Hand, Foot, and Mouth Disease
What Is Hand, Foot, and Mouth Disease (HFMD)? How Does It Spread?
HFMD is a common illness that affects toddlers and children, usually during the summer. It tends to spread in daycares and camps, though can spread outside of these settings as well. It’s caused most frequently by a virus called Coxsackie, which spreads through droplets from coughing, contact with liquid from sores, or via stool from someone who hasn’t washed their hands. It’s fairly contagious, so if your child has it, stay on top of hand hygiene to avoid spread to others.
Can Adults Get It?
Yes, and it’s usually from taking care of a child who’s sick with it! Make sure you’re washing your hands regularly to minimize risk. Symptoms in adults can feel more severe.
What Are The Symptoms?
HFMD usually starts with a mild fever and cold-like symptoms, after which a rash forms. The rash is typically located where you’d expect - on the hands, feet, and inside the mouth. However, it can also occur on the buttocks or genital area, outside of the lips, or on the legs. Mouth sores tend to cause a decreased appetite, and a rash near the genital area can cause issues with urinating.
What Does The Rash Look Like & How Long Does It Last?
It looks like small, faintly red flat spots or slightly raised bumps. Over the next 1-2 days, it changes to fluid-filled blisters that may itch or hurt, which will eventually fade at 5-7 days.
What Can I Do To Help?
Hydration: The painful sores in the mouth can make it hard to eat and swallow, so children run the risk of getting dehydrated, and this is what lands most children with HFMD in the ER. Your goal for older children is urinating at least every 8 hours, making tears when they cry, and not having a dry or cracked mouth. Your fluid options are water, milk, Pedialyte, juice or Gatorade diluted 1:1 with water, soup, or popsicles.
Pain Control:
Tylenol or Motrin every 6 hours as needed (for >6 months of age) is your mainstay of therapy. You can alternate these if desired, or time them in relation to meals if eating / drinking is an issue.
In older kids, your doctor may offer a solution called Magic Mouthwash (a mixture of Benadryl and Maalox) to help with oral discomfort if there’s severe mouth involvement that affects hydration (this is dabbed onto the gums in younger children, and can be used as a swish-and-spit mouthwash in older children). However, it’s not necessary for treatment, so if your doctor doesn’t advise it, that’s OK too.
Avoid any foods that are very spicy, acidic, or citrus (such as limes, lemons, etc.) since this can irritate the the sores. I also recommend avoiding anything really crunchy (e.g., chips), since this can scrape against the sores and worsen discomfort. Opt for soft foods like macaroni and cheese or mashed potatoes.
If there’s a rash in the genital area causing painful urination, try having your child use the restroom during a warm bath (the warm water can help relieve the sting).
If there’s itching, a 1 or 2.5% over-the-counter Hydrocortisone cream twice daily for 3-5 days can help relieve symptoms.
Product Recommendations:
Watch out for peeling skin or shedding fingernails after the illness ends.
What About Peeling Skin & Shedding Fingernails?
One of the things that doctors often forget to mention is that skin on the hands and feet can starting peeling anywhere from 1-3 weeks after the illness. If you notice this, not to worry! It’s not harmful. Use moisturizer (like CeraVe or Eucerin) twice daily to help with quicker healing.
In rarer cases, fingernails and toenails can actually shed, often between 3-6 weeks out from HFMD. They tend to start to look brittle and come off in small layers, prior to completely falling off. It can be one nail or multiple nails. It’s not painful, and the nails will grow back, though it can take months. Avoid actively peeling them off so that you don’t cause bleeding or pain.
When Can My Child Return To School?
This depends on the daycare. However, I recommend 24 hours after the fever has resolved without Tylenol/Motrin, and so long as there’s no draining blisters (the liquid from the blisters is contagious). Some daycares will want the rash fully resolved, which can last up to 1 week.
When Should I Go To The ER?
The main reason to go to the ER is for dehydration. If your child urinates <3 times in 1 day, has cracked lips and a dry mouth, is lethargic, and is not making tears when they cry, it’s time to go to the ER for IV fluids. The other reason is if they’re having severe headache, stiff neck or seeming altered. In very rare cases, HFMD can cause a viral meningitis, so these symptoms warrant an evaluation to see if more treatment is needed.
