Cellulitis

Cellulitis is a bacterial infection of the tissue underneath the skin and above the muscle. This tissue is mostly fat, and does not have a very good blood supply, so it is vulnerable to infection. Bacteria cause cellulitis in one of two ways. They can get into the tissue directly from a break in the skin, like a puncture wound, a cut, or an insect bite. The germs that cause this kind of cellulitis live on the child’s skin or the object that caused the injury. Other kinds of bacteria are carried to the fat tissue by the bloodstream. These bacteria cause cellulitis of the face, often around the eye or on the cheek. New vaccines have made that kind of cellulitis less and less common.

Cellulitis is an "invasive" infection. This means that the infection can spread into other parts of the body. Our biggest concern in cellulitis is to prevent that spread. Facial cellulitis is dangerous because of the important and delicate structures of the face and head. Cellulitis around the eye ("periorbital" or "pre-septal" cellulitis) is the most dangerous. It can spread into the eye socket itself, causing "orbital cellulitis." Orbital cellulitis may damage the eye muscles and the optic nerve. It may break through the bone and cause meningitis. Cellulitis of the cheek is called "buccal cellulitis." Children with periorbital and buccal cellulitis often have bacteria traveling in the blood-stream. This can cause infections in other places, including meningitis or blood poisoning (sepsis). Children with these kinds of cellulitis usually have a fever even before they develop the cellulitis.

Cellulitis caused by a break in the skin is usually less dangerous because it develops more slowly and the germs did not travel in the blood stream. It is also more common in older children who can tell you what hurts even before you can see it. Untreated cellulitis of this kind can eventually spread into the bloodstream and become a more dangerous condition, however.

We treat all forms of cellulitis with antibiotics to kill the bacteria. Children with milder cases of cellulitis can take antibiotics by mouth (read Aftercare Instruction on Oral Medication). They can usually go home from the doctor’s office. Most doctors will want to do some blood tests before they send home a child with facial cellulitis or a any cellulitis with fever. If tests are abnormal or if there is high fever, pain, or loss of movement, doctors treat children in the hospital. These children get intravenous antibiotics. Many doctors will check a CT scan of the head and face if they are concerned about orbital cellulitis.

If your doctor has started your child on oral antibiotics, please be sure to give all of the doses on the correct schedule. Please finish the entire prescription. This will help to treat the infection completely, and also helps to prevent germs from developing resistance to the antibiotic.  You can read our Aftercare Instruction on Administering Oral Medications.

Give your child acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®) as directed to help relieve any mild pain and fever.

Your doctor sent your child home for treatment because s/he felt that the cellulitis was early or mild enough to avoid hospitalization. You can help by giving all of the doses of medication on schedule and by watching out for any of the following warning signs that things are getting worse:

• Spreading of the redness into larger areas. Many doctors will draw a line around the redness when they first see your child to help you tell if it has spread
• Pain that gets worse instead of better
• Fever above about 102° F or 38.5° C for more than 24 hours after starting antibiotics
• Lack of improvement of the cellulitis after the first 24 hours of treatment
• Shaking chills that last more than 30 seconds
• Loss of the ability to move the eye or any other part of the body where there is cellulitis, or pain with movement of those areas
• Any change in vision, or pain with bright light
• A stiff neck

Cellulitis caused by a puncture wound or bite is very common in all children. It usually clears up within a few days of starting treatment. If it does not, a small part of the object that caused the puncture could still be in the wound. Your doctor may want to do an X-ray or open the wound up under anesthesia to try and locate the object. Many doctors refer children to surgeons for this procedure.

Cellulitis caused by organisms in the bloodstream is less and less common these days because of childhood immunizations. Many doctors test the immune system of any child who gets cellulitis without a puncture wound. Any child who gets this kind of cellulitis more than once should certainly have tests of the immune system. Doctors and parents can treat defects in the immune system and prevent infections.

Sometimes if a child has an infection of a joint (septic arthritis) or a bone (osteomyelitis) the skin overlying the infection becomes red, hot, and painful. This can look like cellulitis early in the condition. If the child has trouble moving the joint or supporting weight with an arm or a leg, see your doctor right away. These infections can cause loss of a joint or even a limb if they are not treated in time.

Some conditions that are not infections can look like cellulitis, even to experienced doctors. Many insect and spider bites, for example, become red and swollen around the bite mark. This is from the body’s reaction to the animal’s venom, and not from infection. These bites do not spread or cause fever, though certain kinds of spider bites can be very painful or develop damage to the skin.

Toddlers and younger children may suck on a Popsicle or freeze-pop for so long that they damage the fat in their cheeks. This condition, called "popsicle panniculitis," is easy to mistake for buccal cellulitis. Children with Popsicle panniculitis, though, do not have fever and usually appear completely well otherwise. If you think your child might have Popsicle panniculitis, please let your doctor know!

Having a sick child at home can be tiring and frustrating. As badly as you feel for your child, you yourself may feel out of control, inadequate, or even angry – these are normal feelings. Babies and children who are sick are often fussy and irritable, and parents often feel stressed to the breaking point, especially when there are other children or adults to take care of. One of the best things you can do for your child is to be sure you take care of yourself. If possible, try to have other adults take care of your child for an hour or two each day so you can get some rest or just some quiet time. If you get so stressed that you are worried about your baby’s safety, call your local Parents’ Anonymous Hotline or visit the Parents Anonymous website to find a group near you.