Hand, Foot and Mouth Disease: Symptoms, Causes, Treatment

What are the symptoms of hand, foot and mouth disease?

Hand, foot, and mouth disease (HFMD) is a viral illness that primarily affects infants and children younger than 5 years old, though it can also occur in older children and adults. The symptoms of HFMD typically include:

1. Fever: HFMD often begins with a mild fever, generally between 101°F to 103°F (38.3°C to 39.4°C).
2. Sore Throat: Many individuals with HFMD experience a sore throat or discomfort when swallowing.
3. Mouth Sores: Painful sores or ulcers may develop inside the mouth, including on the tongue, gums, and inner cheeks. These sores can be red with a grayish center.
4. Skin Rash: A non-itchy rash may appear on the palms of the hands and soles of the feet. The rash may also appear on the buttocks or other parts of the body. It typically consists of small red spots or bumps that may blister.
5. Loss of Appetite: Children with HFMD may refuse to eat or drink due to painful mouth sores.
6. Irritability: Infants and toddlers with HFMD may be fussier than usual, especially if they have painful mouth sores.
7. General Malaise: Some people with HFMD may feel generally unwell or fatigued.

It’s important to note that not everyone with HFMD will experience all of these symptoms, and some individuals may have mild or no symptoms at all. The illness is usually mild and self-limiting, with symptoms typically resolving within 7 to 10 days.

What are the causes of hand, foot and mouth disease?

Hand, foot, and mouth disease (HFMD) is primarily caused by several types of enteroviruses, most commonly coxsackievirus A16 and enterovirus 71. These viruses belong to the Enterovirus genus within the Picornaviridae family. The main causes and modes of transmission of HFMD include:

1. Direct Contact: The virus can spread through direct contact with respiratory secretions (such as saliva, nasal mucus, or throat discharge) or fecal matter of infected individuals. This commonly occurs through close personal contact, such as hugging, kissing, or sharing utensils.
2. Airborne Transmission: Respiratory droplets expelled through coughing or sneezing by infected individuals can also spread the virus to others nearby.
3. Contaminated Surfaces: Enteroviruses can survive on surfaces and objects touched by infected individuals. Touching these contaminated surfaces and then touching the mouth, eyes, or nose can lead to infection.
4. Fecal-Oral Route: In some cases, particularly with enterovirus 71, the virus can be shed in the stool of infected individuals. Contact with contaminated feces, such as during diaper changing or improper hand hygiene after using the toilet, can transmit the virus.
5. Crowded Settings: HFMD outbreaks often occur in settings where young children congregate, such as daycare centers, preschools, and schools. Close contact and shared spaces increase the risk of transmission.
6. Incubation Period: After exposure to the virus, symptoms of HFMD typically develop within 3 to 7 days, though the incubation period can range from 2 to 10 days.

HFMD is more common in infants and young children under 5 years old, but older children and adults can also be affected. Good hygiene practices, such as frequent handwashing with soap and water, especially after using the toilet and before eating or preparing food, can help reduce the spread of HFMD. Additionally, avoiding close contact with individuals who are sick and disinfecting frequently touched surfaces can further prevent transmission of the virus.

How is the diagnosis of hand, foot and mouth disease made?

The diagnosis of hand, foot, and mouth disease (HFMD) is typically based on clinical symptoms and signs observed during a physical examination. Here’s how healthcare providers diagnose HFMD:

1. Clinical Evaluation: The healthcare provider will evaluate the symptoms reported by the patient or caregiver. Key symptoms include fever, sore throat, mouth sores, and characteristic skin rash on the hands, feet, and sometimes buttocks.
2. Physical Examination: During the physical exam, the healthcare provider will look for specific signs of HFMD, such as small red spots, bumps, or blisters on the palms of the hands, soles of the feet, and around the mouth. These lesions may progress to ulcers or blisters.
3. Medical History: The doctor will inquire about recent exposure to individuals with HFMD or known outbreaks in community settings like daycare centers or schools.
4. Exclusion of Other Conditions: Since HFMD shares some symptoms with other viral infections or conditions (such as herpangina), the healthcare provider may consider and rule out other possible causes of similar symptoms.
5. Laboratory Tests (if needed): In most cases, laboratory tests are not necessary for the diagnosis of HFMD, as it is primarily clinical. However, in certain situations, such as during outbreaks or when the diagnosis is unclear, the healthcare provider may collect throat swabs, stool samples, or vesicle fluid for viral culture, polymerase chain reaction (PCR), or other laboratory tests to identify the specific enterovirus causing the infection.
6. Imaging (rarely): Imaging studies such as X-rays or CT scans are not typically needed for the diagnosis of HFMD unless complications such as severe neurological symptoms are present, which are rare.

