Hand-foot-mouth Disease (HFMD)


A miserable child who has lost interest in eating solids? Perhaps the child
has hand-foot-mouth disease.

What is it?

Hand-foot-mouth disease is a common childhood illness featuring mouth sores,
fever, and a rash. Similar-sounding “foot-and-mouth disease” is a disease of
cattle and is not related to this condition.

Hand-foot-mouth disease is usually caused by a virus called coxsackievirus
A16. However, many children with coxsackievirus A16 infections do not have
all of the features of hand-foot-mouth disease. Some have no rash, some have
no mouth sores, and some even have no fever. A variety of other viruses in
the Enterovirus family can also cause hand-foot-mouth disease (the
coxsackieviruses are enteroviruses).

Who gets it?

This disease is most common among young children but is seen with some
frequency up until puberty. Adults can get it, but this is much less common.
Once people have had coxsackievirus A16 they are generally immune, but they
could get another case of hand-foot-mouth disease from one of the other,
less common viruses. Most infections occur in the summer or early fall, with
the peak between August and October in the northern hemisphere.

What are the symptoms?

Children with hand-foot-mouth disease usually start to feel crummy 3 to 7
days after they were exposed. Often, the first thing parents notice is their
children’s decreased appetite for solids. Children may also have a fever and
a sore throat. A day or two later, many children develop sores in the mouth.
They begin as small red spots on the tongue, gums, or mucous membranes. They
may blister or form ulcers.

A skin rash may also develop over a day or two, with flat or raised red
spots. Unlike with many rashes, the spots are often found on the palms and
soles. Also, it is common to have the rash on the buttocks. Often, the red
spots will form tender blisters (although not on the buttocks). Unlike with
chickenpox, the rash does not itch.

Usually the rash disappears and the child feels better within about 1 week.

How is it diagnosed?

Usually the diagnosis is made based on the history and physical exam. Lab
tests are available for the coxsackieviruses and other enteroviruses, but
they are not usually necessary. Hand-foot-mouth disease is sometimes
confused with strep throat, which can also begin with a fever and sore
throat. It is sometimes mistaken for chickenpox because they both have
blisters. It might be confused with any of the childhood exanthems. Also,
many children with hand-foot-mouth disease are diagnosed with ear infections
because the eardrums may appear red.

How is it treated?

Antibiotics do not help with hand-foot-mouth disease. The important issues
are pain relief and plenty of fluids.

How can it be prevented?

The viruses that cause hand-foot-mouth disease are present both in the stool
and in the respiratory secretions. It can spread by fecal–oral transmission,
droplet transmission, contact transmission, and by means of fomites. Hand
cleansing—especially after diapering/toileting and before eating—can help
reduce its spread. Children are often kept out of school or daycare for the
first several days of the illness, but it is not clear this prevents others
from becoming infected. Other children in the class are probably contagious
even though they will never develop symptoms.

This information is provided by the Paediatricians of Children’s Medical
Centre, Department of Paediatrics, NUS (National University of Singapore)

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