Hand, Foot, and Mouth Disease

Hand, foot, and mouth (HFM) disease has been going around San Antonio.  If you have a child in daycare or in preschool, you’ve probably gotten reports that there have been outbreaks.  What is this disease?

Hand, foot, and mouth disease is caused by a virus that is transmitted through oral-fecal transmission, meaning that if saliva- or stool-contaminated objects from other children with HFM disease make their way into your child’s mouth, there may be a chance of your child getting this illness.  It is a self-limited illness, meaning that it’ll go away on its own even if you do nothing, and in fact, there isn’t anything you can do to make it go away faster.  Individuals who develop the illness, even after the acute symptoms are resolved, though, may actually still shed the virus for a few weeks after becoming asymptomatic.

There are several strains of HFM disease caused by different strains of the virus, and unfortunately having gone through one strain still leaves individuals susceptible to the other strains.  Symptoms include fever and a red bumpy or blistery rash that predominantly is located on the hands and forearms, feet and lower legs, and around or in the mouth, and frequently on the buttocks.  Depending on the strain, these symptoms may occur with a variety in severity.  Fussiness is often seen, and sometimes also cold symptoms or stomach virus symptoms (vomiting, diarrhea).

If your child has fever or fussiness, that can be treated with acetaminophen (Tylenol) and/or ibuprofen (Motrin/Advil) as needed.  Oral fluids with electrolytes and a sugar source should be encouraged as in the case with any viral illness, and unless the vomiting or diarrhea is a prominent issue, there really isn’t any significant dietary restriction, just what your child is willing to eat.  He/she may not have much of an appetite because the sores in his/her mouth may be causing pain, but as long as he/she is drinking enough to urinate at least four times in a 24 hr period, he/she will be fine.  Follow the instructions on the “stomach viruses” article regarding dietary management of stomach viruses if there is a lot of vomiting or diarrhea. 

No treatment is necessary for the rash, and often in younger children it will actually not be particularly bothersome.  Older children (or adults!) that catch the disease from their younger siblings (or their young children) may complain of itching, which can be relieved by oral diphenhydramine (Benadryl) as needed.  The rash only needs to be monitored for evidence of infection, which will show up as spreading redness and redness around individual bumps or blisters.  Typically the fever should resolve within 96-120 hrs, and the rash should disappear in a week or so.  Remember, though, the child may still be shedding live viral particles in his/her stool so continue to be very careful about washing your hands after diaper changes and spraying disinfectant in the diaper changing area after diaper changes.  If there are other children in the family, disinfect toys, etc that may have gone into the sick child’s mouth to minimize spread to family members.  Spread through the family is often seen, and the management is the same regardless of age.

Daycares have different policies regarding when affected children may return, some requiring a doctor’s note as long as there is no more fever, some requiring that the rash be gone.  Follow whatever your child’s school/daycare policies are.

Note that if the involvement of the fingers or toes was pretty severe, oftentimes the nails may be seen to start peeling and falling off in 1-2 months.  New healthy nails are growing in under the peeling nails, so just keep the peeling parts trimmed to prevent them from catching on things and peeling off sooner than they’re supposed to.