Hand Foot and Mouth Disease in Children
Out, Damned Spot!
Hand, Foot and Mouth Disease (HFMD) a contagious viral infection - that is, an infection that is easily spread, and caused by a virus rather than bacteria. It is an illness charaterised by sores on or in the mouth, and on the hands and feet.
It is more common in children, with pre-schoolers (under 5) often being more unwell than those who are older. Adults and those who are immunosuppressed may also catch HFMD - it is often milder in adults, but can be extremely itchy.
Once you have had HFMD - you are then immune to the virus and cannot get this disease again.
Not Dribble Rash
What Are The Symptoms of HFMD?
It usually takes 3-5 days for symptoms to appear once a child/person has be exposed to the virus that causes HFMD
The symptoms of HFMD are:
- A mild fever usually develops first
- Red spots that develop into fluid filled blisters, starting in the mouth, progressing to hands and feet.
- Loss of appetite
- Sore throat
- Malaise - general weakness or tiredness
- Occasionally spots may also be present on the bottom and legs (but not all over)
It is usually mild and should only last 3-7 days - though most of the symptoms will subside earlier - the spots take a little longer to disappear. They usually do not leave a scar.
It is occasionally mistaken for Chickenpox, cold sores, or in our case, dribble/teething rash! Chickenpox is usually a full body rash.
A personal example of symptom progression:Our 9mth old was grizzly, off her food and a slight temp - we thought "teething" - used pain relief and she settled to sleep.
Following morning - a spot on her chin, and one near her lip, looked like dribble/teething rash.Still off her food, a little 'off' but not sick.
A call from daycare a few hrs later - unsettled ++ (NOT like her), more spots on chin, and one on hand, other cases at daycare of HFMD.
Treatment For HFMD
HFMD does not have a vaccine to prevent it's spread, unlike the virus that causes chickenpox.
Treatment for HFMD mostly involves treating the symptoms, and 'riding it out'.
- Paracetamol or Ibuprofen for the temp - NEVER give Aspirin to a child.
- Plenty of fluids
- Salt water rinses for the blisters in the mouth (not suitable for babies)
Infants may be very clingy, grizzly, generally listless, and weak.
After being picked up from daycare (30mins after call) and brought home - Our 9mth old was very clingy, off her food, grizzly - alternated between a 'whinge' that was almost constant, to a wail - completely miserable little one, and generally tired. Crawling seemed to be a strain on her - previous commando-crawling at speed just days prior. We spent the day on the couch, having lots of cuddles, paracetamol 4-6hourly, encouraging fluids and fruity purees.
Causes of HFMD, and How It is Spread
HFMD is caused by a group of viruses called enteroviruses. The most common virus that causes HFMD is called Coxsackie A16.
It is highly infectious, and is spread easily through contact with bodily fluids that contain the virus, or poor hygiene. This includes:
- Saliva - coughing, sneezing and dribbling
- Fluid from the blisters
- Contact with faeces/poo - nappy changing being high risk
- Poor hand washing technique
Anyone with HFMD is most infectious in the first week after symptoms appear, and while the blisters are filled with fluid.
Spots! And More Spots
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Rare, But Serious Illnesses Related to HFMD
HFMD is usually a mild illness, unpleasant for a few days but recovered from quickly. However, for some people HFMD may be dangerous, or cause other illnesses that are serious and even life-threatening, so it pays to be aware of these.
A small number of people in an epidemic outbreak of HFMD may develop Encephalitis (inflammation of the brain) or Pneumonitis (inflammation of the lung tissue). SIgns of these illnesses include (in addition to those symptoms of HFMD):
- light sensitivity
- stiff neck
- difficult to wake
- problems with walking
- Trouble breathing
- High fever
If you, or your child have any of these symptoms - please seek urgent medical attention.
Pregnancy is situation where contracting HFMD can be dangerous - to the unborn child.
Whilst even rarer than encephalitis and pneumonitis, if HFMD is contracted in the third trimester of pregnancy it can cause the baby to become very unwell once delivered with illnesses including inflammation of the liver, thrombocytopenia (low platelets in the blood - causes bleeding), inflammation of the brain and membranes, and disease of the heart muscle.
If you have contracted HFMD whilst pregnant - please advise your doctor so that you can be monitored appropriately.
Spots, Damn Spots!
Prevention of HFMD
HFMD is highly contagious/infectious, but there are a few simple ways that you can slow or prevent the spread of this common childhood illness.
Proper hand hygiene - regularly washing your hands, particularly after changing nappies, dealing with sick children, before food preparation, after using the toilet - can prevent the spread of many illnesses including HFMD. Childcare workers are recommended to wear gloves if caring for a sick child (while waiting for parent to collect), as well as proper hand washing.
Avoid sharing food or drinks - both with a sick person, and in general everyday life - there are many illnesses spread through saliva, and sharing food or drink bottles promotes the spread of both HFMD and these other diseases.
Avoid sharing toys - particularly if the children are small enough that toys are also 'chew thing', but recommended even in older children, as faecal matter on children's hands can cause the spread of HFMD also.
Good cough 'etiquette" - hand or tissue over your mouth when you cough or sneeze, proper disposal of used tissues, and proper handwashing will also help to contain the spread of the disease - as well as containing the spread of the common cold!
Keeping sick children home from school, childcare - children are generally contagious for 7-10days, so keeping them home from school or daycare can prevent the illness from spreading further. Children who do not have mouth sores, and who's hands and feet only have a few sores that can be covered may attend school/daycare.
HFMD is Common, but Not Usually Serious
HFMD is a common, viral childhood illness, that is highly contagious. Often seen in children younger than 10, it is often more severe in pre-school aged children (under 5 yrs), and can be caught by adults at times as well. Once you have had HFMD once, you cannot get sick with it again.
There is no preventative vaccine for HFMD, and treatment consists mainly of paracetamol/ibuprofen for temperatures and pain relief, fluids and plenty of rest. Preventative measures such as good hand washing, and covering your mouth when you cough or sneeze are useful in preventing the spread of this disease, as well as many others.
Here's to a speedy recovery for any and all of you suffering with HFMD, or caring for a sick child with HFMD - whilst a mild illness, it is not a pleasant one to be struck down with, particularly as an infant!