Table of Contents
Introduction
Trauma or injury to the finger or toenails may cause the nails to partially or completely chip off. Nail avulsion is common among toddlers and can occur on the child’s finger or toes. Initially, a hard layer forms on the nailbed where the new nail grows. The nail bed will remain sensitive until a hard layer forms. An avulsed nail can increase infection susceptibility, requiring immediate care and treatment. Healthcare providers may recommend oral or topical medications for the wound.
What Is a Nail and Its Importance?
The dorsal surface of a finger is covered by nails, which are ectodermal appendages (organs connected to the skin). The distal border of the nail is free, but the proximal nail border is tucked into the skin fold and covered by a skin flap called the cuticle. Therefore, it provides protection and integrity to the fingertip. The nails allow delicate and precise touch, enable skilled hand functions, and improve the ability to pick objects. Any injury or disruption to the nails can impair these functions.
The nail is attached to the nail bed at proximal, lateral, and distal borders. The nail bed attaches the dermis to the periosteum of the distal phalanx (one of the bones in the fingers). The nail bed consists of a sterile matrix on which the grown nail sits and a germinal matrix for the growth of the nail. The growth takes place in the lunule or nail root.
The lunule can be seen in the proximal part of the nail and is crescent-shaped. The nails are not firmly attached but are weakly attached to the root. Loss or deformity of the nail root causes permanent loss or damage to the nail.
What Is Nail Avulsion and How Does It Affect Children?
Nail avulsion is a condition in which nails get partially or completely torn off after injury in the region. It can be a painful experience for children. Nail avulsion can cause profound functional and cosmetic impairments if not correctly managed. Injury to the nails heal within a few weeks, but complete fingernail avulsion takes six months to regrow. But avulsed toenails take 12 to 18 months to regrow. The newly formed nail may appear different from the previous nail.
What Are the Causes of Nail Avulsion in Children?
Some causes of nail avulsion in children are:
1. Trauma
Severe blows to the nails can damage the underlying nail tissues and cause the nail to fall off. Additionally, there can be swelling or blood crusting that causes color changes within the nails.
Nail injuries are caused by slamming doors, crushing heavy objects, frequent biting or sucking, cutting or slicing, stubbing, or excessive clipping of nails.
Shock from injury can halt protein production, which may delay the development of new nails. The average time taken for nails to regrow can be 12 to 18 months. The new nails can differ in color, texture, or shape of its surface from previous nails.
Most nail injuries caused by trauma are treated with minor stitches. In severe nail injury, the healthcare provider may remove the child’s nail repair nail bed and prescribe painkillers or antibiotics.
2. Nail Infections
Nail infections are common among children. Nail infection causes are onychomycosis (fungal infection) and paronychia (bacterial or viral infection).
Fungal infections mostly affect children’s toenails. However, it is rare and occurs only if both parents are infected, or children have Down syndrome (genetic disease) or other immunodeficiencies. Fungus-infected nails appear crumbly, discolored, crackling, and fall off but are painless.
Bacterial and viral nail infections are common among children. These infections cause tenderness and swelling of the skin surrounding the area. Therefore, the child has difficulties moving their fingers and may develop a fever.
Healthcare providers treat nail infections with creams or ointments. Bacterial infections of nails are treated with an antiseptic solution or oral antibiotics. When the infection is cured, the nails will gradually grow back.
3. Vitamin Deficiency
Nail avulsion could also be a sign of an underlying medical condition. The most common causes are iron, calcium, or vitamin B deficiency. They may cause nails to become brittle and prone to breaking or chipping.
How Is Nail Avulsion in Children Treated?
Complete or partial nail avulsion in children requires a surgical procedure to remove the nail, repair the nailbed, and restore the nail into the fold. Small children require general anesthesia for carrying out surgical repair. After surgically removing the nail, the region is carefully cleaned, not debrided, and lightly trimmed. X-rays may be required to analyze damage or fracture of the digit.
Minor nail avulsion injuries are treated with medications. Healthcare providers prescribe antibiotics to prevent bacterial infections. Acetaminophen or Ibuprofen can be prescribed for pain, fever, and swelling. These medications must be taken with consultation from a doctor to avoid side effects.
What Are the Care Instructions for Children Post Nail Avulsion Treatment?
Children who undergo surgical procedures for nail avulsion may have stitches. After the procedure, there can be some swelling, color changes, or blood crusting around the area for two to three days. Parents must properly care for the wound at home for quicker healing and preventing subsequent infections. The following steps can be taken:
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The wounded area must be elevated on a cushion for three days after the treatment whenever the kid sits or lies down. Keeping the injured area above the child’s heart level can reduce swelling.
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After receiving treatment, the bandage cannot be removed for 48 hours. The bandage is taken off after 48 hours, and the wound is cleansed with water twice a day.
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Parents must refrain from getting the area wet for 24 to 48 hours if child has stitches. Covering the area with plastic bags during showers can prevent the injury from getting wet.
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If the bandage has to be changed, apply petroleum jelly on the wound and do the dressing with a nonstick bandage dressing.
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When the child bathes, the wounded region must be properly cleaned with soap and water. A clean bandage can be placed after cleaning the area.
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Parents must not remove stitches on their own.
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Give antibiotics and painkillers if prescribed by the doctor.
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Follow the doctor's instructions.
Conclusion
Children commonly develop complications of finger or toenail avulsion due to various causes. These avulsed areas pose a higher risk of developing infection or deformity. It is important to analyze the extent of injury and adequately treat them. Even after treatment, successful post-care contributes to overall treatment success.
