Hand, Foot and Mouth Disease in Children

If sores appeared in your child's mouth and red spots or small blisters on their hands and feet a few days after a fever started, one of the illnesses that may come to mind is hand, foot and mouth disease.

Hand, foot and mouth disease is a highly contagious viral infection seen especially in babies and children under 5 years of age. It can also be seen in older children and in adults.

In most children the illness runs a mild course and clears on its own within about 7 to 10 days.

However, especially in young children, because the painful sores inside the mouth can reduce fluid intake, care should be taken to prevent dehydration.

What Is Hand, Foot and Mouth Disease?

Hand, foot and mouth disease is an infectious illness caused by a group of viruses called enteroviruses.

The common agents of the illness include:

• Coxsackievirus A16
• Coxsackievirus A6
• Enterovirus A71 (EV-A71)

Although the name of the illness mentions "hand, foot and mouth," the rash is not always limited to these three areas only.

In some children, a rash may also be seen on the legs, the arms, the buttocks, the trunk or around the face.

How Does Hand, Foot and Mouth Disease Begin?

The illness may begin with general signs of infection such as:

• Fever
• Sore throat
• Poor appetite
• Fatigue
• Irritability

Painful sores inside the mouth and characteristic rashes on the skin may then appear.

The course of the illness is not the same in every child.

In some children the mouth sores are more prominent, while in others the rash on the hands and feet may stand out.

What Are the Symptoms of Hand, Foot and Mouth Disease?

The most common symptoms are:

• Fever
• Sore throat
• Poor appetite
• Painful sores inside the mouth
• Small blisters or ulcers on the tongue and the lining of the mouth
• Rash on the palms
• Rash on the soles of the feet
• Rash on the buttocks, arms or legs

The rash on the skin may start as flat or slightly raised red spots and, in some children, may turn into small fluid-filled blisters.

Does the Rash Appear Only on the Hands and Feet?

No.

Although the palms and the soles of the feet are the characteristic areas in classic hand, foot and mouth disease, the illness does not always run this course.

In Coxsackievirus A6 infections in particular, which have been described more often in recent years, the rash can spread to wider areas such as the arms, the legs, the face and the trunk.

In some children, the rash may look different from the classic appearance.

For this reason, it is not correct to make a diagnosis by looking only at where the rash is located.

How Does Hand, Foot and Mouth Disease Spread?

The illness can spread easily from person to person.

The virus can be present in:

• Nasal and throat secretions
• Saliva
• Stool
• The fluid inside the blisters that form on the skin

Transmission happens particularly through close contact.

Respiratory droplets produced during coughing and sneezing, shared items such as cups and forks, toys and contaminated surfaces can also play a role in transmission.

Paying attention to hand hygiene, especially after diaper changes or using the toilet, is important.

How Contagious Is Hand, Foot and Mouth Disease?

The illness is highly contagious, especially in the first days after symptoms begin and during the first week.

However, the virus can continue to be shed for a while after the symptoms have completely passed, particularly in the stool.

For this reason, it is not correct to assume that contagiousness has ended completely the moment the rash disappears.

Care should be taken with hand hygiene after the illness as well.

How Long Is the Incubation Period of Hand, Foot and Mouth Disease?

After coming across the virus, symptoms usually appear within a few days.

During this period the child may have come into contact with the virus before any clear complaints have begun.

For this reason, the illness can spread quickly in settings where children are in close contact, such as daycare centers and preschools.

Why Are the Sores in the Mouth Important?

One of the things families need to pay the most attention to in hand, foot and mouth disease is whether the child is able to take in enough fluid.

The sores in the mouth and throat can be quite painful.

Young children in particular:

• May not want to drink water
• May refuse to eat
• May cry when swallowing

They may drool.

In this situation, dehydration, that is, fluid loss, which is one of the most common complications of the illness, can develop.

A drop in the amount of urine, a dry mouth, fewer tears or marked fatigue can be warning signs of fluid loss.

How Is Hand, Foot and Mouth Disease Treated?

Hand, foot and mouth disease is a viral infection.

In the great majority of patients, no specific antiviral treatment aimed at eliminating the illness is needed.

The main aims of treatment should be:

• To control the fever
• To reduce pain
• To ease the discomfort caused by the mouth sores
• To make sure the child takes in enough fluid

Medicines appropriate for the child's age and weight can be used for fever and pain on a physician's advice.

Aspirin should not be used in children.

Are Antibiotics Used in Hand, Foot and Mouth Disease?

No.

Hand, foot and mouth disease is caused by viruses, and antibiotics are not effective against viruses.

Unless another bacterial infection is identified, using an antibiotic does not make the illness clear any faster.

What Should My Child Eat?

Because of the mouth sores, hot, spicy, salty or acidic foods can increase the child's pain.

Options the child can tolerate may be preferred, such as:

• Cool liquids
• Water
• Yogurt
• Soft-textured foods

The main goal here is not that the child eats a particular food, but that they are able to take in enough fluid.

What Should Be Done About the Rash in Hand, Foot and Mouth Disease?

Most of the rash clears on its own without any special measures.

The blisters should not be popped and the area should be kept clean.

Because the virus may be present in the fluid-filled blisters, hands must be washed after any direct contact.

Is Hand, Foot and Mouth Disease Dangerous?

In the great majority of children the illness runs a mild course and clears without leaving a lasting problem.

However, certain types of enterovirus can rarely be associated with more serious complications.

In EV-A71 infections in particular, the following have very rarely been reported:

• Viral meningitis
• Encephalitis
• Other neurological complications

It should be emphasized that these complications are not the typical course of the illness.

Do the Nails Come Off After the Illness?

In some children, ridging, separation or temporary loss of the fingernails or toenails may be seen a few weeks after hand, foot and mouth disease.

This has been reported particularly after certain Coxsackievirus A6 infections.

It is usually temporary, and the nail grows back.

Does Hand, Foot and Mouth Disease Happen Again?

Yes.

Because hand, foot and mouth disease is not caused by a single virus, a child having had the illness before does not mean they will not have it again.

The child can be infected again with a different type of enterovirus.

Can Hand, Foot and Mouth Disease Be Confused with Chickenpox?

It can.

Especially in some cases with widespread and atypical rashes, hand, foot and mouth disease can be confused with:

• Chickenpox
• Herpes infections
• Allergic rashes
• Other viral illnesses with a rash

The location and appearance of the rash, whether there are mouth sores and the child's other symptoms should be evaluated together.

How Is Hand, Foot and Mouth Disease Diagnosed?

In children in whom the illness runs a typical course, the diagnosis is usually made from the history of the illness and the examination findings.

A blood test, a throat swab or a PCR test is not needed in every child.

In situations that are atypical, severe or where the differential diagnosis is difficult, the physician may use laboratory investigations when it is considered necessary.

Can a Child with Hand, Foot and Mouth Disease Go to Daycare or School?

Waiting for all of the child's rash to disappear completely is not necessary in every case.

A return to school or daycare can be considered if the child:

• Has no fever
• Is in good general condition
• Is able to take part in school or daycare activities
• Does not have uncontrollable heavy drooling because of the mouth sores

However, during outbreak periods, daycare centers, schools or local health authorities may set different practices.

How Can Hand, Foot and Mouth Disease Be Prevented?

To reduce the spread of the viruses causing the illness:

• Hands should be washed regularly with soap and water
• Attention should be paid to hand hygiene, especially after diaper changes and using the toilet
• The child's personal items, such as cups, forks and spoons, should not be shared
• Toys and frequently touched surfaces should be cleaned regularly
• Close contact with sick people should be reduced

Direct contact such as kissing and drinking from the same cup should be avoided.