Dr. Mona's Mom Blog

Hand-Foot-and-Mouth Disease (HFMD)

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…and the weird (non-serious) complication you may not know about

Hand-Foot-and-Mouth Disease is a common virus caused by viruses in the Enterovirus category (Coxsackie A16 is most common)

This virus usually appears during spring, summer and fall seasons–in all ages–but particularly common in children under four. It spreads from person-to-person contact and by touching contaminated surfaces. Due to hand-foot-and-mouth disease being very contagious, it spreads quickly through childcare settings. Contact with respiratory droplets, kissing, sharing utensils, sharing toys, and touching infected surfaces and then touching your eyes/mouth spreads the virus.

This virus IS very contagious. I put it up there with stomach viruses.

Even though it’s a common childhood virus, adults can get it too. Likely these are adults who haven’t been exposed to that particular strain of HFM as a child so are now getting it as adults. Most adults who get it report that symptoms are bothersome — more bothersome to them than their child, but it does improve on it’s own, you can treat it the same way you treat your child.

What are HFMD symptoms?

Fever is common for 1-3 days (but not all children will get it). You will see red spots that will look like blisters on the hands, feet, around the mouth, inside the mouth, and in many cases in the diaper area or elsewhere on the body.

If it does happen in the diaper area, a hand-foot-and-mouth rash will appear to be a horrible diaper rash with bumps. You will open up the area and be surprised to see a diaper rash because you didn’t see any signs of one leading up to it. If your child is clinically unwell and/or has a fever, I would recommend monitoring the diaper rash. If they’re happy, playful, and afebrile; you can do your normal activities but do monitor for the spread of that bumpy, pimple looking rash to the hands, feet or around the mouth.

You will start to see the spots spread to hands and feet after 1-2 days if it is HFM. Some kids may get it in all locations and some will only have the hands, mouth, and feet.

Caring for Hand-Foot-and-Mouth Disease at home

  • Focus on hydration and soft foods. The sores in the mouth can be painful: hard foods, spicy foods, or citrus foods can be uncomfortable.
  • Cold drinks, milk shakes, and popsicles are great because they provide comfort. (and are delicious!)
  • If not drinking, give pain meds and offer liquids by syringe.
  • Pain meds like Ibuprofen or Tylenol are helpful as needed.

The blisters that appear with hand-foot-and-mouth disease do not need any special treatment. They will go away on their own. Continue using your normal ointments. For the diaper area, you can continue to use zinc oxide ointment for symptomatic relief, but the rash will go away on its own. The rash should go away in 7-10 days.

But, if there’s really painful mouth sores and you’ve tried the remedies above, you can create a liquid antacid rinse for children over one.

  • Age 1-6: Put a few drops of Mylanta (or store brand liquid antacid) on a cotton swab and dab on sores 4 times as needed.
  • Over 6 years: Use 5ml 4 times a day as needed as a mouthwash. Spitting out is ideal, but if swallowed at this age is not a problem.

Remember, hand-foot-and-mouth disease is a VIRUS and antibiotics will not treat it. So like any virus, we do supportive care.

When to seek medical attention

  • If you are unsure of the diagnosis.
  • Your child is not hydrated (not making tears or wet diapers/urinating).
  • Fever persists for more than 5 days and/or your child appears worse.

As a heads up, the rash can get worse before it gets better. Meaning, 2-5 days into the illness you can see a mass spread of the rash, which then begins to scab over and go away. If you see this and you are unsure of the diagnosis and/or your child is unwell, seek medical attention.

Returning to daycare/school after hand-foot-and-mouth disease

Hand-Foot-and-Mouth Disease is very contagious, so a child should be pulled out of a childcare setting when there is suspicion of the diagnosis.

The incubation period (the time between being exposed and showing symptoms) of this virus is 3-6 days. A child can then return when they are fever/med free for 24 hours and they are clinically well (playful, drinking, etc).

However, if the child has open, weeping blisters, they should be kept home until these scab over (open, weeping blisters are contagious when touched by others). This can take a week from the onset of the rash.

Why are my child’s nails peeling?

Commonly, this virus can lead to brittle or peeling nails, weeks or a month after the illness. This may seem unusual and weird, but the nails WILL grow back. Nail growth can take a few months to fully return. We don’t know WHY, but it’s likely due to the virus causing irritation to the nail bed leading to the loss.

So, how can I reduce the spread at home?

  • Wash your hands regularly with soap and water, and help children wash their hands too.
  • Clean and disinfect frequently touched surfaces and shared items, including toys and doorknobs.
  • CDC: Best way to disinfect for hand-foot-and-mouth disease, is to first wash the items with soap and water, then disinfect them with a solution of chlorine bleach (made by mixing 1 tablespoon of bleach with 4 cups of water) or a cleaning product that contains bleach.
  • Avoid touching your eyes, ears, and mouth – like any viral illness, this is largely how we introduce a virus into our system.

As a parent, it’s nearly impossible to remember to wash your hands, not share utensils, and not kiss, or wipe boogers from your sick toddlers. So, do your best with the tips I recommend.

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All information presented on this blog, my Instagram, and my podcast is for educational purposes and should not be taken as personal medical advice. These platforms are to educate and should not replace the medical judgment of a licensed healthcare provider who is evaluating a patient.

It is the responsibility of the guardian to seek appropriate medical attention when they are concerned about their child.

All opinions are my own and do not reflect the opinions of my employer or hospitals I may be affiliated with.