The Center for Podiatric Care and Sports Medicine

Children’s Toenail Problems: The Most Common Toenail Disorders For Kids

Posted by on Monday, October 30th, 2017


Even though fewer than 2% of pediatric visits involve concerns with nails, parents often experience anxiety when they notice discoloration, abnormal growth patterns, rough texture, or loss of the nail plate in their children’s toenails. They may fear fungal infections, bacteria, virus, or a more widespread disease. Diagnosis by non-experts is very difficult, so researchers recommend that you see a podiatrist for any children’s toenail problems. Still, it’s good to be informed about the conditions your child is most likely to experience, so here are the top ten toenails disorders commonly found in children.

toenail disorders in children
It’s important to get a professional opinion if your child is experiencing a toenail disorder. Image Source:

Beau’s Lines

Lines in the nail that run from side-to-side across the nail bed are called Beau’s lines, named after the doctor who discovered them in the late 1800’s. These indentations are usually observed after birth, but they can also appear following a high fever or when a child has zinc deficiency. The underlying deficiencies should be treated,so the lines can grow out as the nail continues to grow.


Sometimes called “spoon nails,” this disorder causes the nails to appear abnormally thin and curved downward, especially the big toenails. Some cases of koilonychia are linked with iron deficiency, gastrointestinal blood loss, worms, or celiac disease. Others are associated with congenital conditions like pulmonary stenosis, thyroid disease, or EKG abnormalities. This condition typically resolves itself within a few years.


White spots on the fingernails may appear as the result of minor trauma. Picking and biting the nails while they’re growing causes these marks to occur in small children. Leukonychia is not associated with nutrient deficiencies, as was previously thought, and the white spots generally resolve themselves within eight months.

Nail Pits

Small pinpoint indentations in the nail bed are associated with conditions like alopecia areata, eczema, Reiter syndrome, dermatitis, and psoriasis. Topical creams may be prescribed to combat the unsightly appearance, or natural remedies for pitted nails include olive or almond oil.


Trauma typically causes this separation of the nail from the nail bed, but it can also be seen in children with autoimmune disease, fungal infections, or overactive thyroid glands. Exposure to tetracycline or fluoroquinolone medication combined with sun exposure may cause the nail to lift from its bed as well. Treatment for onycholysis depends on the root cause, but you can expect it to take at least four to six months for a new nail to grow back in.


When all the nails “shed” or peel off completely at the cuticle, doctors often suspect viral infections such as hand/foot/mouth disease, measles, or Kawasaki disease. High fevers and emotional stress can also cause this reaction. When the underlying cause is conservatively managed, the accompanying onychomadesis tends to resolve itself.


Less than 3% of children in developed countries contract the common toenail fungus adults suffer. However, children may be “at risk” for the infection if they have HIV, down syndrome, or family members with chronic occurrences. The tell-tale signs of toenail fungus include yellowed color, thickening, crumbling edges, and raised white patches. Treatment for children may include vinegar soaks, laser therapy, and a three-month course of terbinafine.


Brittle, frayed and split fingernail ends are common in the first few years of life, likely due to the repeated thumb-sucking, nail biting, and trauma kids tend to endure. The best treatment is to soak the affected nails in warm water for five minutes, and then apply a lotion containing lanolin or alpha-hydroxy acids.


Redness, swelling, and pus-filled corners of the nail indicate a bacterial or fungal infection. It is more commonly observed in the finger nails as a result of frequent biting, chewing, and coming into contact with pathogens through touch. Oral antibiotics like amoxicillin, clindamycin, or cephalexin are the most common treatment for S. aureus infections, along with warm water soaks. The infection should resolve in 5-10 days, although chronic cases can take several weeks to clear up.


There is no known cause for a simple thickening, roughening, and discoloration of the nails, but it has been sometimes linked to skin conditions like psoriasis and eczema. Topical steroids have proven effective in resolving the appearance of Trachyonychia in pediatric patients.

For parents, we know your child’s health is of the utmost importance to you. As such, we will treat your child with sensitivity and get them in quickly for an appointment with one of our board-certified NYC podiatrsits. We offer the latest technologies and treatment to take care of any toenail problems your child may be suffering from. For more information or to book an appointment, contact us today.


If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.