Hand, Foot and Mouth Disease In Children

Hand foot and mouth disease (HFMD) is typically a common illness among infants and children (up to the age of 10 years) caused by a group of viruses called Enterovirus especially Coxsackie A16 or enterovirus 71.

It has become an important public health concern because it is very contagious and can cause large outbreaks among children especially in nursery and schools.

What are the symptoms?

The disease is characterised by rapidly ulcerating vesicles (blisters) in the mouth, tongue, palate and on the palms of hand and soles of the feet.  It starts with non-specific symptoms such as fever, sore throat and generally feeling unwell before the blisters develop 1-2 days later.  It can range from being mild or severe with loss of appetite.

How is the virus transmitted?

The most infectious period is the first week of illness and the virus is transmitted by contact with the nasal discharge or saliva, fluids from the blisters and stools of an infected child.

As such, it is important that any infected child is kept away from school and other children.  Avoid close contact like sharing toys, pillows, towels or eating utensils and touching objects or surfaces that could have been contaminated by the virus. 

Any nursery or school which has an infected child is often advised to close for a short period to allow sterilisation of the school premises and prevent virus spread.

How serious is HFMD?

Majority of the children get a mild illness with no complications. Younger children are at risk of getting weak or dehydrated because they  may refuse to eat or drink due to the painful mouth ulcers.

Rare complications occur when the virus (in particular, enterovirus 17 strain) has spread to the brain causing meningitis or encephalitis or to the lung and heart causing pulmonary oedema.

What is the treatment for HFMD?

Bed rest, paracetamol and sponging for fever and keeping the child hydrated is sufficient. Most children recover within 7-10 days without requiring any medication.

However, if the child is getting dehydrated or weak, it is better to admit the child to the hospital for intravenous fluids and observation by the doctor. The child should remain away from school for at least 10 days since the onset of the disease or until certified free from disease by the treating doctor.

What are the danger signs of HFMD?

Take your child to see a doctor when the child has the following symptoms:

  • Not taking enough oral feeds or fluids
  • Not passing much urine
  • Persistent high fever (>38oC) more than 48 hours
  • Weak or drowsy or refusing to play
  • Having shallow rapid breathing
  • Irritable or having some jerky movements (fits)

How should a parent look after the infected child?

Let the child stay at home (away from school) and isolate the child away from the other siblings. Do not let them to share beds, pillow, towels, eating utensils and toys.  It is best to have one person looking after the child to ease the discomfort like giving:

  • Paracetamol for fever. Applying a cool towel over the forehead may be comforting
  • Cold treats like Popsicles or milk shakes/smoothies for the sore throat
  • Oral Aids for mouth ulcers
  • Soft diet as it is easier to swallow

How to prevent the virus from spreading?

Ensure good hygiene by washing your hands after caring for the infected child as well as disinfecting objects or surfaces touched by the child to prevent spreading the virus to other inhabitants in the house.


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