Cellulitis in children

Overview

Cellulitis is a bacterial skin infection that can happen when germs get into a break in the skin. It causes the skin to become red, swollen, warm, and painful. In children, it often affects the legs, arms, or face.

Cellulitis is fairly common in children, especially in those who get minor cuts, scrapes, or have skin conditions like eczema.

Cellulitis can affect any child, but it is more common in children with breaks in the skin (like bug bites, scratches, or cuts), those with eczema or other skin problems, and those who have weakened immune systems.

Symptoms

Common symptoms

• Red, swollen, and warm skin in one area
• Pain or tenderness in the affected area
• The red area may grow larger over hours or days

Symptoms in children

• Redness and swelling that may spread quickly
• A child may feel generally unwell, with fever or chills
• They might cry or say the area hurts when touched
• Sometimes the skin blisters or oozes fluid

Symptoms in older adults

• Symptoms similar to those in children, but older adults may have less obvious redness if their skin is darker
• They might also feel confused or dizzy if the infection spreads

Causes

Main causes

• Bacteria (most often Streptococcus or Staphylococcus) entering the skin through a break, such as a cut, scrape, insect bite, or eczema patch
• Occasionally bacteria can enter from a blister, a burn, or a surgical wound

Risk factors

• Having eczema, psoriasis, or other skin conditions that cause cracks
• Recent surgery or injury with a wound
• Being overweight or having a weakened immune system
• Poorly managed diabetes (if the child has it)

When to see a doctor

See a doctor urgently if:

• If the child has a fever and a red, swollen area on the skin
• If the redness is spreading quickly
• If the child is unusually sleepy or not acting normally

Book a routine appointment if:

• If a cut or scrape looks red and you are worried, it is wise to have it checked even if symptoms are mild

Diagnosis

A doctor will look at the red, swollen area and ask about your child’s symptoms and recent injuries. They can usually diagnose cellulitis just by examining the skin.

Tests that may be done

• Sometimes the doctor may take a blood test to check for infection
• If there is a wound with pus, they might take a sample (swab) to find out which bacteria is causing it
• An ultrasound scan may be done if the doctor suspects an abscess (a pocket of pus) under the skin

What to expect at your appointment

The doctor will likely prescribe antibiotics and explain how to care for the affected area at home. They may ask you to come back in a day or two to make sure the infection is improving.

Treatment

Cellulitis is treated with antibiotics to kill the bacteria. Most children can take antibiotics by mouth (orally) at home. It is important to follow the full course as prescribed, even if your child starts feeling better.

Self-care at home

• Keep the affected area clean and dry. Gently wash with mild soap and water if needed.
• Rest the limb if the infection is on an arm or leg. Elevating it (raising it on pillows) can help reduce swelling.
• Give your child paracetamol or ibuprofen for fever or pain—check with your doctor or pharmacist for the right dose for your child’s age and weight.
• Do not try to squeeze or pop any blisters or pus—this can make the infection worse.

Medical treatments

Doctors usually prescribe antibiotics taken by mouth for 7 to 10 days. If the infection is severe, or if your child cannot take oral medicines, they may need antibiotics through a drip (intravenous) in the hospital. Always complete the full course of antibiotics as directed.

When is surgery considered?

Rarely, if an abscess (a pocket of pus) forms, the doctor may need to drain it with a small procedure. This is done with local anaesthetic to numb the area.

Living with this condition

While your child has cellulitis, they may need to rest more than usual. Keep the affected area elevated if possible, and make sure they take their medicine on time. The infection usually starts to improve within 24 to 48 hours after starting antibiotics.

Lifestyle tips

• Help your child avoid scratching or picking at the affected area
• Encourage good hand washing to prevent spreading bacteria to other parts of the body
• Keep the skin moisturized with fragrance-free cream to prevent cracks (if your child has eczema or dry skin)

Diet and exercise

No special diet is needed, but drinking plenty of water helps the body fight infection. Light activity is fine once your child feels better, but avoid swimming or soaking the area until the infection is fully healed.

Mental health and emotional wellbeing

Cellulitis can be uncomfortable and may cause worry for both you and your child. It is normal to feel concerned, but remember that treatment is very effective. If your child seems anxious or scared, talk to them gently and reassure them that the medicine will help them get better.

Prevention

You can reduce the risk of cellulitis by taking care of your child’s skin: clean any cuts, scrapes, or insect bites with soap and water, apply an antiseptic cream (like antiseptic ointment available at pharmacies), and cover the wound with a clean bandage until it heals.

Complications

If left untreated

• The infection can spread into the bloodstream (sepsis), which is life-threatening
• An abscess (collection of pus) may form under the skin and need drainage
• Rarely, the infection can spread to deeper tissues, like muscles or bone

Long-term outlook

With prompt treatment, most children recover fully from cellulitis without any lasting problems. The key is to start antibiotics as soon as possible. If your child has had cellulitis once, they are at slightly higher risk of getting it again, but good skin care can help prevent that.

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