Dear Dr. Johnson: A child in my son’s day care center was recently diagnosed with hand-foot-mouth disease. What is this, how dangerous is it and how is it treated?
Dear Reader: Hand-foot-mouth disease is a very common infection in children. It usually occurs in children between age 6 months and 4 years but can occur at any age. It is usually caused by the coxsackie virus but can also be caused by other enteroviruses.
Unlike most viruses, the peak time of this infection is during the summer months but is seen throughout the year. As the name suggests, it often affects the mouth, hands and feet.
The sores in the mouth are typically red spots or ulcerations on the soft palate (the back part of the roof of the mouth). Other parts of the mouth, especially the inside of the cheeks and tongue, can be affected. These ulcers are often painful and can lead to drooling and pain with swallowing. Sometimes the ulcers in the mouth occur without a rash anywhere else. This is called herpangina even though it is not caused by the herpes virus.
In addition to the mouth sores, a child may also have a rash on their palms and/or the soles of their feet. The lesions are usually either small thick-roofed blisters or red dots. Less commonly, the rash can be present on the buttocks, arms and legs.
Hand-foot-mouth is often accompanied by a fever. As the infection is caused by a virus, there is not a medication to treat it or to speed recovery. The illness is self-limited and unlikely to have complications as long as the child stays hydrated.
Maintaining comfort and hydration are important. The mouth sores can prevent a child from wanting to eat or drink. It is OK if they don’t want to eat for a few days, but encourage drinking. Often, cool liquids feel best. Some suggestions to try are popsicles, shakes, Jello, pudding, ice cream, etc.
Acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) can also be used. These tend to be most effective 30-60 minutes after they are given, so this is the best time to encourage drinking. Avoid citrus, salty and spicy foods, as these can irritate the sores. An infant may take liquids better from a spoon or syringe; a bottle nipple coming in contact with the sores could cause pain.
One of the easiest ways to monitor hydration is to determine how often your child is peeing. They should go at least once every eight hours. If the pain is severely limiting hydration, discuss this with your child’s doctor. Coating the mouth with a small amount of antacid may help.
A child should be excluded from daycare or school while they have a fever. The rash is not contagious. The mouth sores typically resolve within a week. The rash may last a few more days. The incubation period is 3-6 days, meaning if your child is exposed and has not gotten sick within a week, you should be in the clear.
This article was published in the Wisconsin State Journal on Feb. 16, 2012.