What is it?
Hand, Food, and Mouth Disease (HFMD) is a classic pediatric illness that almost all families will encounter at some point, many on multiple occasions (unfortunately you can get it multiple times). It is caused by a few different viruses, most commonly the coxsackie virus, and it tends to circulate more in the summer and fall, though it can be seen year round.
Many cases of HFMD can be diagnosed and treated at home if you know what you’re looking for, so see below for how it presents and how we manage it.
What are the symptoms?
- Fever
- Irritability
- Sore throat with characteristic blisters in the mouth
- Decreased appetite
- Classic rash with red bumps and blisters on the palms and/or soles of the feet
- The rash can actually be anywhere on the body. In fact it’s common to see it in the diaper area/buttock region too
- The rash can be very tender
- Sometimes kids have peeling of their hands and feet a week or two after the illness resolves, and some even have their fingernails and/or toenails fall off around a month after illness. This is a weird symptom of HFMD but it’s harmless and they will grow back and look normal!
- If the nails fall off and leave any sharp edges, trim them down to avoid them getting snagged on anything
Images sourced from DermNet
How do we treat it?
HFMD is caused by a virus so it cannot be treated with antibiotics or any other prescription medication. We have to rely on your child’s immune system to fight it off which can often take around 3-5 days.
- Pain and fever management with acetaminophen (Tylenol) and/or ibuprofen
- Even if there’s no fever, these medications can decrease sore throat which will help kids drink more
- Push fluids – whatever fluids they want!
- Monitor for at least 3 pees every 24 hours as a marker of adequate hydration
- It’s okay if they have a low appetite and aren’t eating much food as long as they are drinking
- Avoid spicy or citrus foods as these can sting the throat
- Magic Mouthwash – if your child is older than 1 year old and has mouth pain, you can mix equal parts of a liquid antacid (such as Mylanta or Maalox) and liquid Benadryl to form a mouthwash to be used 4 times a day
- For young kids just put a few drops in their mouth or rub it on with a washcloth
- For older kids, have them swish and spit 1 teaspoon of the mixture in their mouth
When can your child return to school/daycare?
Kids can spread HFMD even when they are symptom free (kids can actually shed the virus for a few weeks after their illness), so it’s always a good idea to be mindful of frequent cleaning, hand washing, and not sharing drinks/food etc.
Kids can return to activities once they are:
- Feeling better
- Fever free for 24 hours
- If they have extensive blisters as part of their rash, once those are crusted over (because the blister fluid is contagious)
- If they are drooling a ton because of their sore throat, once their secretions are better managed
When does HFMD need to be seen in the office?
If your child has the classic rash and you feel comfortable with the diagnosis and caring for them at home then we don’t have to see them in the office for a visit.
Reasons that we do need to see kiddos:
- Fever > 3 days
- Concern for dehydration (< 3 pees/24 hours, sunken soft spot in babies, not making tears)
- Severe or extensive rashes that don’t fit the classic rash (for example if the rash is full body, there are lesions around the lips, gums are swollen)
- Your child is acting really sick
- You are worried and would rather us take a look! (This is always a reason to come see us!)
HFMD is such a tough one when kids bring it home because it really makes them feel miserable and the main treatment is time, but rest assured they will recover and be back to their happy, hungry selves after a few days!