Scabies in Babies and Children
Content reviewed against published AAP, CDC, Mayo Clinic guidelines
Last reviewed:
Scabies is a highly contagious skin infestation caused by the microscopic mite Sarcoptes scabiei. The mites burrow into the skin and lay eggs, causing intense itching and a pimple-like rash. In babies, the presentation differs from older children and adults, often affecting the palms, soles, head, and face.
Key takeaways
- Scabies is a highly contagious skin infestation caused by the microscopic mite Sarcoptes scabiei.
- Duration: Mites are killed within 24 hours of proper treatment, but itching typically persists for 2-4 weeks after successful treatment due to ongoing allergic reaction to dead mites and debris. A second treatment at 7-14 days kills newly hatched mites.
- Go to ER if: Signs of serious secondary skin infection with fever
- No vaccine currently available
Symptoms
How It Presents by Age
0-6 months
Unique presentation: rash often appears on the head, neck, palms, and soles — areas not typically affected in adults. May present as widespread small pustules or vesicles. Infants may be extremely fussy due to itching.
Risk level: Moderate — diagnosis often delayed due to atypical presentation
6-12 months
Rash commonly on palms, soles, face, and scalp in addition to typical body folds. May appear as small blisters or nodules. Can be confused with eczema.
Risk level: Moderate
1-3 years
Presentation begins to shift toward adult pattern with involvement of wrists, between fingers, elbows, and waistline. Palms and soles may still be affected.
Risk level: Low to moderate
3-5 years
More classic adult distribution. Intense nighttime itching is the hallmark. May see burrow tracks between fingers and on wrists.
Risk level: Low
Treatment
Permethrin 5% cream
First-line treatment for infants over 2 months. Applied to the entire body from the scalp down (in infants, include head and face avoiding eyes and mouth). Left on for 8-14 hours, then washed off. Repeat in 7-14 days.
Precipitated sulfur 5-10% in petrolatum
Preferred for infants under 2 months. Applied nightly for 3 consecutive nights. Safe but messy and has an unpleasant odor.
Ivermectin (oral)
Used for difficult-to-treat or crusted scabies in children over 15 kg. Given as a single dose repeated in 7-14 days. Not approved for children under 15 kg.
Treat all household contacts
All household members and close contacts must be treated simultaneously, even if asymptomatic, to prevent re-infestation.
Environmental decontamination
Wash all clothing, bedding, and towels used in the past 3 days in hot water and dry on high heat. Items that cannot be washed should be sealed in a plastic bag for 72 hours.
Home Care
- Apply prescribed cream to all skin from scalp to toes (in infants)
- Treat all family members at the same time
- Wash all bedding, clothing, and towels in hot water
- Vacuum carpets and upholstered furniture
- Seal non-washable items in plastic bags for 72 hours
- Keep fingernails very short to reduce scratching damage
- Apply calamine lotion or cool compresses for itch relief
- Give age-appropriate antihistamines at bedtime for itching (with doctor approval)
When to Worry
Go to the ER if:
- Signs of serious secondary skin infection with fever
- Infant with widespread skin breakdown and signs of systemic illness
- Severe allergic reaction to scabies treatment
Call your doctor if:
- Suspected scabies — need confirmation and prescription treatment
- Baby is under 2 months old
- Rash is not improving after two rounds of treatment
- Signs of bacterial skin infection from scratching
- Uncertainty about correct application of medication in infants
- Itching persisting more than 4 weeks after treatment
Keep an eye on:
- Itching is not improving 2-4 weeks after treatment (note: itching can persist for 2-4 weeks after successful treatment)
- New burrows appearing more than 2 weeks after treatment
- Signs of secondary bacterial infection (pus, increasing redness, warmth)
- Baby is not sleeping or feeding due to itching
- Widespread crusted or scaly patches (Norwegian/crusted scabies)
Prevention
- Treat all household contacts simultaneously when a case is identified
- Avoid prolonged skin-to-skin contact with infected individuals
- Do not share bedding, towels, or clothing with infected individuals
- Wash bedding in hot water weekly during an outbreak
- Notify daycare or school so other families can be alert for symptoms
- Re-examine household members 2-4 weeks after treatment
Contagion & Incubation
Incubation
4-8 weeks for first infestation (before itching begins). Only 1-4 days for re-infestation due to prior sensitization.
Contagious for
Contagious until mites and eggs are destroyed by treatment. A person can spread scabies even before symptoms appear (during the 4-8 week incubation period).
Duration
Mites are killed within 24 hours of proper treatment, but itching typically persists for 2-4 weeks after successful treatment due to ongoing allergic reaction to dead mites and debris. A second treatment at 7-14 days kills newly hatched mites.
Frequently asked questions
How long does scabies last?
How does scabies (sarcoptes scabiei infestation) spread?
When should I take my baby to the ER?
Can scabies (sarcoptes scabiei infestation) be prevented?
When can my child return to daycare?
Sources
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
Related Illnesses
Bottom line
Scabies is treatable with appropriate medical care. Seek emergency care if signs of serious secondary skin infection with fever.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.