Hand Foot Mouth Disease: A Summertime Virus

Hand-Foot-Mouth Disease

It's that time of year that, as pediatricians, we see lots of hand-foot-and-mouth disease! So, since your child may have already had, or may develop this common illness, let's explore what this summertime virus is all about.

What is hand-foot-and-mouth disease?

Hand-foot-and-mouth disease (HFM disease) is a viral infection common in young children, usually age 5 and under, but can occur at any age. It's telltale sign is a rash on the hands and feet, and sometimes in the mouth, hence the name.

More specifically, the rash usually involves the palms of the hands and the soles of the feet, distinguishing it from many other illnesses that can cause a rash. The rash consists of red bumps that are usually not itchy, painful, or bothersome at all to the child. The rash tends to bother us, as parents, far more than it does our child(ren) due to the look of the rash.

Sometimes the bumps blister, making the skin a little itchy or irritated. If the bumps do blister, you may notice some peeling of your child's skin. This type of peeling, especially of the hands and feet, may last longer than the actual virus and can linger on for a few weeks even after the rest of the illness has resolved.

While the rash is the most classic finding, hand-foot-and-mouth disease can also cause:

• Fever

• Painful, red spots or sores in the mouth (usually on the tongue, gums or insides of the cheeks)

• Decreased appetite in younger children or sore throat in older children, and

• Increased fussiness or irritability in younger children or generally feeling unwell in older children

Fever is often the first sign of hand-foot-and-mouth disease, followed by the rash 1-2 days later. However, sometimes no fever occurs and the first sign is the rash or mouth sores.

Outbreaks of hand-foot-and-mouth disease are most common in the summer and fall seasons in the United States. In tropical climates, outbreaks occur year-round.

What causes hand-foot-and-mouth disease?

HFM disease is most commonly caused by a group of viruses called enteroviruses, and usually specifically by a virus called coxsackievirus.

How is hand-foot-and-mouth disease spread?

HFM disease is contagious and spreads from person to person. The illness spreads by contact with an infected person's:

• Respiratory droplets

• Saliva

• Nasal secretions

• Fluid from blisters, or

• Stool

Hand-foot-and-mouth disease is commonly spread in childcare settings because small children are not the most hygienic and often put their hands in their mouths (and other places). However, the virus can also be passed by adults and older children who may not show signs or symptoms of the disease (usually because they have already developed an immunity to the virus) but can still spread the disease through respiratory droplets and the other means mentioned above.

Children are most contagious during the febrile stage (if fever occurs) but can remain contagious during the first week of the illness. When fever does not occur, there is no way for parents or childcare workers to know that a child has been exposed...until the rash develops.

By this time, a child may have already passed the virus to others, which is another reason why the virus is spread so easily.

Children usually develop immunity to hand-foot-and-mouth disease after exposure to the virus. However, because HFM disease is caused by a group of viruses and not just one virus, it is possible to get HFM disease again. It is also possible, but less common, for older children and adults to get the disease (if they have never been exposed before).

How do you treat hand-foot-and-mouth disease?

Since HFM disease is caused by a virus, there is no treatment that will make the illness go away faster. Fortunately, the illness is typically mild and will resolve on its own, usually within 7-10 days.

You can treat some of the symptoms of HFM disease if they are bothersome for your child. This may help them feel better while their body does the work of fighting off the virus.

• For fever: You can give your child fever-reducing medications as recommended by your child's pediatrician or by following the medication label(s).

• For rash:

  • If your child is not bothered by the rash, you don't need to do anything and there are no medications to make the rash go away faster.

  • If your child's rash is slightly itchy, you can apply calamine lotion to their skin to help soothe their skin. **My trick is to leave the calamine lotion in the refrigerator. The additional coolness can be very soothing for an itchy, inflamed rash.**

• For mouth sores/pain or sore throat:

  • Cold foods and liquids will be very soothing for the mouth pain your child may be experiencing. This is the time to give them plenty of ice-cold or frozen beverages or treats. This will help soothe their mouth pain and get in some much-needed electrolytes and calories for a child who may not be eating much while ill.

  • Your child's doctor might prescribe medication to help with mouth pain as this can be one of the most bothersome symptoms of HFM disease.

Are there any complications of hand-foot-and-mouth disease?

The most common complication of HFM disease is dehydration since the painful mouth sores can lead to a child not eating or drinking like usual. To prevent this:

• Encourage plenty of clear fluids (water and/or age-appropriate electrolyte beverages) to help your child stay well-hydrated, even if they don't want to eat solid foods.

• Monitor your child's urine output to ensure that they are still having their usual amount of wet diapers or using the bathroom their usual amount.

• Monitor you child's activity level to ensure your child is not becoming weak or having difficulty awakening or moving.

• If you think your child may be dehydrated, call your child's doctor right away or take them to an urgent care or emergency room. Severe dehydration may require IV fluids and/or monitoring of your child in a healthcare facility.

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