How should I care for an ingrown toenail in a newborn?

Management of Ingrown Toenails in Newborns

For newborns with ingrown toenails, conservative management with gentle nail care, warm water soaks, and topical emollients is the appropriate first-line approach, avoiding any surgical intervention in this age group.

Initial Conservative Management

The management of ingrown toenails in newborns differs significantly from older children and adults due to the delicate nature of neonatal tissues and the typically mild presentation at this age.

Primary Treatment Approach

• Apply gentle warm water soaks to the affected toe to reduce inflammation and soften the surrounding tissue 1, 2
• Use bland, thick emollients (petroleum jelly or petrolatum-based ointments) applied at least twice daily to the periungual area to maintain skin barrier function and reduce friction 3
• Avoid cutting nails too short and ensure nails are trimmed straight across rather than curved, though in newborns, nail trimming should be minimal and extremely gentle 4

Specific Techniques for Mild Cases

• Place cotton wisps or dental floss gently under the ingrown nail edge to lift it away from the lateral nail fold, though this requires extreme caution in newborns due to tissue fragility 1, 5
• Apply mid- to high-potency topical corticosteroids after soaking if there is visible inflammation or erythema of the nail fold 1
• Ensure proper footwear by avoiding tight socks or booties that create excessive pressure on the toes 4

When to Escalate Care

Signs Requiring Medical Evaluation

• Presence of purulent discharge, significant erythema extending beyond the nail fold, or signs of cellulitis warrant evaluation for possible bacterial infection 4
• Obtain bacterial cultures if infection is suspected before initiating antibiotic therapy 4
• Consider topical povidone-iodine 2% applied twice daily if grade 1 inflammation (nail fold edema or erythema with cuticle disruption) is present 4

Antibiotic Considerations

• Oral antibiotics should be reserved for cases with clear signs of infection (grade 2: nail fold edema with pain, discharge, or nail plate separation) 4
• Topical antibiotics combined with corticosteroids may be used for mild inflammatory changes 4

Critical Pitfalls to Avoid in Newborns

• Never perform surgical interventions (partial nail avulsion, phenolization, or matricectomy) in newborns, as these are reserved for recurrent cases in older children and adults 1, 6, 5
• Avoid harsh soaps or cleansers that disrupt the immature neonatal skin barrier 7
• Do not use emollients with fragrances or preservatives due to increased risk of contact sensitization in newborns 7, 3
• Avoid aggressive manipulation of the nail or surrounding tissue, as newborn skin is particularly fragile 7

Preventive Measures for Parents

• Daily application of topical emollients to cuticles and periungual tissues helps maintain tissue integrity 4
• Ensure cotton socks and comfortable, well-fitting footwear that doesn't compress the toes 4
• Avoid repeated friction and trauma to the toes from tight clothing or bedding 4
• Monitor closely for early signs of inflammation or infection, as newborns can progress quickly if secondary bacterial infection develops 4

Reassessment Timeline

• Reassess after 2 weeks of conservative management to determine if inflammation is improving or worsening 4
• If no improvement or worsening occurs, refer to pediatric dermatology or podiatry for specialized evaluation rather than escalating to surgical management 4