Scabies in children and toddlers: signs, symptoms and treatment

Scabies spreads through skin-to-skin contact, including hand holding – but it's not instant, so a brief touch of hands is likely to be OK.

It can also spread by sharing bedding and towels, as the mites that cause it can survive when they're not on human skin for about 24 to 36 hours.

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Here's how to spot the signs and symptoms of scabies – and what to do if you think your child has it

What are the symptoms of scabies?

The first symptom you'll notice is that your child has some intense itching – and therefore a strong urge to scratch.

The itching is mostly likely, at first, to be centred around the wrists and between the fingers, and is often worse when your child is hot – so, after a bath, for example, or at night.

You might also see little silvery lines: they generally have a little dot at the end of them, though these can be hard to spot.

After the silvery lines appear, a raised rash can develop, which then turns spotty over time – looking a bit like acne or mosquito bites. This rash can spread across the whole body (apart from the head and neck). On white skin, the rash can look red or brown; on brown or black skin, it can look darker than your usual skin colour and is often harder to spot – although you'll be able to feel the raised bumps on the skind.

The rash can take as long as 2 to 8 weeks to appear. If you have had scabies before, though, the rash may appear much sooner.

scabies black skin — A scabies rash on black skin

How can I be sure it's scabies and not something else?

There are many other skin conditions that can cause itchy skin and rashes. What tends to set scabies apart are the silvery lines and how super-itchy it is.

If you're not sure if your child has scabies or not, ask your pharmacist; if your child is under 2 years old, take them to your GP.

What's the treatment for scabies?

To treat scabies, everyone in the household will need to apply a lotion or cream over their whole body. The cream contains permethrin and the lotion contains malathion, and both are available over the counter at pharmacies or on prescription.

For a child under 2 years, it's best to see a GP first, so your GP can advise the best treatment; if you're pregnant or breastfeeding, check with your pharmacist before you purchase a scabies treatment.

The treatment needs to be applied in 2 doses a week apart– and must be applied everywhere, including between fingers and toes. As a guide, an adult generally needs 30g cream or 100ml lotion for 1 application, so be sure to purchase enough for everyone to have 2 doses.

Follow the instructions carefully and leave the treatment on for the required amount of time. If you're treating a baby or toddler, it can help to cover their hands with socks or mittens to stop them sucking off the cream.

Everyone else in the household – and anyone who has daily close contact with any of you (including anyone you have had sexual contact with in the past 8 weeks) – needs to be treated, too, even if they aren't itching. This is because scabies is so infectious, and you can't always tell who has it, as it can take 6 weeks for the rash to appear.

You might also want to ask your pharmacist if there's anything your child can safely use or take to reduce the itching such as calamine lotion.

The itching of the rash can take 2 to 3 weeks to subside, even after treatment.

Is there anything else I'd need to do? Disinfect clothes or bedding?

Yes! Scabies mites can live for about 2 days on clothes, bedding and towels. After you've put on the 1st application of treatment, machine-wash everyone's bed linen, towels and clothes at 50°C or above to kill the mites.

If you have any items of clothing or bedding (such as duvets) that can't be washed or can't be washed at that high a temperature, then you can also kill the mites by doing one of the following:

Put the item in a plastic bag for at least 72 hours
Iron the item with a hot iron
Put the item into the tumble dryer on a hot cycle for about 30 minutes

Pets do not need to be treated: they can't get scabies from humans. (Pets do actually get scabies but from a different type of mite – one that can't reproduce in human skin.)

Do I need to take my child to the GP?

Yes, if your child is under 2. But with an older child, they only need to see your GP if they are still itching 4 weeks after treatment or if the rash has become oozy or blistered (this could be a sign of a skin infection that may need treating with antibiotics).

Should my child stay off school or nursery with scabies?

Yes please. Keep your child off school or nursery until 24 hours after the first application of treatment.

It's fine to go back after that. But it may take the itching and rash weeks to resolve, even once the infection has been treated.

What exactly is scabies?

Scabies is a mite infestation: tiny mites called Sarcoptes scabiei burrow into your skin and lay eggs. The little silvery lines you might see on your child's skin are the burrows the mites are making.

It's unlikely that you'll spot the mites themselves. They're very, very small – about half a millimetre long, making them extremely difficult to see with the naked eye.

Scabies is very common and anyone of any age can get it. It is extremely infectious, and is passed on by coming into close contact with someone who has it.

Will my child get scabies again?

It's possible. You can get scabies more than once.

Pics: Getty; @Brownskinmatters

Dr Philippa KayeGP

Dr Philippa Kaye works as a GP in both NHS and private practice. She attended Downing College, Cambridge, then took medical studies at Guy’s, King’s and St Thomas’s medical schools in London, training in paediatrics, gynaecology, care of the elderly, acute medicine, psychiatry and general practice.