Cellulitis in Children

What is cellulitis?

Cellulitis is a spreading skin infection. It may affect the upper skin layer. Or in more severe cases it may affect the deeper skin and layer of fat under the skin. When cellulitis affects the upper skin layer, it may be called erysipelas. This type of infection is more common in children. Cellulitis is most common in the lower legs. But it may affect any part of the body. One area that may be affected is around the eyes. This is called periorbital cellulitis.

What causes cellulitis?

Any opening in the skin can lead to an infection and to cellulitis. The germs that often cause cellulitis are:

• Strep (beta-hemolytic streptococci)

• Staph (Staphylococcus aureus), including methicillin-resistant Staphylococcus aureus (MRSA)

Who is at risk for cellulitis?

A child is at risk for cellulitis if they have any of these:

• Skin injury. It may be minor, such as an insect bite, scrape, or cut. Or it may be more serious. It may be an animal bite, or from something entering the skin (penetrating injury).

• Skin inflammation. This may be caused by a skin condition, such as eczema or from radiation therapy.

• Skin infection. Other skin infections that are common in children include impetigo and ringworm (tinea).

• Immune system problems. HIV/AIDS and other conditions make the immune system weak. Cancer medicines also affect the immune system.

What are the symptoms of cellulitis?

Symptoms can occur a bit differently in each child. They can include:

• Skin that is swollen, painful, or warm

• Skin that looks red, bruised, dimpled, or blistered

• Swollen lymph glands (nodes) nearby

• Swollen lymph vessels nearby, appearing as red streaks on the skin

• Fever and chills

• High heart rate

• Low blood pressure

The symptoms of cellulitis can seem like other health conditions. Make sure your child sees their healthcare provider for a diagnosis.

How is cellulitis diagnosed?

The healthcare provider will ask about your child’s symptoms and health history. They will give your child a physical exam. Testing is often not needed. But in some cases, samples of wound drainage or blood may be taken. These are then tested for signs of bacteria. This is called a culture.

How is cellulitis treated?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

The main treatment is antibiotic medicine. Antibiotic medicine is given by mouth (oral) for mild cellulitis. Antibiotic medicine is given in a vein (by IV or intravenously) in the hospital in these cases:

• The oral antibiotic medicine isn't working well.

• The infection is getting worse.

• Your child has moderate to severe cellulitis.

• The cellulitis involves certain areas of the body, such as around the eyes.

• Your child has symptoms affecting the whole body, such as fever or chills.

• Your child is a newborn baby.

If your child is treated at home, the healthcare provider may tell you to raise your child’s affected body part. For instance, if the cellulitis affects the lower leg, you may be told to keep your child's leg up on pillows.

What are possible complications of cellulitis?

In some cases, serious complications can happen. They may include:

• An area of pus in the skin (abscess)

• Area of dead skin or tissue (necrosis)

• Infection spreading to other tissue or organs

Treating cellulitis quickly can prevent more serious infections.

Can cellulitis be prevented?

Cellulitis may be prevented by:

• Cleaning cuts, scrapes, or other injuries right away

• Making sure your child doesn’t touch or scratch cuts, scrapes, or insect bites

• Keeping your child’s fingernails short to prevent scratching

When should I call my child's healthcare provider?

Call the healthcare provider if your child has:

• Symptoms that affect a large area

• Symptoms that get worse

• Signs of a skin infection, such as increased redness, warmth, swelling, or drainage

• New symptoms

• Symptoms around the eyes or ears

• Numbness, tingling, or other changes in a hand, arm, leg, or foot

• Blackened skin

• Fever

Key points about cellulitis

• Cellulitis is a spreading skin infection. It may affect the upper skin layer. Or it may affect the deeper skin and layer of fat under the skin.

• Any opening in the skin can lead to an infection.

• Complications can often be prevented if your child is treated quickly. 

• Mild cellulitis can often be treated with antibiotic medicine taken by mouth (oral).

• A child with moderate to severe cellulitis may need to stay in the hospital and have IV (intravenous) antibiotic medicine.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new directions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s healthcare provider after office hours. This is important if your child becomes ill and you have questions or need advice.