail infections or being exposed to a parent that has it.

• Taking certain medications that affect your child’s immune system’s ability to fight off infections.

• If your child has a condition where their immune system is weaker than others.

Your child’s nails may look discolored, cracked or peeled.

Nails feel harder and lose their normal nail shape.

Pieces of the nail break off or crumble.

There is an unpleasant smell from the nail.

Your child may complain of pain or discomfort when putting pressure on the nail.

Your child’s primary care provider will ask you and your child (if age appropriate) some questions.

Your child’s primary care provider will examine your child.

Your clinician may ask you to collect nail clippings to perform a fungal culture.

Rarely, your child may need to see a specialist like a podiatrist (foot doctor) or dermatologist (skin doctor).

• Your child’s primary care provider will refer your child to a specialist if needed.

Keep your child’s nails dry and clean.

• Be sure to dry in between the toes.

Encourage your child to consume a healthy diet with lots of fruits and veggies, and try to limit the amount of sugar.

• Eating processed sugar, unlike natural sugars found in fruits and veggies, can increase the risk of fungal infections.

File the nails as needed to keep smooth edges and trim them so that the nail is straight across, avoid curves at the end of the nails.

• Try to avoid sharing nail clippers, and clean them after use.

• Check your child’s fingers and toes for any changes in the nails or skin around them.

• When old enough, encourage your child to check for any skin peeling or cracking, changes in skin color, or bad smells.

  • This can help them with learning responsibility and how to take care of their body.

Rotate shoes so they can dry completely in between uses.

• Avoid sharing shoes with others.

• Hand me down shoes may have fungus in them.

• You can use UV shoe sanitizers on shoes to help kill any fungus.

• If able, choose shoes that have breathable material and take socks and shoes off as soon as able.

• Cotton socks are a good option, as they allow the feet to breathe well.

Put your child to bed barefoot, avoid socks since they are moisture trappers.

• Use light blankets when possible for sleep to avoid sweaty feet.

Use sandals in locker rooms, public showers or public pool areas.

• This helps your child avoid exposure to fungus in these places.

Clean showers and bathroom floors regularly.

• With shower or bath mats, use quick dry options to avoid any fungal growth.

Use antifungal sprays where safe, to remove any mold or fungus in household areas.

Encourage your child to stop sucking on fingers or toes, as this continuous moisture is a risk for fungal growth.

• This link has helpful tips for this.

The most common treatment involves the use of antifungal medication.

Nails are sturdy parts of the body, so the length of treatment is usually from 4 to 8 weeks, sometimes longer.

Your child’s healthcare provider may recommend a topical medication that you apply on the nail or an oral medication.

• These are examples of some commonly used medications:

  • Ciclopirox and efinaconazole are topical treatments.

  • Terbinafine and fluconazole are oral medications.

Laser therapy is a painless option that is safe to use on kids.

• This would be done by a specialist like a podiatrist, who helps with different types of foot issues.

• Usually topical or oral medications work well, but sometimes the nail or a portion of it, needs to be removed by a podiatrist.

At home treatments are not usually as effective as prescription medication, but may help so here are some options:

• Mix one part vinegar with two parts warm water and soak the affected nails for 10 minutes.

• You can rub coconut oil into the affected part of the nail, since coconut oil is a natural anti-fungal.

You think your child has a fungal infection.

You are concerned about your child’s skin or nails.

You have other concerns or questions.