How to spot nail issues in toddlers

“Nail diseases in toddlers are not as common as in adults but can cause much anxiety to the parents,” says Dr Mamello Ntsele, a specialist dermatologist based in KwaZulu-Natal. 

Dr Ntsele says that nail disease can be congenital/hereditary or acquired, and shares some of the causes of nail conditions in children:

Nutritional deficiencies 

Deficiencies can affect nail health, leading to various changes in the nail’s appearance. Some examples include: 
• Iron deficiency: Koilonychia (spoon-shaped nails), brittle nails or nail ridging.
• Vitamin B12 deficiency: Yellowish discolouration, brittle or ridging on nails.  
• Vitamin C deficiency: Fragile or bleeding nails.
• Zinc deficiency: Nail dystrophy, brittle nails or delayed nail growth.

Trauma or infections

Injuries to the nail or infections could cause the following:
• Beau’s lines: Transverse grooves on the nail that can be caused by trauma or infections. 
• Onychomadesis: Presents as nail separation, and is painful with bleeding and discharge. It can be caused by trauma, infection and can be a sign of systemic illness or even side effects to medication.
• Leukonychia: This milky white discolouration is located within the nail plate and can be caused by trauma to the toenails caused by ill-fitting shoes, for instance. 

Finger sucking

Thumb sucking is a common childhood habit resulting in prolonged exposure to saliva. This may cause irritation, infection and cuticle damage. 

Skin conditions

Trachyonychia: Also called "twenty-nail dystrophy (TND)", and refers to a condition where the nails become rough, often with a sandpaper-like texture, due to excessive longitudinal ridging, and usually affects all twenty nails on the hands and feet
This condition can hav no identifiable cause or can be associated with skin conditions like psoriasis, alopecia areata, eczema or lichen planus, which is a chronic inflammatory disease. 

Signs and symptoms of a nail condition  

On her website, Dr Temi Awotedu, a dermatologist based in Johannesburg, shares these as signs of a nail condition:

• Nail discolouration
• Lifted nail plate
• Thickened nails
• Ridged nails
• Splitting nails
• Deformed or brittle nails
• Ingrown toenail
• Inflammation of the skin alongside the nail
• Infections of the nail (bacterial or fungal)

If you notice anything unusual in the appearance of your child’s nails, such as discoloured or brittle nails, or if your child has an ingrown nail or is biting their nails excessively, seek expert help. A paediatrician or a paediatric dermatologist would be able to assess the symptoms and share treatment options with you, which could include best practises for nail care, topical treatments or treating underlying causes, if there are any. 

Tips for keeping toddler nails in good condition

Taking proper care of your little one’s nails will also help keep them in good condition. Here, the American Academy of Dermatology Association shares a few tips:

1. Trim regularly. A good time to trim your toddler’s nails is after a bath when the nails are softer. If they refuse to sit still, you could trim them while they are sleeping. You can use a nail clipper or a scissors, and cut nails straight across to help prevent ingrown nails.
2. Finishing touches. You can use a nail file to soften any rough edges. File in one direction only as filing back and forth can cause the nails to weaken. There is no need to push back cuticles as they protect the nail root.
3. Remove hangnails. If there is some hanging or loose skin around their nails, cut them away using a clean nail clipper or scissors rather than allowing your little one to bite or pull the skin as this could cause an infection.
4. Encourage hand washing. Teach your toddler to keep their hands clean by thoroughly washing them with soap and water. Ensure their hands are dried properly as having the nails wet for a period of time can cause an infection. It is also a good idea to keep their nails moisturised with a small amount of hand cream.
5. Remember the feet. Your child’s socks and shoes can also lead to nail issues like ingrown toenails or infections if they are too tight or not kept clean. Pay special attention to this, and ensure your child is wearing sandals or shoes when they are in public spaces like bathrooms or swimming pools to prevent them picking up infections like athlete’s foot.

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