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                     Hand-foot-and-mouth disease

What is Hand-foot-and-mouth disease?

• Hand-foot-and-mouth disease (HFMD) is a viral illness that usually affects infants and children.
  
  
• It is caused by a number of different viruses, most commonly coxsackieviruses.
  
  
• HFMD is not to be confused with Foot-and-Mouth disease, which is a disease affecting sheep, cattle and swine, and which is unrelated to HFMD.

 How does a child get HFMD?

• HFMD is highly contagious and is spread through direct contact with the nasal or mouth secretions or feces of an infected person.
  
  
• It typically occurs in small epidemics in nursery schools or kindergartens, usually during the summer months.

How long will it take my child to become ill after being exposed to someone else with a viral infection that can cause HFMD?

• Remember, just because your child is exposed to an ill person does not necessarily mean they too will become ill.
  
  
• But if your child is to become ill, it generally takes 2 – 6 days after being exposed to one of the viruses responsible for HFMD.

What are the signs and symptoms of Hand-foot-and-mouth disease?

1. For 12 - 36 hours your child may have one or more of the following:
   • Low-grade fever 
   • Poor appetite
   • Abdominal pain
   • Sore mouth
   • Cough
     
     
     
2. Mouth lesions begin as red flat lesions that evolve into small vesicles (fluid-filled bumps) on a red base (see photo called Hand-foot-and-mouth disease).
   
   
   • The vesicles may involve any part of the mouth, including the gums and tongue. In some cases, the tongue may be swollen and tender.
     
     
     
3. Skin lesions are characteristic and are present in two-thirds of patients.
   
   
   • Typically, the hands, feet, and buttocks are involved (see photos called HFMD 2 and 3)
     
   • The hands are usually involved more often than the feet.

How can HFMD be diagnosed?

• HFMD is a clinical diagnosis meaning that the diagnosis based on the child’s signs and symptoms and physical examination.
  
  
• In general, laboratory studies are unnecessary but the virus can be found from swabs of the vesicles, the mouth or from stool specimens.

What is the treatment for HFMD?

• There is no specific treatment for HFMD. 
  
  
• Fever and pain from the sores, may be eased with the use of Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).
  
  
• A topical application of an anesthetic (e.g., viscous lidocaine) as well may be helpful for the discomfort.  
  
  
• Medications such as diphenhydramine (Benadryl) and aluminum and magnesium hydroxide (Mylanta) may be given by your doctor too. Several times daily, the child should swish the medication(s) in their mouth and spit it out.
  
  
• Popsicles work well for discomfort and to keep your child from getting dehydrated if drinking fluids is a problem.

How long will my child be sick with HFMD?

• The lesions on the hands and feet are present for 5-10 days.
  
  
• The mouth and skin lesions heal on their own in 5-7 days.

When can my child return to daycare or school?

• Each facility usually has its own rules, but in general, children can return to school when they:
  
  Have no fever
  Can eat and drink normally
  Are rested and alert enough to pay attention in class

When should I call my pediatrician concerning a barky cough in my child?

• You should call your doctor if your child has had a fever for more than two days, is having difficulty taking fluids or appears dehydrated or appears very lethargic.
  

How can HFMD be prevented?

• Frequent hand washing is recommended to decrease the chance of becoming infected. Click on how to prevent infection for more details.