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Spooning nails in 3 year old

Discussion in 'Pediatrics' started by hollien, Nov 25, 2010.

  1. hollien

    hollien Member

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    Just wondering if anyone has any ideas on how to treat spooning nails in a 3 year old. Wide nail, lysed half way up nail bed. Nail involuted and callous in the sulci. Any ideas appreciated.

  2. Verdantlily

    Verdantlily Member

    Unable to answer your question from a pod perspective, but as an osteopathy student doesn't this red flag a possible heart condition?? Has he been checked out? Sorry if this is going on a tangent but interested in the pod view.
  3. footfan

    footfan Active Member

    Hollie you need to describe the nail presentation better, e.g. Wide nail is very subjective i regard a brachonychia to be wide.

    Hope we can help

  4. hollien

    hollien Member

    Hopefully this will paint a better picture

    Thin nail, lysed half way up nail bed, nail wider than nail bed. Nail involuted on both sides, and with the added complication of lysing, I was unable to freely feel the edge of the nail with the black's file. Some swelling of the nail fold, further obscuring the nail edge. Callous around and under the lysed edges. The spooning of the nail starts as the nail becomes lysed.

    I know this type of nail does often resolve in children over time, and just wondering if there is a way to re-shape the nail without having to consider surgery. Keeping in mind the size of a 3 year old toe, the fact they are hard to keep still, and the obscured edge, I am reluctant to try and free the edge with a blade. Was hoping someone had an idea of a safer way to try and free the nail edge.
  5. hollien

    hollien Member

    I should have mentioned my client is a twin, both girls have the same 1st spooning nails. Mum mentioned that the older borther, now 6 y.o, also had spooning nails, which are now fine. She does mention that the twins' nails are much worse than her sons. Should I suggest they be tested for an iron or vit B12 def?
  6. footfan

    footfan Active Member

    Hi Hollien,

    I think i may know what this is but first need some more info. Is there Keratosis and has the nail colour been affected? Also are there any other health problems or abnormal presentation (Skin, Hair and teeth).
  7. Sally Smillie

    Sally Smillie Active Member

    Sounds like Koilonychia, which is rare in children, but more common in older folk and linked there with systemic disorders and metabolic deficiencies. However the very little literature available does describe this nail presentation in under 5's, but significantly WITHOUT any of the undesirable associations found in the over 50's. Remember systemic disorders/heart probs/metabolic imbalances have more symptoms than merely koilonychia - that would be the least of their problems!

    I agree it is pretty unusual. I work F/T in paeds I've seen half a dozen in the last couple of years. My best advice is just to reassure parents it's ok, nothing serious, show them how to file nails flat (I will demonstrate and then let them use my tools to practice under guidance) and trim any edges that will catch and give potential to tearing, which is the greatest risk they have.
  8. Sally Smillie

    Sally Smillie Active Member

    Hi Jon, hope you're enjoying the snow! I'm 40cm under and the back door is snowed in! Incidently, Harry has two koilonychia of both hallucis
  9. Sally Smillie

    Sally Smillie Active Member

    oops, not sure what I've just done...
  10. footfan

    footfan Active Member

    With this patient i was thinking Koilonychia was secondary to a condition i have in my Text Atlas of NAil disorders, but needed more info from the thread starter to confirm .
  11. mtj45

    mtj45 Member

    Is the spooning just in the toenails?

    If it's fingers too, check their teeth and hair. If they have pointed teeth and thin hair could be Witkop Syndrome.

    Can always refer to Paediatrician if unsure.


  12. lucycool

    lucycool Active Member

    I don't work in paeds or anything and only qualified this yr, but my 4 yr old daughter had this condition in both hallux with all the symptoms you described and her nails are slowly "calming down". I keep them quite short to avoid tearing, but they don't bother her as the nails are so soft. I often thought about more serious conditions, but as she is perfectly well in all other respects I decided she's fine and it's just a child like condition.
    I'll follow this thread with interest, but my daughters nails are certainly becoming flatter as time goes on.

  13. Sally Smillie

    Sally Smillie Active Member

    Quite right, it IS secondary, but only in adults, where the systemic probs are significant. See my earlier post (the one with content)
  14. Sally Smillie

    Sally Smillie Active Member

    That is the natural course of this finding in little people and the same advice I give for it. Incidentally my 7 week old has it too. Maybe is is more frequent than referrals would indicate, which would be the case if parents don't notice or seek referrals for it. In little people it does not have the same systemic connections as when it 's found in adults.

    Interesting about Witkop Syndrome "A genetic disorder characterized by the absence of several teeth at birth and abnormalities of the nails. The disorder is also known as hypodontia and nail dysgenesis or, more picturesquely, as the tooth and nail syndrome (TNS). The tooth and nail defects in the syndrome are highly variable. The number and type of congenitally missing permanent and/or primary teeth vary." I couldn't find anything much more sinister than that with this condition.
  15. jeffgrant

    jeffgrant Welcome New Poster

    I don't think it's Koilonychia, because that's more common to finger nails. Rarely appears in toes.
  16. hollien

    hollien Member

    Thank you for all your suggestions. There are no other symptoms, both girls are very active, no hair, teeth or finger nail concerns. I am inclined to agree with Sally, I do think this is possibly a lot more common than referrals indicate.

    Hopefully, as most of you have indicated, this condition will ease over time.
  17. JAYNES

    JAYNES Active Member


    where can i get a copy of Text Atlas of nail disorders that you mention in this thread.

    Thanks for any info
  18. footfan

    footfan Active Member

    Hi Jaynes,

    If you seriously love nails get the updated version for £130 from AMAZON , Im an Ivan Bristow fan but I still couldnt justify it so went for the hardcover previous edition which is still podiatry specific and Ivan wrote for that edition aswell it was £100 when it first came out but its on ebay atm brand new delivered for £35 so a bargain. Its an extremely userfriendly book one of my favourite. It has the basics of gait ect in it aswell and goes through the changes in nails due to biomechanical influences e.g. thats why your toenails appear more abruptly curved than your nails on your hands. Also the actual quality of the print and binding surpasses any other book i have and some cost £200. DO NOT BUY THE RING BOUND VERSION AS MANY PEOPLE TRY TO SELL THEM AS THEYRE RUBBISH SO MAKE SURE WHAT YOU ARE BUYING FIRST.

    It even tells you why we have nails in the first place and NO they are not cutting/digging tools as some people suggest. :dizzy:


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