Red flags & when to go in person for Nail Fungus (Onychomycosis) in Children

Audience: pediatric

Nail fungus, also called onychomycosis, is a common condition where fungi infect the nails, causing changes in color, thickness, or texture. In children, nail fungus often develops slowly and may not cause pain. Telemedicine can help assess typical cases by reviewing symptoms and photos of the nails. However, some signs mean a child should see a healthcare provider in person. These include sudden worsening, severe pain, signs of spreading infection, or if the child has other health problems like weakened immunity. Early in-person care can prevent complications. This guide helps parents and caregivers know when telemedicine is appropriate and when to seek face-to-face evaluation for their child’s nail concerns. It also explains how to prepare for a telemedicine visit and what to expect afterward. Remember, this information is educational and not a substitute for professional medical advice or diagnosis.

Red flags — go in person / ER

• Rapid worsening of nail appearance or new pain develops — seek in-person care promptly.
• Signs of spreading infection such as redness, swelling, warmth, or pus around the nail — get urgent medical evaluation.
• Fever or general illness with nail changes — immediate in-person assessment is important.

What telemedicine can do

• Initial evaluation of nail changes through photos or video.
• Providing general advice on nail care and hygiene.
• Discussing treatment options for mild or typical cases.
• Monitoring progress with follow-up virtual visits.

What telemedicine cannot do

• Performing laboratory tests like nail clippings or cultures.
• Treating severe or spreading infections requiring urgent care.
• Managing nail conditions complicated by other health issues needing physical examination.
• Providing surgical or procedural treatments.

What is Nail Fungus (Onychomycosis)?

Nail fungus is an infection that affects the fingernails or toenails. It usually causes the nail to become thick, discolored (yellow, white, or brown), brittle, or crumbly. In children, it is less common than in adults but can happen, especially if nails are injured or the child has other skin conditions.

When Telemedicine Can Help

Telemedicine allows healthcare providers to look at your child's nail changes through photos or video. They can ask about symptoms, how long the problem has lasted, and any treatments tried. This can help decide if the nail changes are likely due to fungus or another cause and whether home care or medication may be helpful.

Red Flags That Need In-Person Care

Some signs mean your child should see a healthcare provider in person right away:

In-person visits allow for tests, treatments, and closer monitoring.

Preparing for a Telemedicine Visit

To get the most from a telemedicine visit:

After the Telemedicine Visit

Your healthcare provider may suggest:

Follow the provider’s instructions and reach out if new symptoms develop.

How to prepare for your tele-visit

• Take clear, close-up photos of the affected nails in good lighting.
• Note the start date and progression of nail changes.
• List any symptoms such as pain, itching, or swelling.
• Gather your child's medical history and current medications.
• Prepare any questions or concerns to discuss with the provider.

After your tele-visit

• Follow the healthcare provider’s advice on nail care and treatment.
• Use prescribed medications as directed, if any.
• Monitor the nails for improvement or worsening.
• Schedule an in-person visit if red flags or new symptoms appear.
• Keep nails trimmed and dry to prevent further infection.

FAQs

Can nail fungus be treated at home?

Mild cases of nail fungus may improve with good nail hygiene and over-the-counter treatments. However, treatment often takes weeks or months, and some cases need prescription medicines. Always consult a healthcare provider before starting treatment.

How can I tell if my child’s nail problem is fungus or something else?

Nail fungus usually causes thickening, discoloration, and brittleness. But other conditions like psoriasis, eczema, or injury can look similar. A healthcare provider can help determine the cause, sometimes needing tests.

Is nail fungus contagious?

Yes, nail fungus can spread from person to person or through shared items like towels or shoes. Good hygiene and not sharing personal items help prevent spread.

When should I take my child to see a doctor in person?

If the nail changes worsen quickly, become painful, show signs of infection (redness, swelling, pus), or if your child has fever or other health problems, seek in-person medical care promptly.

Sources

1. Onychomycosis — MedlinePlus, U.S. National Library of Medicine.
2. Fungal Nail Infection (Onychomycosis) — Centers for Disease Control and Prevention (CDC).
3. Onychomycosis: Diagnosis and Treatment — Mayo Clinic.
4. Nail Disorders in Children — American Academy of Pediatrics.

This telemedicine guidance is for educational purposes only and is not a substitute for in-person medical care. If your child has concerning symptoms or red flags, seek prompt evaluation by a healthcare provider in person.