Q: Our day care has sent home a letter stating that multiple children in my son’s class have hand, foot and mouth disease. Do I need to be worried? What is it? How is it treated?
A: Hand, foot and mouth (HFM) disease is an illness caused by a virus called Coxsackievirus. Because it is a virus, it is relatively self-limited (requires no specific treatment and is not helped by antibiotics), but this does not mean that it doesn’t make children feel awful. It causes fever, rash (often on hands and feet, obviously, but also on the trunk and groin), lesions in the mouth (which can make eating painful), and other aches and pains. HFM is transmitted most commonly via the fecal-oral route, so it is commonly spread among toddlers.
The main treatment for HFM is to keep children comfortable. Acetaminophen and ibuprofen can be used to control fever as well as pain. Occasionally, pediatricians need to prescribe a “magic mouthwash” that can be applied to the oral lesions to soothe them. The main concern is whether children will get dehydrated, given that it tends to be most prevalent during the summer and can diminish a child’s desire to eat or drink. Thus, it is even more important to treat the pain sufficiently.
This year, there is a different strain (“A6”) than in years past. The rash is a bit more severe, and many patients have had some toenails and fingernails fall off four to eight weeks after the infection. This will improve on its own, but it is scary if parents are not expecting it. It is not due to a vitamin deficiency, and there are no dietary changes that need to be made.
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I hope your child does not catch this particular illness, but if he does, please know that he should recover without any difficulty, and if you are able to manage his symptoms well, your family will be ahead of the game. If your tricks don’t seem to be helping, though, call your pediatrician for further advice.
Brian Eichner is a pediatrician and assistant professor of pediatrics at Duke Children’s Primary Care in Durham and is the medical director of the Duke Pediatric Diagnostic Clinic.