Hand, Foot, and Mouth Disease

Overview

Hand-foot-and-mouth disease (HFMD) is a mild, contagious viral infection common in young children. The primary causes are coxsackieviruses and other nonpolio enteroviruses. HFMD symptoms include sores in the mouth, a rash on the hands and feet, fever, sore throat, and feeling unwell. HFMD is most commonly seen in children in child care settings and is spread through person-to-person contact. The disease typically affects young children but can also be found in older children and adults, though they often have immunity against it. Although rare, some complications include dehydration, viral meningitis, and encephalitis. It is essential to encourage fluid intake during the illness and seek medical attention if the symptoms persist or worsen, especially in younger children or those with weakened immune systems.

Understanding the disease

Symptoms

The symptoms of hand-foot-and-mouth disease include fever, sore throat, feeling sick, painful, blister-like lesions on the tongue, gums, and inside of the cheeks, a rash on the palms, soles, and sometimes the buttocks, and fussiness in infants and toddlers. The rash is not itchy but may have blisters. The usual period from initial infection to the time symptoms appear is 3 to 6 days. If your child is younger than six months, has a weakened immune system, or has mouth sores or a sore throat that makes it painful to drink fluids, you should call your health care provider. If your child's symptoms don't improve after 10 days, you should also call your provider.

Risk Factors

The main risk factor for hand-foot-and-mouth disease is age, as the disease mostly affects children younger than 5 to 7 years old. Children in child care settings are particularly vulnerable due to the infection's spread through person-to-person contact. The disease can be contracted through contact with an infected person's saliva, nasal discharge, or blister fluid. The risk of complications, such as dehydration, is higher in younger children. Although anyone can get hand-foot-and-mouth disease, older children and adults usually have immunity to the disease due to prior exposure to the viruses causing it. However, adolescents and adults can still develop hand-foot-and-mouth disease under certain circumstances.

Development

Hand-foot-and-mouth disease is caused by a group of viruses called enteroviruses. The most common cause of hand-foot-and-mouth disease is infection from coxsackievirus 16. Other types of enteroviruses may also cause the disease. The virus spreads through person-to-person contact, primarily through respiratory droplets or direct contact with the virus particles on objects and surfaces. It can also be spread through fecal-oral transmission, as the virus can be present in the stool of infected individuals. The incubation period for hand-foot-and-mouth disease is usually 3 to 6 days, and the illness typically causes fever, sore throat, and a rash on the hands and feet. In some cases, the virus can cause more severe complications, such as viral meningitis or encephalitis, although these are relatively rare.

Assessment and Diagnosis

Diagnosis

To diagnose hand-foot-and-mouth disease, a healthcare provider typically evaluates the child's age, symptoms, and the appearance of the rash or sores. In some cases, oral cultures or biopsies may be performed to determine if the infection is bacterial, viral, or fungal in nature.

Management and Treatment

Complications

Potential complications of hand-foot-and-mouth disease include dehydration and, in rare cases, viral meningitis, encephalitis, or seizures. Dehydration can occur due to the painful sores in the mouth and throat, making it difficult for the child to swallow and stay hydrated. In severe cases, hospitalization and intravenous fluids might be necessary. While these complications are rare, they can be serious, particularly in young children and those with weakened immune systems. As always, consult a healthcare professional if you have concerns about your child's health.

Prevention

Hand-foot-and-mouth disease can be prevented by taking certain precautions. You can lower your child's risk of hand-foot-and-mouth disease in many ways, including:

1. Washing hands often: Wash your hands for at least 20 seconds, especially after using the toilet, changing a diaper, before preparing or eating food, and after blowing your nose, sneezing, or coughing. If soap and water are not available, use hand sanitizer.
2. Teaching good hygiene: Show your children how to wash their hands and help them practice good hygiene. Explain to them why it's important not to put their fingers, hands, or objects in their mouths.
3. Disinfecting common areas: Clean and disinfect high-traffic areas and surfaces, including door knobs, toys, and shared items. Follow a strict cleaning and disinfecting schedule if you're in a child care setting.
4. Avoiding close contact: Keep children with hand-foot-and-mouth disease out of child care settings or schools until their fever is gone and mouth sores have healed. If you have the illness, stay home from work. By following these precautions, you can help reduce the spread of hand-foot-and-mouth disease.

Home Remedies

While there is no specific treatment for hand-foot-and-mouth disease, there are some home remedies that can help provide relief from the symptoms:

1. Pain relief: You can give your child over-the-counter pain relievers like ibuprofen or acetaminophen to help reduce fever and relieve pain from mouth sores. Always follow the dosage instructions on the label and consult with your healthcare provider before giving any medication to a child.
2. Cold solutions: To provide relief from mouth sores, you can give your child cold drinks, ice pops, or frozen fruit bars to suck on. This can help soothe their sore throat and mouth.
3. Soft diet: Offer your child a soft diet of cool, soft foods like frozen fruit bars, ice pops, yogurt, gelatin, or cold cereal. Avoid hot or spicy foods, as they can irritate the mouth sores.
4. Hydration: Encourage your child to drink plenty of fluids, including water, clear broths, frozen water or ice pops, and electrolyte solution like pediatric electrolyte drinks. This helps prevent dehydration and maintain proper hydration.
5. Saltwater rinse: In some cases, a saltwater rinse can help relieve mouth pain and reduce inflammation. Dissolve 1/2 teaspoon of salt in 8 ounces of warm water and have your child rinse their mouth with it, then spit it out.
6. Over-the-counter pain relievers: As mentioned earlier, pain relievers like ibuprofen or acetaminophen can help relieve fever and pain associated with hand-foot-and-mouth disease. Always follow the dosage instructions on the label and consult with your healthcare provider before giving any medication to a child. Remember, it's important to consult your healthcare provider if your child's symptoms worsen, if they have difficulty drinking or eating, or if they experience additional symptoms like severe vomiting, signs of dehydration, or if they seem very unwell.

Treatment

Frequent hand-washing and avoiding close contact with people who have the illness may help lower the risk of infection. If your child has hand-foot-and-mouth disease, it's generally recommended to manage the symptoms by providing plenty of fluids to prevent dehydration, offering soft foods, and administering over-the-counter pain relievers for pain and discomfort as recommended by a healthcare professional. Always consult a healthcare provider for personalized advice on managing hand-foot-and-mouth disease.

Preparing for medical consultation

To prepare for an appointment for hand, foot, and mouth disease, you should:

1. Be aware of any pre- or post-appointment restrictions. Ask if there is anything you need to do in advance, such as limiting your diet or isolating yourself to avoid spreading the infection.
2. Write down symptoms you are experiencing, including any changes in your mood, thinking, or behavior. Note when you developed each symptom and whether you had cold- or flu-like symptoms.
3. Make a list of key personal information, including any recent travel, exposure to possible sources of infection, and major stresses or recent life changes.
4. Compile a list of all medications, vitamins, herbs, or other supplements you are taking, including doses.
5. Bring a copy of any medical or dental records, including test results, that are related to the hand, foot, and mouth disease.
6. Take a family member or friend along, if possible, for support and to help you remember everything.
7. Prepare a list of questions to ask your healthcare provider, such as:
   • What's likely causing my symptoms?
   • What tests do I need?
   • What's the best course of action?
   • How can I manage my symptoms at home?
   • Are there any restrictions I need to follow?
   • Are there brochures or other printed materials I can have? What websites do you recommend? Remember to inform your healthcare provider about any recent travel or exposure to possible sources of infection, as well as your medical history and current medications. This information will help them provide the most appropriate care and guidance.