What Is Hand, Foot and Mouth Disease and How Can You Prevent It?

There are many factors putting you and your family at risk for illness this season. As a nurse in the Children’s Hospital Los Angeles Float Pool, I often work in our Emergency Department. A common issue I see parents bring their children in for, and one that I would like to focus and educate you on, is hand, foot and mouth disease.

What is hand, foot and mouth disease?

Hand, foot and mouth disease, or HFMD, is a common, viral illness that typically affects infants and small children less than 5 years of age. However, older children and adults can also get it.

What are the symptoms?

The most common symptoms of HFMD are fever, malaise (feeling unwell or tired), mouth sores and skin rash. Some children may show all these symptoms, while others may just have a mild skin rash. Mouth sores may begin as small red spots, but can develop into painful blister or ulcers. They are often seen in the mouth along the gum line and/or back of the throat. It can be difficult for parents of very young children to detect sores in the mouth and throat as they may not be able to communicate they have a sore throat or that it hurts to swallow. If a child stops eating or drinking, or is drinking and eating less, it is often a sign that something is wrong. Some additional clues for parents to look for include:

• Becoming more irritable or sleepy than usual
• Increased drooling (from not wanting to swallow due to pain)
• Only taking in cold fluids

A skin rash can look like flat or raised red spots usually seen on the palms of the hands and soles of the feet, but can also appear on the elbows, knees, buttock or genital areas.

Is hand, foot and mouth disease contagious?

YES! A child with HFMD is usually most contagious during the first week of illness. The viruses that cause HFMD can be found in an infected person’s:

• Nose and throat secretions
• Fluid within blisters
• Feces (stool)

An infected person may spread the virus that causes HFMD through:

• Close personal contact
• The air (sneezing or coughing)
• Contaminated objects and surfaces in the home or school
• Contact with feces

How serious is hand, foot and mouth disease?

Generally, HFMD is not serious. The illness period for children is usually mild. Fevers can last anywhere from one to three days and mouth sores/skin rash may last 7 to 10 days. Your child should completely recover from the illness, and complications are rare.

How do you treat hand, foot and mouth disease?

HFMD is a viral illness, so there is no antibiotic or medication to treat or protect against it. As parents, your role is to provide support and help make your child comfortable during this period of illness. To relieve symptoms, parents can:

• Give over-the-counter medications to relieve pain and fever.
• Use a cup instead of a bottle to give fluids to young children.
• Offer a soft food diet. Cold foods like ice cream and popsicles also help by numbing the area. Avoid citrus fruits and salty or spicy foods.
• How do you prevent hand, foot and mouth disease?
• Like any other viral illness, parents and children can lower their risk of being infected by:
• Washing hands well with soap and water.
• Cleaning and disinfecting common surfaces and objects including toys, play areas, tables, countertops, door knobs, etc.
• Avoiding close personal contact including kissing, hugging, sharing eating utensils and drinking cups.

Your child should stay home when sick with HFMD, especially with fevers. Typically, when your child has not had a fever for more than 24 hours, they may return to school/daycare. Talk with your health care provider if you are not sure when your child can return to school.

When should I be concerned and call my doctor for hand, foot and mouth disease?

It is important for children with HFMD to drink enough fluids to prevent dehydration. If mouth sores/blisters become too painful, preventing your child from drinking enough fluids, they may need fluids given through an IV. Other signs of dehydration to look for include:

• Dry, sticky mouth or tongue
• No tears when crying
• Sunken eyes
• Decreased urine output (no urine in the diaper for more than 8 hours)

Call IMMEDIATELY or visit your local emergency room:

• If you see signs of dehydration
• If your child develops a stiff neck

If your child starts acting very sick Call your doctor during office hours for:

• Fever for more than three days
• Any other questions or concerns

I hope this helps you to identify hand, foot and mouth disease, and prepares you for how to care for your child.