Can children get toenail fungus?

Yes, children can develop onychomycosis—the medical term for fungal nail infection—commonly referred to as “ringworm of the nail” or colloquially as “gray nail.” While less common in pediatric populations than in adults, onychomycosis does occur in children and typically presents with characteristic signs such as nail discoloration (often yellow, white, or brown—not necessarily gray), thickening, brittleness, subungual debris, and mild onycholysis (separation of the nail plate from the nail bed). Risk factors in children include exposure to communal areas like swimming pools or locker rooms, participation in contact sports, underlying dermatophytosis (e.g., tinea pedis or tinea manuum), immunocompromise, or a family history of fungal infections. Diagnosis should be confirmed via potassium hydroxide (KOH) preparation microscopy and/or fungal culture—or increasingly, PCR-based testing—to distinguish dermatophytes (most commonly *Trichophyton rubrum* or *T. interdigitale*) from non-dermatophyte molds or yeasts. Treatment requires careful consideration: topical antifungals (e.g., efinaconazole or tavaborole) may be appropriate for mild, distal lateral subungual onychomycosis involving ≤2 nails and minimal matrix involvement; however, systemic therapy (e.g., terbinafine or itraconazole) is often necessary for more extensive disease—but must be weighed against safety profiles, dosing guidelines, and FDA-approved indications in pediatric age groups. A dermatologist or pediatric infectious disease specialist should guide management to ensure accurate diagnosis, appropriate therapy, and monitoring for efficacy and adverse effects.