Children and Cellulitis

Cellulitis (sell-you-lite-us) is an infection of
the tissue just below the skin. Signs of cellulitis
are swelling, redness, warmth, and tenderness
of the skin. These signs can occur anywhere
on the body. Children may also develop a
fever and chills. Children with cellulitis on the
face or near a joint usually need to go to the
hospital for treatment.

The infection is caused by bacteria that may
have entered the body through an injury or a
surgical opening. The bacteria may also have
traveled through the blood from some other
site of infection such as an ear infection.

There is a higher risk of cellulitis in children
with chicken pox.

Cellulitis should be treated immediately.
Without treatment, the infection may spread
to the blood, bone, or other organs.

How do you prevent cellulitis?

Keep wounds clean and dry and wash your hands
well. Children one year or older should receive
the varicella vaccine. This will help keep your
child from getting chicken pox.

How do you treat cellulitis?

• Antibiotics may be given by mouth or
directly into a vein (through an IV).
• Acetaminophen (Tylenol®) or ibuprofen
(Advil®) may be given for fever and
discomfort. Aspirin should not be given
to children who have both chicken pox

and cellulitis (see the note at the end of
this article).
• A surgical opening may be needed to drain
the infection.
• Blood may be drawn to find the bacteria
causing the infection.
• Sometimes fluid is drawn from the infected
site through a needle. This will help find
out what antibiotics should be used.
• X-rays may be taken to find out if the
infection has spread to the bone.

Your child’s treatment and length of stay
in the hospital depend on how serious the
infection is. Children with cellulitis may stay
in the hospital up to 10 days. Children are
usually allowed to eat a regular diet and
participate in normal activities that are
comfortable for them.

Note: acetaminophen (Tylenol®) may be used
for temperature over 101°F (38.3°C). Aspirin
should NOT be given to children with chicken
pox since it may lead to a brain, liver, and
kidney disease called Reye’s syndrome.
Read the label on all medicines, including
brand names like Alka Seltzer®, to make sure
they do not contain small amounts of aspirin.
Ibuprofen is approved for children 6 months
of age and older; but it should never be
given to children who are dehydrated or
vomiting (throwing up) continuously.

Cellulitis

Pediatric Education Services
(801) 588-4060 Rev.7/03
© Primary Children’s Medical Center 2004

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Cellulitis

Kid's Health

Cellulitis is an infection of the skin and underlying tissues that can affect any area of the body. Not to be confused with cellulite - the cottage-cheese-like, lumpy fat often found on the hips, thighs, and buttocks, primarily of women - cellulitis begins in an area of broken skin, like a cut or scratch, allowing bacteria to invade and spread, causing inflammation, which includes pain, swelling, warmth, and redness.

Disorders that create breaks in the skin and allow bacteria to enter, such as eczema and severe acne, will put a child at risk for cellulitis. Chicken pox and scratched insect bites are also common causes. Cellulitis may also start in areas of intact skin, especially in people who have diabetes or who are taking medicines that suppress the immune system.

Cellulitis can be caused by many different types of bacteria, but the most common are Group A Streptococcus and Staphylococcus aureus. In special cases, other bacteria can cause cellulitis. Cellulitis after a cat or dog bite may be caused by Pasteurella multocida bacteria. Cellulitis due to Pseudomonas infection occurs after nail-puncture wounds through sneakers. Other types of bacteria from fish and farm animals can also cause cellulitis.

One specific type of cellulitis that can occur in children and requires close monitoring is periorbital cellulitis, an infection of the eyelid and tissues surrounding the eye. It can be the result of minor trauma to the area around the eye (such as an insect bite or a scratch), or it may be the extension of another site of infection, such as sinusitis. Periorbital cellulitis is treated with antibiotics and close follow-up. If untreated, it can progress to orbital cellulitis (infection of the eye orbit, or socket), a much more severe infection that results in a bulging eyeball, eye pain, restricted eye movements, or visual disturbances. This is an emergency that requires hospitalization and intravenous antibiotics.

Signs and Symptoms

Cellulitis begins as a small, inflamed area of pain, swelling, warmth, and redness on a child's skin. As this red area begins to spread, the child may begin to feel sick and develop a fever, sometimes with chills and sweats. Swollen lymph nodes (commonly called swollen glands) are sometimes found near the area of infected skin.

Contagiousness

Cellulitis is not contagious.

Prevention

You can prevent cellulitis by protecting your child's skin from cuts, bruises, and scrapes. This may not be easy, especially if you have an active child who loves to explore or play sports. Protective equipment worn to prevent other injuries during active play can also protect your child's skin: elbow and knee pads while skating, a bike helmet during bike riding, shin guards during soccer, long pants and long-sleeved shirts while hiking in the woods, sandals (not bare feet) on the beach, and seatbelts while riding in a motor vehicle.

If your child does get a scrape, wash the wound well with soap and water. Apply an antibiotic ointment and cover the wound with an adhesive bandage or gauze. Check with your child's doctor if your child has a large cut, deep puncture wound, or bite (animal or human).

Incubation

The incubation period varies, depending on the type of bacteria causing the cellulitis. For example, cellulitis caused by Pasteurella multocida has a very short incubation period - less than 24 hours after an animal bite. But other types of bacteria may have incubation periods of several days.

Duration

Cellulitis usually resolves after a few days of antibiotic therapy. However, it's very important that the child receives the medication on schedule for as many days, usually 7 to 10, as the doctor directs.

Diagnosis

Your child's doctor can usually make the diagnosis of cellulitis by asking a few questions and examining the area of affected skin. Sometimes, especially in younger children, the doctor may also order blood cultures - samples of your child's blood that are examined in the laboratory for growth of bacteria.

Positive blood cultures mean that bacteria from your child's skin infection have spread into the bloodstream, a condition known as bacteremia. This can potentially lead to septicemia, a generalized infection affecting many systems of the body. Bacteremia can also be a cause of cellulitis in certain cases.

Professional Treatment

If your child has severe cellulitis, your child's doctor may decide to treat him or her in the hospital using intravenous (IV) antibiotics.

Home Treatment

Children with milder cellulitis can be treated at home with the entire course of prescribed oral antibiotics, but with follow-up from the doctor to make sure symptoms are improving. The doctor may also suggest that the affected part of the body be immobilized and elevated to reduce swelling and pain. Using pain-relievers such as acetaminophen or ibuprofen may also help reduce discomfort.

After 1 or 2 days of antibiotics at home, your child's doctor may schedule an office visit to check that the area of cellulitis has improved and that the antibiotics are working to heal the infection.

When to Call Your Child's Doctor

Call your child's doctor whenever any area of your child's skin becomes red, warm, and painful - with or without fever and chills. This is especially important if the area of skin is on your child's face, or if your child has a chronic illness (like diabetes) or a condition that suppresses the immune system.

Because cellulitis can happen very quickly after an animal bite, call your child's doctor whenever your child is bitten by an animal, especially if the puncture wound is deep. Human bites can also cause dangerous skin infections and should be seen by a doctor. If red streaks develop from the infected area or symptoms worsen despite antibiotic treatment, your child should be reexamined.

Updated and reviewed by: Elana Pearl Ben-Joseph, MD

Date reviewed: September 2003

Originally reviewed by: Joel Klein, MD