Hand, Foot and Mouth Disease

BY LINDA STEVENSON, PhD, RN, FNP-C, PEDIAQ SENIOR NURSE PRACTITIONER

Hand, foot and mouth disease is a common contagious illness that is caused by the Coxsackie virus, a member of the Enterovirus family. Children age 1 to 4 are most affected, usually because they are in childcare centers, preschool or play groups, or anywhere there is close contact with other children. The virus lives in the digestive tract and is spread from person to person by touching others or contaminated objects (think toys) or other surfaces. Because the virus lives in the digestive tract the contaminant is poop! We are always telling children to wash their hands, and this illness is one of the many reasons why.

 The illness often starts with a child having a low-grade fever (100.4 to 101F) a sore throat and loss of appetite. A day or 2 later you may notice mouth ulcers or your child’s refusal to open their mouth, drooling or refusal to eat. Painful mouth blisters, can be on the tongue, the palate, on the back of the throat, the gums or inside the cheeks. In the mouth the blisters look white with a red base. They can break open and leave an ulcer. Those ulcers are painful. There are also flat red spots that can look like small blisters that occur on the palms of their hands and the soles of their feet. Parents usually notice the hands and feet after seeing a pinkish red rash on other parts of their child’s body such as the chest, back, buttocks and thighs. Other symptoms can include irritability, poor sleeping, along with the fever mentioned earlier, drooling and refusal to eat.

 A virus causes this illness and there is no cure, it just needs to run its course.  Acetaminophen or ibuprofen can help with the fever and discomfort. Your pediatrician may prescribe “magic mouthwash”, a mixture you can apply to the mouth sores/ulcers or if your child is older they can swish and spit the solution out. Cool liquids, ice cream, Jell-O and popsicles also help with the discomfort, and since it is hard to get your child to eat and drink, they can help prevent dehydration. You want to be sure your child has a wet diaper every 4-6 hours if an infant, every 6 hours as a toddler and to urinate every 6 to 8 hours if they are school age.

 The blisters on the hands and feet need to be kept clean and dry. They do not need to be covered, but if any of the blisters pop, apply a small amount of an over the counter antibiotic ointment such as Polysporin ointment.

Although it will seem longer, hand, foot and mouth usually lasts 5 to 7 days, with day 3 and 4 being the worst days, before they slowly improve. If your child has persistent irritability, can’t be comforted or they are lethargic you should call your pediatrician. It is also important to remember that this is a contagious illness and your child can shed the virus in their poop for several weeks. So, be sure everyone washes his or her hands frequently.