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Impetigo—Child Care and Schools

2026-03-31

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What is impetigo?

Impetigo is a common skin infection caused by group A Streptococcus (see Strep Throat [Streptococcal Pharyngitis] and Scarlet Fever Quick Reference Sheet) or staphylococcal bacteria (see Staphylococcus aureus [Methicillin-Resistant (MRSA) and Methicillin-Sensitive (MSSA)] Quick Reference Sheet).

What are the signs or symptoms?

Small, red or dark pimples or fluid-filled blisters (pustules) with crusted yellow scabs found most often on the face or on abraded areas anywhere on the body

What are the incubation and contagious periods?

  • Incubation period: Variable. Bacteria that could cause impetigo commonly live harmlessly on the skin. Minor skin trauma may result in skin infections like impetigo.

  • Contagious period: Until treatment (topical or oral antibiotic) is started for skin sores or the crusting lesions are no longer present.

How is it spread?

  • Contact with the sores of an infected person or from contaminated surfaces.

  • Germs enter an opening on skin (eg, cut, insect bite, burn, eczema) and cause oozing, leading to honey-colored crusted sores.

  • Occurs year-round but most commonly in warm weather. Also occurs in cold weather when the skin around the nose and face is damaged by runny nasal secretions and nose wiping that irritates the skin.

How do you control it?

  • Cover lesions, after which infected individuals should be treated with an appropriate antibiotic regimen (oral or topical) at the end of the day.

  • Use good hand-hygiene technique at all the times listed in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition .

  • Clean or sanitize surfaces that are touched by hands frequently, such as toys, tables, and doorknobs, according to the Routine Schedule for Cleaning, Sanitizing, and Disinfecting in Chapter 8 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition .

  • Clip fingernails to reduce further injury of tissues by scratching and subsequent spread through contaminated fingernails.

  • In the event of an outbreak (more than one infected child or staff member in a group). Report outbreaks to the Child Care Health Consultant, if available, and to the local health department.

Impetigo. Crusted lesions inside and around nostrils start as red bumps.

COURTESY OF H. CODY MEISSNER, MD, FAAP

Person's nostrils and lips showing crusted yellow clustering lesions and red bumps inside the nostrils and around the upper lip.

What are the roles of the educator and the family?

  • Consult the child’s health professional for a treatment plan.

  • Clean infected area.

  • Use medication recommended by the child’s health professional.

  • When possible, loosely cover infected area to allow airflow for healing and avoid contact with others in educational settings.

  • Wear gloves. Perform hand hygiene after coming into contact with sores or when changing bandages in the educational setting and at home.

  • Launder contaminated clothing articles daily.

  • In an outbreak, follow the directions of the local health department.

Exclude from educational setting?

Immediate exclusion is not necessary. Wash the affected area and cover the sores. Notify the parents/guardians that the child should see a health professional. If impetigo is confirmed, treatment (topical or oral antibiotic) should begin before returning. If treatment is started before the next day, no exclusion is necessary, but the child may be excluded until treatment has started.

Readmit to educational setting?

Yes, when all the following criteria are met:

  • As long as the lesions are covered, the child can return once appropriate treatment has started (topical or oral antibiotic). When possible, lesions should be kept covered until they are dry.

  • When the child is able to participate and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group.

Comment

Pediatric health professionals may use topical antibiotic ointment or an oral antibiotic for treatment.

Disclaimer

Adapted from Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide , 7th Edition.

The American Academy of Pediatrics (AAP) is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety, and well-being of all infants, children, adolescents, and young adults.

Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Copyright © American Academy of Pediatrics Date Updated: 2026-03-31T03:29:39.543Z Version 0.2

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Changes from the previous version.

The latest version shifts from a more general child-care guidance sheet to a more current, education-setting-focused clinical resource with clearer operational language and updated references. It modernizes terminology, adds specificity around treatment timing and outbreak reporting, and places greater emphasis on practical infection-control steps and parent/guardian notification. The current standard also appears more aligned with contemporary pediatric communication, with streamlined sections, updated edition references, and a more explicit distinction between topical and oral antibiotic management. - “Teacher/caregiver” has been updated to “educator,” and “group setting” to “educational setting,” reflecting broader, more current terminology. - The contagious period is clarified: transmission risk ends once topical or oral antibiotic treatment has started, or lesions are no longer present. - Outbreak guidance is strengthened: report to the Child Care Health Consultant, if available, and the local health department. - Surface-cleaning guidance is more specific, naming high-touch items such as toys, tables, and doorknobs and referencing the routine cleaning schedule in the 7th edition. - Exclusion guidance is more direct: immediate exclusion is not necessary if sores are washed and covered, but parents/guardians should be notified and treatment should begin before return if impetigo is confirmed.