Sophia Delgado
There are several reasons why a child's fingernail may fall off, including injury, infection, or an underlying condition. Fingernail injuries in children are common and can occur due to various traumatic events, such as finger-slamming in doors, stepping on toes, or heavy objects falling on nails. These injuries can cause cuts, scrapes, blood blisters, bruising, or even partial amputation of the fingertip. In some cases, fingernails may also be affected by conditions like onycholysis, onychomadesis, or hand, foot, and mouth disease. Additionally, certain medications and vitamin deficiencies can contribute to nail loss. It is important for parents to seek medical attention if they suspect any serious injuries or notice unusual symptoms to ensure proper diagnosis and treatment.
| Characteristics | Values |
|---|---|
| Crush injuries | A heavy object falling on a nail with great force, a finger slammed in a door, or a finger or toe being stepped on |
| Avulsion | Losing a toenail or fingernail due to an injury |
| Onycholysis | A nail separating from the skin underneath, caused by fungal infections, certain medications, skin conditions, an overactive thyroid, iron deficiency, or working in a wet environment |
| Hand, foot, and mouth | Certain strains of hand, foot, and mouth can cause nail shedding or nails falling off |
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What You'll Learn
Crush injuries
If the nail bed is injured, a doctor may need to put a small hole in the nail to drain the blood that has collected underneath. Even if the nail is stitched or glued back in place, it may still fall off in a few weeks. If the nailbed was damaged, the new nail may have a bend, crease, or split in it, or it may not fully grow back. It can take up to nine months for a fingernail to grow back after such an injury.
If the nail appears to have been pulled out, either completely or partially, it is recommended to go to the emergency room to have it sewn back in place. If this is not done, a new nail may not grow back. If a trip to the ER is not possible, apply an antibiotic ointment to the injured area and tape the nail down to protect it from being pulled out further.
To treat the pain and swelling of a crush injury at home, apply ice to the injury. Do not apply ice directly to the skin; instead, soak the child's hand in a bowl of water with ice cubes or use a medical cold pack. A bag of frozen vegetables can also be used as a cold pack. Over-the-counter painkillers such as children's ibuprofen or acetaminophen can also be given to the child to help with the pain.
If the injury looks serious, or if there is excessive swelling or the fingers appear bent out of shape, take your child to an urgent care center or emergency department right away.
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Hand, foot, and mouth disease
Fingernail avulsion in children can be caused by crush injuries to the fingertip or by hand, foot, and mouth disease (HFMD). Crush injuries can occur when a finger is slammed in a door, stepped on, or when a heavy object falls on a nail with great force. These injuries can cause cuts, scrapes, blood blisters, bruises, or even broken bones. In the case of HFMD, a common contagious disease that affects mainly children under the age of 10, fingernails may fall off in severe cases.
HFMD is characterized by vesicular rashes and ulcers in the oral mucosa, accompanied by occasional fever. It is caused by the Coxsackie virus, with Enterovirus 71 and coxsackievirus A16 being the most common causative agents. A severe form of HFMD has emerged since 2012 due to a new Coxsackie A6 virus strain, which can cause a rash to spread to the arms, legs, and face.
Onychomadesis, or nail shedding, is a rare complication of HFMD that occurs in about 4% of severe cases. It usually occurs 4 to 6 weeks after the onset of the disease and is typically self-limited, requiring no treatment. Nail abnormalities can range from leukonychia and Beau lines to partial or complete nail shedding. Beau lines are horizontal grooves that run across the nail plates.
If your child experiences fingernail avulsion due to a crush injury or HFMD, it is important to take them to a doctor or urgent care center. The doctor will assess the injury, clean the wound, and provide treatment options. In some cases, stitches or glue may be used to repair the nail bed, and your child may be given pain medication. It is important to keep the wound clean and dry and to follow up with any recommended appointments.
Most fingernails will grow back within 3 to 6 months, but it is important to trim them if they catch on things during the healing process. Injured nails may look different when they grow back, with possible bends, creases, or splits. It is normal to have some swelling, color changes, and bloody crusting on or around the wound for a few days after treatment.
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Onycholysis
There are several factors that can cause onycholysis in children. One common cause is crush injuries to the fingertip or toe, which can result from a heavy object falling on the nail with force, a finger being slammed in a door, or a finger or toe being stepped on. These types of injuries can cause various types of damage, including cuts, scrapes, blood blisters, bruises, and fractures.
