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Hand, Foot, and Mouth Disease

  • Lisa Asta, M.D.
  • Posted March 11, 2013

What is Hand, Foot, and Mouth Disease?

Hand, Foot, and Mouth Disease (HFM) is a common childhood illness caused by a virus and marked by painful mouth sores. Symptoms may include blisters in the mouth and small, grayish red blisters on the palms of the hands, the soles of the feet, and sometimes on the buttocks. Rashes on the palms and soles are unusual and are one of the things that distinguish HFM from other viral rashes.

The disease affects children from 6 months old through school age. Children with HFM typically run a temperature of 100 to 102 degrees F for a few days. About 70 percent of them also develop the rashes, which disappear in approximately 10 days. The mouth sores can take up to a week to heal. Located on the tongue, the inside of the cheeks, and the back of the throat, they look like canker sores and are painful. As a result, some children refuse to drink and may become dehydrated.

What causes it?

The virus usually responsible is a tongue twister known as Coxsackie A 16; this virus, named after the town in New York where it was first described, is a member of the enterovirus family. Other enteroviruses can also cause HFM. Exposed children can be infected for three to six days before showing symptoms. This contagious virus is spread through the feces-to-mouth route (which can happen when a child forgets to wash up after using the toilet; it can also spread by children mouthing toys that an infected child has mouthed or handled). HFM tends to run through play groups and day care centers, striking susceptible children.

How do I take care of my infected child?

Since dehydration is a big risk, help prevent it by offering your child plenty of liquids. Some children prefer ice-cold liquids and frozen juice bars; these can numb the mouth a bit, so the sores hurt less, and provide necessary fluids. Other kids may find warm liquids and broth soothing. Anything your child will drink is okay, except citrus drinks; don't give your child orange juice, citrus fruit bars, or food that's spicy or salty as they'll probably sting. Use children's acetaminophen or ibuprofen for pain and fever; don't give aspirin to children under 18, though, since it can trigger a potentially fatal illness known as Reye's syndrome. Some physicians recommend mixing equal parts of Benadryl and Maalox together and dabbing it on the sores to provide relief. If the rash is itchy, an over-the-counter anti-itch cream will help; an antihistamine like Benadryl given by mouth can also help ease itching. Generally children can go back to school when their temperature is back to normal.

When should I call the pediatrician?

Call if your child shows signs of dehydration, including a dry, tacky mouth, tearless crying, or urinating less than usual. You should also call if the fever lasts more than three days or if your child appears to be getting worse.

Enteroviruses can cause other illnesses as well, including viral meningitis; it's not as serious as bacterial meningitis, but can make your child feel quite ill. Call for an emergency appointment if your child has a stiff neck, headache, or stays drowsy after sleep and seems foggy and confused.

You should also call your pediatrician immediately if you see greyish-red blisters any place other than your child's buttocks, palms, the soles of his feet, or between his toes or fingers. A rash anywhere else means that HFM is probably not the cause, although another virus could be. Rashes that look like bruises or broken blood vessels, or appear purple in any way, can be a sign of a more serious condition like meningitis. A simple way to tell the difference is to press on the spot; if it doesn't blanch or go away with pressure, it's not part of HFM and your child needs to be seen right away. Call for an emergency appointment if you detect a rash fitting this description.

Does HFM have anything to do with animals?

No. People often confuse HFM with hoof and mouth disease, a cattle infection. There is no connection. Likewise, there is no relation between HFM and trench mouth, a bacterial infection of the gums.

Further Resources

National Institute of Child Health & Human Development
http://www.nichd.nih.gov/default.htm

Pantell, Robert H. M.D., James F. Fries M.D., and Donald M. Vickery M.D. Taking Care of Your Child: A Parent's Illustrated Guide to Complete Medical Care, Eighth Edition. 2009. Da Capo Lifelong Books.

National Institute of Child Health and Human Development, http://www.nichd.nih.gov/default.htm

Pantell, Robert H. M.D., James F. Fries M.D., and Donald M. Vickery M.D. Taking Care of Your Child: A Parent's Illustrated Guide to Complete Medical Care, Eighth Edition. 2009. Da Capo Lifelong Books.

Mayo Clinic. Reye's Syndrome. September 2009. http://www.mayoclinic.com/health/reyes-syndrome/DS00142

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