Hand, Foot, and Mouth Disease in Children
What Is Hand, Foot, and Mouth Disease?
Hand, foot, and mouth disease (HFMD) is a contagious viral infection. It is an illness characterized by sores on or in the mouth and on the hands and feet.
It is more common in children, with pre-schoolers (under five years old) often being at a higher risk 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.
What Are the Causes of HFMD and How Is It 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 feces/poo—changing diapers causes a high risk of contracting it
- 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.
If you contract hand, foot, and mouth disease while pregnant, or if you or your child develop additional symptoms, please seek medical attention immediately. This could be the sign of a more serious illness caused by HFMD.
What Are the Symptoms of Hand, Foot, and Mouth Disease?
It usually takes 3-5 days for symptoms to appear once a child has been exposed to the virus that causes HFMD.
Here the symptoms to watch out for:
- A mild fever usually develops first.
- Red spots that develop into fluid-filled blisters (these usually start in the mouth before progressing to the hands and feet)
- Loss of appetite
- A 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 and while 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! However, remember that chickenpox is usually a full body rash.
How the symptoms progressed in our child:
Our nine-month-old was complaning, wasn't eating, and had a slight temperature. We thought she was "teething", so we gave her some pain relief, and she settled to sleep. The following morning, there was a spot on her chin and one near her lip that looked like dribble/a teething rash. She was still not eating and seemed a little 'off' but wasn't sick. Her daycare called a few hours later and said she was unsettled (not like her). She had more spots on her chin and on one on hand. We found out there were other cases of HFMD reported at daycare.
What Are Treatment Options for HFMD?
HFMD does not have a vaccine, unlike the virus that causes chickenpox. Treatment for the disease mostly involves treating the symptoms and 'riding it out'.
- Paracetamol or Ibuprofen for the fever—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, generally listless, and weak.
How we treated our daughter's HFMD:
After being picked up from daycare (30 minutes after they called) and brought home, our 9-month-old was very clingy, off her food, and complaning. She alternated between a 'whinge' that was almost constant to a wail—she was completely miserable and generally tired. Crawling seemed to be a strain on her—she was commando crawling at speed just days prior. We spent the day on the couch having lots of cuddles, giving her paracetamol every 4-6 hours, and encouraging fluids and fruity purees.
Have you or your child ever had HFMD?
There Are a Few Rare but Serious Illnesses Related to Hand, Foot, and Mouth Disease
HFMD is usually a mild illness and is unpleasant for a few days, but people recover from it quickly. However, for some people, HFMD can be dangerous or cause other illnesses that are serious and even life-threatening, so it's important 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). Here are the signs to watch out for in each of these illnesses (in addition to symptoms of HFMD).
- light sensitivity
- stiff neck
- difficulty waking up
- problems with walking
- Trouble breathing
- High fever
If you or your child have any of these symptoms, please seek urgent medical attention.
HFMD in pregnant women 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 alert your doctor so that you can be monitored appropriately.
How Can I Prevent Hand, Foot, and Mouth Disease?
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, or 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 the 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 drinks promotes the spread of both HFMD and other diseases.
- Avoid sharing toys, particularly if the children are young enough to consider toys a 'chew thing'. Recommend this to older children as well since faecal matter on children's hands can cause the spread of HFMD.
- Encourage good cough etiquette: Putting a hand or tissue over your mouth when you cough or sneeze, properly disposing of used tissues, and properly washing your hands will also help to contain the spread of the disease—as well as the common cold!
- Keeping sick children home from school or childcare: Children are generally contagious for 7-10 days, so keeping them home from school or daycare can prevent the illness from spreading further. Children who do not have mouth sores and whose hands and feet only have a few sores that can be covered may attend school/daycare.