What to Know About Scabies in Infants and Children

Of all the pesky childhood conditions you'd like to avoid, scabies is probably near the top. This parasitic infestation happens when mites burrow into the upper layer of the skin, lay eggs, and leave you with a terribly uncomfortable rash.

Scabies often spreads in daycare and school settings, putting parents on high alert. With more than 200 million cases worldwide at any given time, it's considered a common condition, but that doesn't make it any less miserable.

As a parent, you probably have lots of questions: What causes scabies? What does scabies look like? How do you get rid of scabies? Whether you've been notified about a potential scabies outbreak, or you're just hoping to avoid it, check out our comprehensive guide for parents.

How Do You Get Scabies?

Scabies mites thrive with prolonged person-to-person contact, and are therefore most likely to spread in crowded places like daycares, hospitals, schools, and nursing homes. A scabies infestation spells bad news for environments like these, since the mites can easily survive for a few days without a host, says Hadley King, MD, a dermatologist based in New York City.

This is quite unlike many other types of mites, like lice or bedbugs. "And if just a single mite survives, you can be reinfected with scabies due to their super fast rate of reproduction," warns Dr. King.

Contact with an infested object (like bedding, towels, or clothing) can also lead to scabies in kids, but it's not the most common mode of transmission.

Scabies Symptoms in Kids

Scabies symptoms usually appear 4–6 weeks after infestation, according to the World Health Organization (WHO). Scabies often begins as an insidious itch that gets worse in the evening, followed by a widespread, pimple-like red rash that can occur all over the body.

In young kids, scabies can affect the face and neck, while older kids and adults are often spared the itch in these locations. The most commonly affected areas in a scabies infection include:

• Hands (especially between the fingers)
• Wrists
• Midsection
• Groin
• Legs
• Buttocks
• Armpits
  

Sores can develop after scratching the scabies rash, which can lead to infection. Cutting your child's fingernails can help prevent this.

If your child has been infested with scabies, you may notice a series of bumps in a straight line; this is a sign of the arthropods burrowing into the skin, and it's a hallmark of scabies in kids and adults alike. The burrows might not be easy to find because most people only have 10-15 mites, notes the CDC.

At first, though, you may not see any symptoms at all. They sometimes don't appear for several weeks, says Dr. King. This is especially true for first-time scabies infections; if you've been infected before, symptoms may appear within days. But remember that infected kids can still spread scabies without symptoms, says the CDC.

Diagnosing Scabies in Children

Think your infant or child might have scabies? Bring them to a health care provider. They'll examine your child's rash, and they might also scrape the skin to look for mites under a microscope.. If they diagnose scabies, they'll also inform you about the best course of treatment.

Scabies Treatment for Kids and Babies

There isn't much good news when it comes to scabies in infants and kids. And the treatment for scabies isn't exactly a walk in the park either. According to the American Academy of Pediatrics (AAP), the best way to cure scabies is usually a 5% permethrin treatment, prescribed by a doctor. "This comes in the form of a topical cream, and can safely be used on kids 2 months of age and older, and women who are pregnant," says Dr. King.

Below, we've included step-by-step instructions for how to treat scabies in kids using permethrin cream. Always make sure to read manufacturer's directions, though, and talk to a doctor for any questions.

1. In the evening before bed, undress your child completely, including their diaper. Give them something to distract their attention.
2. Liberally apply the cream from the neck down. (Infants and young children often need treatment for their scalp and face, too, says Dr. King.) Be sure to hit every single inch of skin, including between the fingers, in the armpits and groin, behind the knees, and even the bottoms of their feet.
3. Let the lotion dry for at least 30 minutes. Then dress your child in pajamas that provide full coverage to avoid them rubbing the lotion off or putting it in their mouth (for younger children, footed pajamas work well for this).
4. First thing in the morning, remove all of your child's clothing, along with any and all bedding (blankets, comforters, stuffed animals, etc.) and place everything in a trash bag. Seal the bag tightly and store it near your washing machine for at least 24 to 48 hours.
5. Shower your child in very warm water, removing lotion completely.
6. Wash your child's belongings using the hottest water possible in a washing machine, and then use the hot setting in a dryer, Dr. King says. "If something cannot be washed, have it dry cleaned, or seal it in a plastic bag for at least one week. And vacuum all rugs and upholstered furniture on the day you start treatment." This step is essential and must be done thoroughly in order to prevent re-infestation.
7. Repeat the cleaning process as needed, and the permethrin treatment one week later if your doctor recommends it.

Your child can return to school the day after treatment for scabies, says the AAP. The itching might last for a few weeks after treatment; topical medications might help.

For stubborn cases of scabies that aren't resolved with the use of permethrin cream, oral ivermectin might be safely used, says Dr. King. Talk to your child's pediatrician to determine the best course of treatment to bring quick relief to the miserable scabies rash. And remember that scabies treatment is also recommended for members of the infected person's household, as well as anyone who had close contact with them.

What To Do If Your Child Is Exposed to Scabies

If you have a young child at daycare or school, you may one day get that dreaded note in their backpack indicating there's a scabies outbreak. If you receive this news, it's essential to act fast.

"Scabies is very contagious," says Dr. King. "Everyone who had close contact with the outbreak needs treatment. People do not have to have signs and symptoms of scabies to have mites on their skin"—it can take weeks before symptoms develop.

It's prudent for all household members to be treated—not just those with symptoms. Those who have regular contact with the infected person, such as babysitters and grandparents, should also receive treatment, says the AAP. Avoid skin-to-skin contact with infected individuals.