Another potential cause of onycholysis is fungal infections. Fungal infections of the nails can thicken the tissue underneath the nail plate, causing the edge of the nail to lift and separate from the skin. Certain medications, notably those from the psoralen, tetracycline, or fluoroquinolone groups, can also increase sensitivity to sunlight, leading to onycholysis.
Additionally, certain skin conditions, such as allergic reactions and psoriasis, can contribute to onycholysis. Medical conditions like hyperthyroidism and iron deficiency have also been associated with this nail condition. Working with the fingers or toes in a wet environment can increase the likelihood of onycholysis, as nails expand when exposed to moisture and then shrink upon drying, making them more brittle.
The treatment for onycholysis depends on the underlying cause. In the case of hyperthyroidism and iron deficiency, addressing these conditions can allow the nails to regrow normally. Similarly, treating psoriasis with medications like tazarotene gel can improve nail health. Oral prescription medications are available for fungal infections, although they may have side effects and can be costly.
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Iron deficiency
Fingernail avulsion, or the complete or partial removal of a fingernail, is often caused by trauma or injury to the area. This can include crush injuries, which are common in children, such as slamming a finger in a door or having a heavy object fall on the nail. Such injuries can cause bleeding or blood clots under the nail, cuts, tears, or nail loss. In the case of nail loss, it may take up to nine months for a child's fingernail to grow back, and the new nail may have bends, creases, or splits.
While nail problems are usually not indicative of anything serious, spoon-shaped nails that curve inward (koilonychia) can be a sign of iron deficiency anaemia. This condition is characterised by a decrease in red blood cell count due to inadequate iron levels, which can affect oxygen transport throughout the body. Iron deficiency anaemia can be caused by various factors, including an iron-deficient diet, impaired iron absorption, or increased iron loss.
Children are particularly vulnerable to iron deficiency due to their rapid growth and development, which requires an adequate supply of iron. Certain groups of children are at a higher risk of developing iron deficiency anaemia, including preterm infants, infants exclusively fed cow's milk or plant-based milk, children with low birth weight, and children with dietary restrictions or inadequate dietary intake.
The symptoms of iron deficiency anaemia extend beyond spoon-shaped nails. Other signs and symptoms may include fatigue, weakness, pale skin, pica (craving and consuming non-nutritive substances), decreased appetite, and poor weight gain in infants. In some cases, children may also experience behavioural changes, such as irritability or decreased cognitive function.
If you suspect your child is experiencing iron deficiency anaemia, it is important to consult a healthcare professional for a proper diagnosis and treatment plan. Treatment typically involves addressing the underlying cause and may include dietary changes or iron supplements. In severe cases, blood transfusions or other medical interventions may be necessary.
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Fingernail avulsion
Following such an injury, the nail may be completely or partially torn off, or a doctor may remove it, repair the nail bed, or put part of it back into place. The finger or toe may be sore after treatment, and there may be stitches, swelling, colour changes, and bloody crusting on or around the wound for 2–3 days. These are typical parts of the healing process, but proper wound care at home is necessary to prevent infection and promote healing.
Crush injuries to the fingertip can also cause damage to the skin, bone, or nail bed. If there is a cut where the nail grows, there may be bleeding around the cuticle or a tear in the nail (nail laceration). A blood blister or haematoma may form under the nail, which can be prevented by keeping the finger cold. In the case of a bone fracture, a splint or cast may be required to immobilise the bone and aid healing.
After treatment for a fingernail avulsion, it is important to follow up with all recommended appointments and to contact the doctor if any problems arise. The fingernail may take up to 6 months to grow back, and the new nail may have a different appearance. It may have a bend, crease, or split, and it may not fully stick to the skin or grow back completely.
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Frequently asked questions
Onycholysis is when a nail separates from the skin underneath, also known as nail separation. It is common and generally lasts several months or over a year. It is usually not painful but can be contagious if caused by a fungus.
Onycholysis can be caused by injury or trauma, fungal infections, certain skin conditions such as psoriasis, certain medications, an overactive thyroid, iron deficiency, and working with the fingers or toes in a wet environment.
Treatment options for onycholysis include trimming and protecting the nail, wearing gloves, avoiding nail products and irritants, changing medications, using supplements, or taking medication to treat a nail infection.
Signs of onycholysis include an irregular border between the pink portion of the nail and the white outside edge, and discoloration of the nail, which may include white, yellow, or green.
If your child has onycholysis, you should contact a healthcare provider as soon as possible. They will be able to advise on the best course of treatment, which may include antifungal medication or other medical treatments.
