If your child winces when a toe is touched or resists wearing socks and shoes, the toenail may be growing into the skin at its edge, which is called an ingrown toenail. Mild cases are often managed at home, but infection signs are worth watching for.
Why It Happens
An ingrown toenail happens when the edge of the nail presses into the surrounding skin, causing inflammation and pain. Common causes include cutting nails too short or rounded, tight or outgrown shoes and socks, repeated stubbing or pressure on the toe during sports, and nails with a curved shape. The AAD advises cutting toenails straight across, and the same approach applies to children. It often starts as mild redness and swelling beside the nail, but if left alone it can drain fluid or become infected.
How It Differs by Age
Newborns and infants have thin, soft nails that can look pressed into the skin, and this may change as they grow. Toddlers often wear shoes that do not fit well. In school-age children and teens, tight sneakers or cleats and repeated impact during sports are common triggers. Young children may not say it hurts, and may instead refuse to let you touch the foot or limp.
Care at Home
The AAP’s HealthyChildren.org symptom guide describes these steps for a mild ingrown toenail. Soak the toe in warm, soapy water for about 20 minutes, twice a day, and dry it well. Then tuck a small wedge of cotton from a cotton ball under the corner of the nail so the nail is lifted off the skin. If cotton is hard to place, a small piece of dental floss or fishing line can be used instead. The AAFP patient handout says the cotton can be dampened with water or a disinfectant and should be changed at least once a day. After a soak, an over-the-counter antibiotic ointment can be applied to the swollen area. While it heals, open shoes such as sandals, or going barefoot when practical, keep pressure off the toe. Trim nails straight across and avoid rounding the corners. Keep an eye on children so they do not pick or cut at the nail themselves.
Common Misunderstandings
First, that cutting out the buried nail at home speeds healing; a squirming child can be hurt or the area infected, so this is not advised. Second, that short, rounded nails prevent the problem; straight-across trimming is the advice instead. Third, that if it doesn’t hurt much it can be ignored; mild pain can grow worse. Fourth, that once it heals it won’t return; with the same shoes and trimming habits it can come back.
Signs That Need Emergency Care Right Away
The AAP guide advises contacting a doctor within 24 hours if a red streak spreads from the toe, the whole toe becomes red and swollen, or a pocket of pus forms. Go to urgent care or the emergency room right away if your child has a fever, red streaking that spreads quickly up the foot, or seems unusually ill. The AAFP handout says to call the doctor if the toe does not improve with home care or if pain, swelling, or drainage increases, and notes that a clinician can numb the toe and remove the ingrown part of the nail in a minor procedure. If your child has diabetes or the same toe keeps getting ingrown, see a pediatrician, podiatrist, or dermatologist. Consider talking with a pediatrician if you are unsure. This information reflects general guidance for the United States; if you live elsewhere, check with a local pediatrician. This information isn’t a diagnostic tool and doesn’t replace advice from a medical professional.