Scabies—Child Care and Schools

What is scabies?

Scabies is an infestation of the skin by small insects called mites.

What are the signs or symptoms?

• Rash, severe itching (increased at night).

• Itchy red bumps, pimple-like lesions (called pustules), or blisters found on skinfolds between the fingers, toes, wrists, elbows, armpits, waistline, thighs, genital areas, abdomen, and lower buttocks.

• Children younger than 2 years are likely to be infested on the head, neck, palms, and soles of feet or in a diffuse distribution over the body.

What are the incubation and contagious periods?

• Incubation period

  • ? 4 to 6 weeks for those who have never been infected.

  • ? 1 to 4 days for those who have been previously infected and sensitized. (Repeated exposures tend to be milder but produce symptoms earlier after exposure.)

• Contagious period: Until the insect infestation is treated.

How is it spread?

Prolonged and close person-to-person contact

How do you control it?

• Treatment of the affected child and family by a health professional, usually with a cream containing 5% permethrin. May need a second application a week after the first. Household members who are close contacts should be treated at the same time.

• Launder bedding and clothing (hot water and hot drying cycle) worn next to skin during the 3 days before start of treatment.

• Items that cannot be laundered should be placed in plastic bags for at least 4 days. Scabies mites cannot survive away from humans for more than 4 days.

Rash of scabies, which is a widespread area of irritation, often with pink to red bumps along lines and tracks where the insects have burrowed, causing blisters and pimple-like lesions.

AMERICAN ACADEMY OF PEDIATRICS

Top view of a child's foot covered in pimple-like bumps, some pink and some a darker red, most of which appear white in the center and filled with pus. Lesions are more concentrated around the ankle, the largest of which has irregular, purple edges.

Pustules on wrist and base of thumb

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Close-up view of a hand bent backwards, exposing the wrist and base of the thumb, with a rash spreading across the skin, the main portion of the rash spreading in a line from the base of the wrist and along the base of the thumb. Portions of the rash contain yellow, scabbed bumps surrounded by red patches of skin.

What are the roles of the educator and the family?

• Report the infection to the staff member designated by the early childhood education program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms.

• Contact the child's health professional if itching continues for several weeks after treatment. This could indicate a reinfestation.

• Family members and very close contacts should be treated at the same time as the child, even if no signs or symptoms are present.

Exclude from educational setting?

At the end of the day, the child should be seen by a pediatric health professional, and, if scabies is confirmed, the child should start treatment before returning. If treatment is started before the next day, no exclusion is necessary.

Readmit to educational setting?

Yes, when treatment has been completed (usually overnight)