AAP

PDF | Print or Share

What is scabies?

Scabies is an infestation of the skin by small insects called mites .

What are the signs or symptoms?

Rash, severe itching (increased at night).
Itchy red bumps, pimple-like lesions (called pustules ), or blisters found on skinfolds between the fingers, toes, wrists, elbows, armpits, waistline, thighs, genital areas, abdomen, and lower buttocks.
Children younger than 2 years are likely to be infested on the head, neck, palms, and soles of feet or in a diffuse distribution over the body.

What are the incubation and contagious periods?

Incubation period
- – 4 to 6 weeks for those who have never been infected.
- – 1 to 4 days for those who have been previously infected and sensitized. (Repeated exposures tend to be milder but produce symptoms earlier after exposure.)
Contagious period: Until the insect infestation is treated.

How is it spread?

Prolonged and close person-to-person contact

How do you control it?

Treatment of the affected child and family by a health professional, usually with a cream containing 5% permethrin. May need a second application a week after the first. Household members who are close contacts should be treated at the same time.
Launder bedding and clothing (hot water and hot drying cycle) worn next to skin during the 3 days before start of treatment.
Items that cannot be laundered should be placed in plastic bags for at least 4 days. Scabies mites cannot survive away from humans for more than 4 days.

Rash of scabies, which is a widespread area of irritation, often with pink to red bumps along lines and tracks where the insects have burrowed, causing blisters and pimple-like lesions.

AMERICAN ACADEMY OF PEDIATRICS

Top view of a child's foot covered in pimple-like bumps, some pink and some a darker red, most of which appear white in the center and filled with pus. Lesions are more concentrated around the ankle, the largest of which has irregular, purple edges.

Pustules on wrist and base of thumb

REPRODUCED WITH PERMISSION FROM ©DERMNET 2025. HYPERLINK “ HTTPS://DERMNETNZ.ORG/ ” DERMNETNZ.ORG .

Close-up view of a hand bent backwards, exposing the wrist and base of the thumb, with a rash spreading across the skin, the main portion of the rash spreading in a line from the base of the wrist and along the base of the thumb. Portions of the rash contain yellow, scabbed bumps surrounded by red patches of skin.

What are the roles of the educator and the family?

Report the infection to the staff member designated by the early childhood education program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms.
Contact the child’s health professional if itching continues for several weeks after treatment. This could indicate a reinfestation.
Family members and very close contacts should be treated at the same time as the child, even if no signs or symptoms are present.

Exclude from educational setting?

At the end of the day, the child should be seen by a pediatric health professional, and, if scabies is confirmed, the child should start treatment before returning. If treatment is started before the next day, no exclusion is necessary.

Readmit to educational setting?

Yes, when treatment has been completed (usually overnight)

Comments

Scabies affects people from all socioeconomic levels without regard to sex, age, or personal hygiene.
Itching is related to an allergic reaction to the mites and often goes on for weeks after effective 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.

The latest version keeps the core public-health guidance intact but shifts to a more polished, educational, and current-standard presentation. It uses clearer clinical language, adds visual aids and more descriptive lesion terminology, and updates the setting-specific wording from “child care” to broader “educational setting” with “educator” and “staff members.” The medical philosophy remains conservative and practical, but the current standard places slightly more emphasis on treatment nuance, family/household management, and professional framing from the AAP. - Adds that the rash may include pimple-like lesions/pustules, not just bumps or blisters. - Clarifies incubation wording to “previously infected and sensitized.” - Updates treatment guidance to note a second permethrin application may be needed after one week. - Expands contact management to explicitly include household members and close contacts treated at the same time. - Introduces figures with captions and alt text, improving visual education and lesion recognition.

Preview Articles

Scabies—Child Care and Schools