Should a Child With Impetigo Be in School

Impetigo (im-pet-eye-go) is an infection of the skin caused by bacteria. It is often called school sores because it is common among school children. Impetigo causes sores on the skin, which are usually itchy. The sores may start out as blisters that burst and become weepy, before being covered with a crust.

Impetigo is not usually a serious infection, and should clear up a few days after starting medical treatment. Children with impetigo are very infectious (contagious), but the spread of impetigo can be reduced by practising good hygiene, covering the sores with dressings and keeping your child away from other children until they are no longer infectious.

Signs and symptoms of impetigo

• The sores can be anywhere on the body, but are often on the face near the mouth and nose, or on the arms and legs.
• Impetigo may start with a blister or a group of blisters.
• The blister bursts leaving a patch of red, wet, weepy skin.
• The sore usually becomes coated with a tan or yellowish crust, making it look like it has been covered with honey.
• There can be small spots around the first sores, spreading outwards.
• There is often superficial peeling on the edge of the sore.
• Impetigo is usually itchy.

Parents sometimes worry about impetigo because it can look quite serious, but it is usually a mild infection that is easy to treat.

What causes impetigo?

Impetigo is an infection of the skin caused by staphylococcus or streptococcus bacteria. These bacteria can live on the skin, in the throat or nose, or on other parts of the body without causing a problem, but sometimes they can cause an infection such as impetigo. Impetigo can occur on healthy skin, but it usually happens when the skin has already been damaged by a scratch, bite or a disease affecting the skin, such as eczema or chickenpox.

Impetigo is very easily spread, usually through contact with the fluid or crusts of an impetigo sore, which contain the bacteria.

• Contact with the sore or with things that have been on the sore (e.g. clothing, dressings, towels) can spread the infection to other people.
• A sore takes about one to three days to develop after contact with fluid or crusts from a sore.
• The sore is itchy and children can scratch it, often spreading the infection to nearby skin or to other parts of their own body.
• A sore can be infectious for as long as it is weeping. It will usually stop being infectious about 24 hours after starting antibiotic treatment, once it has begun to heal.

Impetigo can occur even when the skin is kept clean, and it is not a sign of poor hygiene or bad parenting. Impetigo is more common in the hotter months.

When to see a doctor

If your child has signs and symptoms of impetigo, take them to see a GP. The doctor will make sure the sores are impetigo.

Treatment for impetigo

Your doctor may prescribe antibiotic medicine in the form of a cream, ointment, tablets or syrup. Give these to your child as directed, and make sure you complete the course of antibiotics.

If your child gets impetigo repeatedly your doctor may do a nose swab to test for bacteria in the nose. Your child may need antibiotics, which are delivered into the nose, to prevent further instances of impetigo.

Care at home

• Continue any creams or ointments that you have been prescribed until all sores are healed. The sores should clear up in a few days with treatment.
• A daily 10 minute bleach bath may help to reduce the amount of bacteria on your child's skin and reduce the risk of the impetigo spreading. Use regular White King Bleach 4% chlorine: add 12 mL for every 10 L of water.
• It is important to remove the crusts from the sores, to allow any ointments treating the sores to reach the infection properly. The best way to do this is to soak your child in a bleach bath for 20–30 minutes, while wiping the crusts away with an unused, wet disposable cloth (e.g. a Chux).
• Try to prevent your child scratching the sores as much as possible to avoid scarring, bleeding or further infection. Cover the sores with a watertight dressing, and cut your child's fingernails.
• Keep your child home from child care, kindergarten or school until 24 hours after starting medical treatment. After this time, they can be around other children again, but cover up their sores completely with dressings.

Take your child back to the GP if:

• the sores are spreading or getting worse, even after treatment
• your child has become unwell, for example, with a fever
• you are worried for any other reason.

Reducing the spread of impetigo

The following strategies may help reduce the chances of your child catching impetigo from another child, or reduce spread of impetigo if your child has it.

• A daily bath or shower with soap and water may reduce the risk of impetigo. Antiseptic soaps can be used, but these may irritate the skin of some people.
• Encourage your child to practise good hygiene, including regular hand washing and throwing away used tissues. Cut your child's fingernails short and keep them clean.
• Make sure that grazes or cuts are thoroughly washed. If your child is scratching a sore, cover it with a watertight dressing.
• People coming in contact with someone with impetigo need to wash their hands regularly.
• Put all dressings from impetigo sores in a bin with a lid as soon as they are taken off.
• If your child has impetigo, wash their clothes, towels and bed linen separately from the rest of the family. Wash them in hot water and dry in the sunshine or a hot tumble dryer. Toys can be washed using a mild disinfectant.

Key points to remember

• Impetigo is very infectious and can be easily spread to other children.
• Try to prevent your child scratching the sores as much as possible. Cover the sores with a watertight dressing and cut your child's fingernails.
• It is important to remove the scabs from the sores.
• Complete all courses of antibiotics as prescribed and continue treatment with creams or ointments until all sores are healed.
• Your child can go back to child care, kindergarten or school after 24 hours of treatment and when the sores are completely covered with dressings.

For more information

• Kids Health Info fact sheet: Staphylococcal infections
• Kids Health Info fact sheet:  Stopping the spread of germs
  
• Better Health Channel: Impetigo – school sores
• See your GP.

Common questions our doctors are asked

Will my child's impetigo sores scar?

If your child does not scratch and cause bleeding, almost all impetigo lesions will heal without leaving any scarring.

How long do I need to keep my child away from child care?

As impetigo is very infectious, it is important to keep your child home until 24 hours after you start medical treatment. When your child returns to child care, make sure you completely cover with dressings any sores that other children might come into contact with.

Developed by The Royal Children's Hospital General Medicine department and Centre for Community Child Health, in collaboration with Child and Youth Health Services Adelaide. We acknowledge the input of RCH consumers and carers.

Reviewed September 2020.

Kids Health Info is supported by The Royal Children's Hospital Foundation. To donate, visit  www.rchfoundation.org.au.

Should a Child With Impetigo Be in School

Source: https://www.rch.org.au/kidsinfo/fact_sheets/Impetigo_school_sores/

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