What is the treatment for hand, foot and mouth disease?

The treatment for hand, foot, and mouth disease (HFMD) is primarily supportive, aimed at relieving symptoms and promoting comfort while the body fights the viral infection. Here are key aspects of treatment:

1. Fever Management: Over-the-counter medications such as acetaminophen (Tylenol) or ibuprofen can be used to reduce fever and alleviate discomfort. Follow dosing instructions based on age and weight, and consult with a healthcare provider before giving medication to children.
2. Pain Relief: Painful mouth sores can make eating and drinking difficult, especially for young children. Using topical oral anesthetics (gels or sprays) under the guidance of a healthcare provider can help numb the sores temporarily and ease discomfort.
3. Hydration: Encourage adequate fluid intake to prevent dehydration, especially if mouth sores make swallowing painful. Offer cool, soothing liquids such as water, milk, or oral rehydration solutions (ORS).
4. Nutrition: Soft, bland foods that are easy to swallow and do not irritate mouth sores are recommended. Avoid acidic or spicy foods that can worsen discomfort.
5. Rest: Adequate rest helps the body recover from the viral infection and supports the immune system’s response.
6. Good Hygiene Practices: Practice frequent handwashing with soap and water, especially after using the toilet, changing diapers, or caring for someone with HFMD. This helps prevent the spread of the virus to others.
7. Avoiding Close Contact: Individuals with HFMD should avoid close contact with others, particularly young children, pregnant women, and individuals with weakened immune systems, until symptoms improve and fever resolves.
8. Monitoring and Follow-up: Keep a close watch on symptoms and seek medical advice if there are signs of dehydration (e.g., decreased urination, dry mouth, dizziness) or if symptoms worsen.
9. No Antibiotics or Antiviral Medications: HFMD is caused by a virus (enterovirus), so antibiotics are not effective. Similarly, there are no specific antiviral medications for treating HFMD. Supportive care is the mainstay of treatment.

Most cases of HFMD resolve on their own within 7 to 10 days without complications. However, complications such as dehydration, secondary bacterial infections of skin lesions, or, rarely, neurological complications may require medical attention. If you suspect HFMD or have concerns about symptoms, it’s important to consult with a healthcare provider for guidance tailored to your specific situation.

Can I hug my child with hand, foot, and mouth disease?

If your child has hand, foot, and mouth disease (HFMD), it’s understandable to be concerned about spreading the virus to others, including yourself. Here are some considerations regarding physical contact, such as hugging, when your child has HFMD:

1. Viral Spread: HFMD is primarily spread through close personal contact, respiratory droplets, and contact with contaminated surfaces. The virus can be present in saliva, nasal secretions, blister fluid, and feces of infected individuals.
2. Close Contact Precautions: While physical contact like hugging does carry a risk of transmitting the virus, the risk is generally lower compared to activities that involve direct contact with saliva or nasal secretions (e.g., kissing on the mouth).
3. Hygiene Practices: It’s crucial to maintain good hygiene practices to minimize the risk of spreading the virus. Wash hands frequently with soap and water, especially after caring for your child, handling items they have touched, or changing diapers. Use alcohol-based hand sanitizers if soap and water are not available.
4. Symptom Management: Encourage your child to cover their mouth and nose with a tissue or elbow when coughing or sneezing to reduce the spread of respiratory droplets. Dispose of used tissues promptly and wash hands afterward.
5. Avoiding Close Contact if Possible: If your child has open sores or blisters, particularly on the hands, consider avoiding activities that involve close contact with others, including hugging, until the symptoms improve and fever has resolved for at least 24 hours.
6. Comfort and Emotional Support: Balancing the need to prevent transmission with providing comfort and emotional support to your child is essential. You can express affection through other means, such as verbal reassurance, spending time together at a safe distance, or gentle physical contact that minimizes direct exposure to saliva or blister fluid.
7. Consult Healthcare Provider: If you have specific concerns about physical contact or need guidance based on your child’s individual situation (e.g., severity of symptoms, presence of complications), consult with your healthcare provider for personalized advice.

Ultimately, while it’s important to take precautions to prevent the spread of HFMD, including minimizing close contact during the contagious period, supportive care and comfort for your child are also crucial aspects of managing the illness at home.