Last fall, Monica Sangoi’s three-year-old daughter, Olivia, complained that her mouth hurt. “When she wouldn’t eat or drink, I immediately checked her hands and feet for blisters,” she says. It’s not the most obvious reaction, but Sangoi—a kindergarten teacher in Richmond Hill, Ont.—knew exactly what she was looking for: Hand, Foot and Mouth Disease (HFMD).
The illness, most commonly caused by the coxsackievirus, presents as painful oral lesions and a spotty rash or blisters on the hands, feet and bum. Anyone can catch it (adults included) but it’s at daycare centres and nursery schools—where the virus clings to surfaces and toys and the kids spread it through saliva, mucus and feces—where HFMD runs rampant.
Usually, by the time parents notice the characteristic rash, kids have been contagious for a few days. “Children may initially have a low-grade fever, headache and sore throat, and this is when they’re most contagious,” says Alyson Shaw, a paediatrician in Ottawa.
Generally, sores will then appear in the mouth. “They can look like little yellowish ulcers on the inside of the mouth, palate or even the tonsils,” says Shaw. (Or, like Sangoi, you might not see them at all.) Two-thirds of kids with HFMD also get red lesions on the palms of hands or soles of feet, which blister and eventually scab. A doctor doesn’t need to diagnose HFMD, but if you’re unsure about the symptoms, make an appointment.
Complications of HFMD include pneumonia and meningitis, explains Shaw, but are very rare. “The main issue parents need to watch for is dehydration,” she says. “Sometimes, the lesions are so sore that your child won’t eat or drink.” If you see signs—such as your child not peeing very much, having a dry mouth and seeming lethargic—have her checked out.
The good news is that HFMD will probably run its course naturally within a week or so. The bad news is, since it’s a virus and therefore not treatable with antibiotics, little ones have to wait it out. “I gave Olivia acetaminophen to treat the pain and fever, and encouraged her to drink as much water as possible,” says Sangoi, who also whipped up easy-to-eat comfort foods, like chicken soup.
Popsicles are another kid-friendly source of hydration (and may help your child’s mood, too!). The rash doesn’t usually itch, but a soothing cream may discourage kids from picking at the sores.
Repeat infections are common, though, so try to avoid HFMD as you would any other virus — by encouraging frequent, thorough handwashing, especially before meals.
Looking to outsmart hand, foot, and mouth disease like a pro? Pediatrician Dr. Christina Johns, MD, MEd, FAAP, has the playbook for tackling it from square one all the way to the finish line. From hand washing to avoiding close contact with sick individuals, here are some tips and tricks she recommends keeping in mind:
To minimize the chances of getting HFMD, Dr. Johns advises making a habit of washing your hands with soap and water regularly, particularly after using the bathroom and before having meals or snacks. “It’s also important to regularly clean and disinfect surfaces and toys that are frequently touched to reduce the spread of the virus,” adds Dr. Johns.
If you’ve got a sneaking suspicion that your little one might be brewing up a case of HFMD, Dr. Johns recommends creating a special zone for them to sit or catch some Z’s. This reduces the risk of the virus spreading to other members of the household. “At home, one way to help prevent it is to designate a ‘sick chair/sofa,’” advises Dr. Johns.
“Cover a chosen piece of furniture with a sheet and encourage the sick person to sit there exclusively… and everyone else to steer clear!”
Since HFMD spreads through saliva, nasal secretions, and feces, Dr. Johns suggests steering clear of close contact with those who have it.“This is especially challenging for young children and toddlers, which is why it is known for spreading rapidly in environments such as daycares,” explains Dr. Johns.
While foot and mouth disease usually doesn’t cause serious issues, Dr. Johns warns that in rare cases, it can lead to more severe symptoms like viral meningitis or encephalitis. She also mentions that dealing with dry mouth from those pesky sores is another thing to watch out for, so keep an eye on the little ones and make sure they stay hydrated.
Dr. Johns points out that HFMD is highly contagious during the first week of illness, especially when symptoms like fever, mouth sores, and rash are present. But don’t let your guard down — Dr. Johns says that the virus can still be shed in the stool for several weeks after symptoms have subsided, making good hygiene practices essential to prevent its spread during that time.
Dr. Johns says kids should stay home from school until their fever has been gone for a whole day (24 hours, to be exact) and their mouth sores have healed; then they’re good to go back to school, playdates, or daycare. “However, specific guidelines may vary, so it's wise to check with the childcare facility or school for their specific policies on returning after HFMD,” adds Dr. Johns.
Since there are various virus strains that cause HFMD, Dr. Johns says that children can contract the illness more than once. Therefore, while having the illness may offer some defence against that specific strain, she states that it doesn’t necessarily provide complete protection against other strains. “The immunity acquired after having HFMD also might decrease over time, leaving a person susceptible to re-infection with a different strain of the virus,” adds Dr. Johns.
According to Dr. Johns, you won’t catch HFMD just by sharing the same airspace with someone who has it — it’s not like catching a cold at all. “Instead, it’s primarily spread through close personal contact, such as saliva, nasal secretions, blister fluid, and feces of an infected person,” explains Dr. Johns. However, she suggests being aware that the virus can also exist in respiratory secretions and spread through coughs or sneezes.
Yep, grownups can definitely pick up HFMD from a child or someone else who’s infected. While it’s more common in children, Dr. Johns says that adults who haven’t come across the viruses that cause hand, foot, and mouth disease can still come down with it.
Hand, foot, and mouth disease doesn’t play favorites when it comes to boys or girls — it can affect both equally, according to Dr. Johns. “It’s more about how much you’ve been exposed to the virus rather than your gender,” explains Dr. Johns.
A version of this story appeared in our October 2013 issue with the headline "Hand, foot and mouth disease," p. 36.
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