Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease is a very common illness, but there is a lot of confusion about it. It is caused by several different viruses in the enterovirus group. It can make kids (and some adults) miserable, but like most viruses we don't have a specific treatment to fix it. There are things we can do to help kids stay more comfortable and to decrease spread.

Daycares in my area often make unreasonable demands of when to let kids return, which makes me aware that they aren't aware of how it's spread and how to control the spread as much as possible. Do they realize that many adults can have the virus and spread the disease without having any symptoms themselves?

How can you recognize hand, foot, and mouth?

Hand, foot, and mouth disease can look different in different people.

Of course the name gives a clue: there's often a rash on the hands and feet, and in the mouth. If there is  a classic rash, you'll know what you're dealing with. The rash can look like red spots or blisters, classically on the palms and soles, but it can extend up the arms and legs. I often call it hand, foot, mouth, and butt disease because bumps in the diaper region are common. You might not recognize the blisters unless you can get a good look in their mouth to see blisters on the gums, tongue, or throat.

Some kids will be fussy and eat less than normal.

Many, but not all, will have a fever. Don't fear fever.

This photo shows typical blister-type lesions around the mouth of a toddler. Notice the drool at the chin. Many kids have these blisters on their throat, which makes it painful to swallow. They often refuse to eat or drink - or even swallow their saliva!

Are there any serious complications?

Most kids recover completely within a week or so, but some can have a more significant illness.

Some kids refuse to eat or drink and may require hospitalization for dehydration.

A rare complication is viral meningitis, an inflammation around the brain. Symptoms can include fever, headache, stiff neck, and irritability. Viral meningitis might require hospitalization to help with comfort measures or to treat with antibiotics while ruling out bacterial meningitis.

Even less commonly children can get encephalitis or a polio-like paralysis. Encephalitis is an inflammation of the brain. Symptoms include fever, seizures, change in behavior, confusion and disorientation, and related neurological signs depending on which part of the brain is affected.

One consequence I tend to see every few years is fingernails and/or toenails falling off weeks after recovery from hand, foot, and mouth disease. While this is not serious and the nails eventually grow back normally, it can be distressing to parents. Simply knowing that this might happen can hopefully stop your worry before it starts!

How is it spread?

Most enterovirus infections in the US are during the summer and fall. Enterovirus infections are common worldwide. Most kids have been infected by the time they're school aged. Pets do not get infected with enteroviruses.

The virus easily spreads from person to person. This happens through contact with saliva, nose and throat secretions, fluid in blisters, or stool of an infected person. The virus can spread from mother to infant prenatally and in the newborn period.

Enteroviruses may survive on environmental surfaces for periods long enough to allow transmission from fomites.

Respiratory tract shedding usually only occurs for 1-3 weeks, but the virus can exist in the stool for months after infection. Careful hand washing after all diaper changes is essential. In most cases it is not possible to keep kids home from daycare until they are "no longer contagious."

Infection and viral shedding can occur without signs of clinical illness, especially in adults. This means many parents and daycare providers can unknowingly spread the virus to susceptible infants and children.

The incubation period (time from infection until symptoms show) for enterovirus infections is typically 3 to 6 days.

What treatment can be given?

Because this is caused by a virus, there is no specific medicine that is needed to make it go away.

Fluids are very important. Some kids refuse to swallow due to pain, so they are at risk of dehydration. Giving pain relievers, such as acetaminophen or ibuprofen, can help to decrease the pain and improve how well they will drink. Offer cold drinks, smoothies, and popsicles if age appropriate.

Older children and adults can use throat lozenges or mouth sprays that numb the pain.

Magic Mouthwash

A mixture of liquid diphenhydramine (a common antihistamine) and a liquid antacid, such as Maalox, in a one-to-one ratio can help alleviate pain. Give the amount that equals the diphenhydramine dose per weight.

For example, if a child's dose is 2.5 ml of diphenhydramine, mix 2.5 ml diphenhydramine with 2.5 ml of the liquid antacid. If a child can swish, gargle, and spit the mixture, it can help numb the sores. When younger children swallow the mixture, it may also help if it coats the sores in the mouth adequately.

Control measures to prevent hand, foot, and mouth disease

Hand washing, especially after diaper changing, is important in decreasing the spread of enteroviruses.

Don't share foods or drinks. Avoid contaminated utensils.

Wash toys and disinfect surfaces regularly.

Chlorination treatment of drinking water and swimming pools may help prevent transmission.

Can kids get this more than once?

Since there are several different viruses that cause hand, foot, and mouth disease, it is possible to get it more than once. Keep washing those hands, toys, and surfaces!