Hand, foot and mouth disease (HFMD) is a common infection among young children. It primarily affects those under the age of 10, and those aged 5 and lower are particularly vulnerable. The disease is not gender-specific and affects both boys and girls equally. HFMD is not the same as the better known foot and mouth disease, which affects only animals.

Causes and Transmission

HFMD is a viral infection that is caused by coxsackievirus a16 and enterovirus 71. These viruses reside in the fluids and waste matter in an infected person’s body. Contact with saliva, mucus from the respiratory system, excreta and fluid from blisters and scabs are the most common sources of infection. It typically spreads through:

• Coughing and/or sneezing
• Close contact like kissing, hugging or sharing utensils or cutlery
• Touching surfaces that have the virus on them – usually from being touched previously by an infected person
• Coming into contact with excreta such as when changing diapers

Because HFMD spreads through close contact or proximity, the most common source of infection is in childcare settings such as nurseries and primary schools. A big danger comes from the fact that while the symptoms usually disappear within 7 days, a child can still be a carrier and allowing children who have had HFMD to return to schools without testing to ensure that he or she is virus-free is a major factor in the spread of the disease. While the disease can be uncomfortable and painful, it is rarely, if ever, serious.

Symptoms

HFMD has a variety of symptoms. A child may display all of them or only one or a few. The symptoms include, but are not limited to:

• Fever
• Sore throat
• A general feeling of lassitude and being unwell
• A rash that develops on the palms of the hands, soles of the feet and, in some cases, on the buttocks
• Painful and sensitive blister-like lesions on the gums, on the inside of the cheeks and on the tongue
• Loss of appetite
• Irritability, bad mood and frequent bouts of crying for no apparent reason or crying at the slightest provocation

The incubation period (the time from the first infection to the appearance of symptoms) of HFMD is usually between 3 to 6 days. Fever is often the first sign and this is typically followed by sore throat. The lesions appear about 2 days after the fever starts and the rashes appear in another 1 or 2 days. If sores develop at the back of the mouth, that is an indication that the child may have a related infection called herpangina.

When to See a Doctor

HFMD is a minor ailment and if the symptoms are fairly mild, normal home care and age-appropriate over-the-counter medication to soothe the sores and rashes and bring down the fever are usually all that is required. However, if the child experiences severe pain or discomfort or if the mouth sores make it difficult to swallow, a doctor should be consulted without delay so that stronger medication can be prescribed. Because difficulty in swallowing may lead to dehydration, oral hydration supplements may be prescribed as well.

Treatment

There is no vaccine to prevent HFMD or a specific course of treatment. Since it is a viral infection, antibiotics will be ineffective in treating the illness. Since the disease normally fades away after 7 to 10 days, and the symptoms are mild, the following medicines and actions can help the child feel better.

• Over-the-counter age-appropriate pain-reducing medicines and mouth-numbing sprays or gels.
• Calamine lotion to reduce the itchiness from the rashes.
• Cold foods like curds, flavoured ices, ice creams and smoothies will help soothe the soreness in the mouth and throat.

As already stated, if the child is in serious discomfort or if the infection does not fade away, a doctor should be consulted. It is better to keep the child at home for 2 weeks after the last of the symptoms has completely disappeared to prevent him or her from being a carrier and infecting other children.

When in doubt, it is best to consult a paediatrician so that the parents' fears may be put to rest and any special treatment that may be required may be started. The right place to go to is a hospital with a specialized paediatrics department where qualified and experienced doctors as well as the best diagnostic and treatment technologies and equipment will be available.

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Also Read: Paediatric Care – Choosing the Right Hospital

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Complications

Complications arising from HFMD are rare and not normally a cause for concern. However, in a few cases the following complications are possible:

• Dehydration due to difficulty in swallowing
• Encephalitis – swelling of the brain
• Viral meningitis – the swelling of the membranes around the spinal cord and brain
• Myocarditis – swelling of the heart muscles
• Paralysis

Although these complications may make a minor infection more serious, they can all be treated.

Prevention

There is no guaranteed way of preventing HFMD, but these simple steps will help to significantly reduce the chances of infection:

• Parents should wash their hands carefully, especially after changing diapers or before washing or bathing the child.
• Items that the child touches like toys, door handles and other items should be disinfected regularly.
• The child should be taught to cover his or her nose and mouth when sneezing and should keep a distance from other children who cough or sneeze frequently.
• If there is more than one child in the house, isolate the one who has the infection to prevent it from spreading to the others.
• Do not send the child to school until a week after all the symptoms have gone and the child is no longer at risk of being a carrier.

HFMD is, in almost all cases, a minor and normal childhood illness and is no cause for concern. However, since there is the remote possibility of complications arising, if home care appears to be ineffective, or if there are any doubts or concerns about the child’s condition, it is important to consult a paediatrician without delay.

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