Hand, foot and mouth disease (HFMD) is a common viral infection of childhood, particularly in children under 5. It often appears in small outbreaks in nurseries and schools and spreads relatively easily from child to child.
Despite the appearance of the rash, which sometimes worries parents, in most cases it is a mild illness that clears up on its own within 7–10 days. CDC
What causes it?
The disease is caused by various enteroviruses, most often Coxsackie viruses. Coxsackie A16 is a common cause, while Coxsackie A6 can cause a more extensive rash. Enterovirus A71 has, more rarely, been associated with more serious complications. CDC
In everyday clinical practice, however, we usually don’t need to know exactly which virus caused the infection. The diagnosis is generally made from the child’s age and clinical picture, that is, the symptoms and the characteristic appearance of the rash. CDC
What are the symptoms?
The illness may start with fever, a sore throat, reduced appetite and feeling unwell.
Then characteristic painful small sores or blisters inside the mouth appear, and a rash may develop on the palms and soles. Spots may also appear on the buttocks, legs or arms. CDC
Not all children have exactly the same picture. In some the rash is limited, while in others it can be quite extensive.
How long does it last?
In most children the illness resolves without specific treatment within
7 to 10 days. CDC
The problem that most often needs attention is not the rash itself but the pain from the mouth sores. Because of the pain, a young child may refuse to drink and so be at risk of
dehydration. CDC
What can we do at home?
There is no specific treatment for the virus, and antibiotics have no place in treating uncomplicated hand, foot and mouth disease.
Treatment aims to make the child feel better until the infection passes.
Offer fluids often. Cool drinks may be easier to tolerate when the mouth hurts. Acidic drinks, such as some juices, are best avoided if they irritate the sores.
Choose soft, cool foods, such as yoghurt or other foods the child can swallow without much discomfort. There is no need to push them to eat. For a few days, getting enough fluids matters more than the amount of solid food.
For fever or pain,
paracetamol or ibuprofen can be used, at the right dose for the child and according to the pediatrician’s instructions.
Aspirin is not given to children. CDC
Blisters should not be popped. Keep the skin clean and let the sores heal on their own. CDC
How does it spread?
Hand, foot and mouth disease is highly contagious.
The virus can spread through droplets and secretions from the nose and mouth, close contact, fluid from the blisters, contaminated surfaces and objects, and also through stools. CDC
Children are most contagious during the first week of illness, but the virus can continue to be shed for days or even weeks after symptoms have gone. CDC
That is why good handwashing is particularly important — especially after nappy changes or using the toilet — as well as cleaning toys and frequently touched surfaces. Sharing cups, cutlery and towels should also be avoided. CDC
When can my child go back to nursery or school?
There is no need to wait for all the skin spots to disappear.
According to CDC guidance, a child can usually return when they have no fever, feel well enough to take part in activities and do not have uncontrolled drooling because of mouth sores. The school or local health authorities may also have more specific instructions, especially during an outbreak. CDC
Staying at home until the very last blister has gone usually offers little real benefit in limiting spread, as the virus can be shed for quite a long time. nhs.uk
Can peeling skin or nail changes occur?
After recovery, some children may develop
peeling skin on the hands or feet.
Nail changes, or even temporary loss of nails a few weeks after the illness, have also been reported rarely. Nails usually grow back normally. The CDC notes, however, that it has not been definitively proven that the disease itself causes the nail loss. CDC
When should you contact the pediatrician?
In most cases the illness runs a smooth course. However, medical assessment is needed when the child cannot drink enough or shows signs of dehydration, has a fever lasting more than three days, has severe symptoms or does not improve within about 10 days. The threshold for contacting a doctor should be lower for very young infants and children with a weakened immune system.
CDC
Urgent medical assessment is needed if the child shows unusual sleepiness or difficulty waking, seizures, difficulty breathing, a severe headache with a stiff neck, or any significant change in their general condition. Serious neurological complications are very rare but require immediate assessment. CDC
The most important things to remember
Hand, foot and mouth disease can look dramatic, but in the vast majority of children it is mild and self-limiting.
During the illness we focus on hydration, pain relief, hand hygiene and monitoring the child’s general condition.
And, as always, when your child’s condition worries you or does not progress as expected, contact your pediatrician.
For appointments and information, contact Dr. Giannis Ritsas, pediatrician Thessaloniki and pediatrician Evosmos.