Every spring I breathe a big sigh of relief that flu and RSV (respiratory syncytial virus) season are over. Unfortunately, the reprieve is short-lived. Winter viruses give way to spring and summer illnesses. One such illness is called hand, foot and mouth disease. That’s right, not hoof and mouth but hand, foot and mouth. This illness is caused by the coxsackie virus which is an enterovirus, meaning it can spread through contact with fecal matter. It can also be spread via nasal and oral secretions through a cough or a sneeze. So basically, if you have kids around don’t touch anything!
Hand, foot and mouth starts with fever and poor appetite. A few days later blisters begin to develop in the back of the mouth but can also be seen on the palate and inside the lips and on the tongue. A few days after that red blisters can develop on the palms of the hands and soles of the feet. For some kids, the rash can spread to other parts of the body including the trunk and extremities. I’ve seen some bad cases of blisters clustering on the knees and elbows. Furthermore, the blisters and associated swelling of the hands and feet can be extremely painful. I see this mostly in older kids, teens and parents.
Because HFM is an enterovirus, many kids will have some vomiting and/or diarrhea at some point during the illness. For symptomatic treatment of these symptoms, see my post here.
As stated above, HFM is be spread by touching a contaminated surface, touching a contaminated bottom (think diaper changing) or being exposed to respiratory secretions. These secretions come from a sneeze or cough and rest on surfaces we all touch like door knobs and table tops. Don’t worry, the infection does not come from animals, again no hooves involved, and usually infects kids under 5. Unfortunately, children can get the infection more than once, up to about 5 times. For older kids and teens who didn’t have the pleasure of getting HFM when they were younger, they can get it.
Of note, this infection can spread through ingesting contaminated water, including contaminated pool water. This happens from fecal matter present in an incompletely chlorinated pool. Furthermore, the virus can shed from an individual for weeks to months after infection and since it is mostly present in the summer, make sure you are swimming in a properly chlorinated pool!
The good news about HFM disease is it typically resolves without any consequence. Some patients do experience finger and toe nail loss a few weeks after infection but this is rare. The nails do eventually grow back normally and the process is painless. Some patients experience headache and stiff neck because of viral (aseptic) meningitis. While aseptic meningitis is not life threatening, bacterial meningitis is so if your child is experiencing fever, headache and stiff neck, please see the doctor right away.
The main treatment is comfort care. Give your child Tylenol or Ibuprofen for pain and fever. (Follow dosing instructions carefully or ask your doctor.) Keep in mind that children should not be given aspirin. A mouthwash of Benadryl and Maalox mixed together in a 1:1 ratio can be used for gargling to coat the mouth and throat. Make sure your child can spit the mouthwash out before using it. Your doctor can also prescribe this mixture with a numbing medicine mixed in.
Your child may not want to eat while they have sores in the mouth, and that is ok. Make sure he/she is staying hydrated with lots of fluids. You can also try crushed ice or a popsicle.
As always, good hand washing is the best thing anyone can do to prevent the spread of germs. For this illness, patients are most contagious in the first week of illness when they are most likely to have symptoms. Therefore, while your child is feeling sick or having a fever, keep him/her at home to rest. Once they are feeling better, let them return to school/daycare, even if the rash is still present. Because this virus is so prevalent during outbreaks and can shed for so long in the stool, it is hard to control the spread. Furthermore, the infection is self-limited and without any long term consequences. Therefore containing spread, while not feasible anyway, is not really necessary.