MRSA in children: babies, newborns and kids

MRSA in children is a staph infection. The bacterium behind it, Staphylococcus aureus, lives harmlessly on the skin or in the nose of about one in three people, children included. MRSA is the strain that has become resistant to methicillin and other penicillin-type antibiotics, so it needs different medicine.

The great majority of childhood cases are skin and soft-tissue infections — boils, abscesses and infected scratches. They are usually very treatable. What matters is spotting them early, keeping them covered, and not waiting if your child has a fever or the redness is spreading.

Parents most often describe "a spider bite that won't go away". Typical features:

• A red, warm, tender lump that appears over a day or two and keeps growing.
• A boil or abscess with a white or yellow centre, sometimes leaking pus.
• Impetigo-like crusting — honey-coloured scabs, often around the nose and mouth in younger children.
• Spreading redness around the spot, which suggests cellulitis rather than a simple boil.
• Common sites: knees, elbows, shins, buttocks and the nappy area, plus any scratch, bite or eczema patch.

For side-by-side descriptions of each stage, see what MRSA looks like and the full MRSA symptoms guide.

Newborn infection is the biggest single reason parents search for MRSA, and it is treated differently from a boil on a ten-year-old. A newborn's immune system is immature and infection can move quickly from the skin to the bloodstream.

• Where exposure happens. Maternity and neonatal units, where staff, equipment and other babies can be sources, or a carrier at home.
• What it looks like. Small pustules or blisters, redness or discharge around the umbilical stump, sticky infected eyes, or a red patch in the nappy area.
• Go to hospital now if your baby is under three months and has a temperature, is feeding poorly, is unusually floppy or sleepy, is unusually irritable, or has a rash that is spreading.

Do not attempt home treatment in a baby. Any suspected skin infection in the first weeks of life should be seen by a clinician the same day.

In older children, MRSA behaves like the community strains seen in adults. Risk clusters around close contact and broken skin:

• Nurseries and schools, where hands, toys and surfaces are constantly shared.
• Contact sports — wrestling, rugby, football and basketball — plus shared kit, mats and towels. See sports, gyms and locker rooms.
• Grazes, insect bites and eczema, which give bacteria a way in.
• Sharing towels, flannels, water bottles, hairbrushes and clothing.

MRSA does not travel through the air like a cold. It spreads by contact:

• Skin to skin — hugging, wrestling, sharing a bed, nappy changes.
• Shared items — towels, bedding, clothing, sports kit, toys.
• Surfaces — staph survives for days on door handles, mats and changing tables.
• Silent carriage — a parent or sibling with MRSA in the nose can pass it on without ever being ill.

The household side of this is covered in detail on MRSA at home and protecting your family.

What happens when the infection gets past the skin is explained on invasive MRSA.

A doctor cannot tell MRSA from ordinary staph by looking. Diagnosis relies on a swab and culture of the pus or wound, which also shows which antibiotics the strain still responds to.

• Drainage first. For a simple abscess, incision and drainage by a clinician is the main treatment, and small ones may need no antibiotic at all.
• Oral antibiotics when needed are chosen by culture and by age — commonly clindamycin or trimethoprim-sulfamethoxazole, with doxycycline avoided in younger children. Never use leftover or adult medicines.
• Hospital treatment with intravenous antibiotics such as vancomycin is used for severe, bloodstream, bone or newborn infections.
• Finish the course. Stopping when the spot looks better is a common cause of relapse and of further resistance.

The full picture of drug choices is on the MRSA treatment page, and the difference between resistant and non-resistant staph is set out in MSSA vs MRSA.

A child with a covered wound is a low risk to others. Practical household rules while the infection heals:

• Keep the sore covered with a clean, dry dressing and change it with clean hands.
• No shared towels, flannels, bedding, clothing or sports kit.
• Hot wash for towels and bedding; dry thoroughly.
• Wipe down bath toys, changing mats, door handles and taps.
• School and nursery are usually fine once the wound is covered and drainage is contained; keep the child home if it cannot be covered.

Recurrence in households with young children is common because the bacteria persist in noses, on skin and on shared items. Handwashing, wound covering, laundry hygiene and not sharing personal items do most of the work.

Decolonisation — nasal mupirocin and chlorhexidine washes — is sometimes prescribed for the whole family after repeated infections, but only on a doctor's instruction and with age-appropriate products. Why infections return is covered on why MRSA keeps coming back.