You know the feeling. The sign posted on the door of daycare announcing the current illness that is floating around. Oh the dreaded sign! “We want to inform you that cases of hand, foot and mouth disease have been diagnosed here at the center.” GREAT! There are likely two questions that are running through your head: 1) So what are we going to do when our child comes down with this latest illness? and 2) What exactly is Hand, Foot and Mouth disease? Well, that first question is one that I have struggled with many times in my own household, and unfortunately, I can’t help you answer, but that second question…I CAN help with that one!
Hand, foot and mouth (HFM) disease is a very common viral illness in children, particularly those under 5 years of age. Older children, teens and even adults can get HFM, but it is much less common as most people have had HFM by that time and therefore have natural immunity to these viruses. This illness is typically seen in the late summer to fall, but especially here in Louisiana with our mild climate, I will see cases of HFM year round. The virus is spread through contact with droplets of someone who is infected, so it is spread by sneezing and coughing as well as the saliva that children “share” with each other on toys. It is not uncommon to see mini “epidemics” of HFM that spread through daycare centers or other child care facilities. The incubation period for HFM is 3-6 days, so I generally tell parents to be on the lookout for signs of HFM for about 1 week after “the sign” is posted at daycare.
So what are the symptoms of HFM? As with any other virus, each child may present differently, but most children will start out with fever. In the next few days, children will often develop the classic rash that really can be anywhere on the body but, as the name suggests, most commonly is seen on the hands, feet, and around and in the mouth. The rash looks like small blisters or ant bites, and you will find these spots on the palms and soles of the feet (there are not a lot of illnesses that will cause a rash on the palms and soles but HFM is one of them).
Especially in infants and toddlers, I will almost always see the rash in the diaper area and on the backs of the thighs as well. If you look inside the mouth, you may see ulcers on the inside of the lips or tongue as well as in the back of the throat. These blister lesions will typically continue to pop up over the first 3-5 days of the illness. After that time the rash will slowly begin to fade, and parents may even notice peeling of the skin where the blisters were located in the coming week. Finally, some children will have changes to their fingernails or toenails about 4-6 weeks after HFM, and it may appear like the nail is “splitting” horizontally and coming off. No worries…there is a new nail under there!
Since HMF is caused by a virus, antibiotics will not make the illness or the rash go away. The mainstay of care for HFM is making sure children are drinking lots of liquids and using acetaminophen or ibuprofen to help with fever. Sometimes the throat can be so painful for children that they will not want to drink liquids, and then the concern is that they could be become dehydrated. When it comes to liquids to offer, I often say that when kiddos are sick, they can have free reign of the liquids…so that means juice, milk, popsicles, Slurpees or even ice cream. Just something that has liquid form to it! If your child is refusing to take liquids, make sure and call your pediatrician as there are some occasions where a special mouthwash can be used to help with the pain. As far as the rash goes, most children are not bothered by the rash. It doesn’t hurt or itch typically and may only cause mild discomfort when walking for those children that have their little feet covered in blisters.
Now for the last remaining question that every parent asks, “When can my child go back to daycare/school?” and the answer might surprise you. Once your child is fever free for 24 hours and tolerating liquids well, they can return to school. Unlike chicken pox, the HFM rash itself is not contagious! The only time I would recommend keeping kids out of daycare in regards to the rash is if they have many open sores that they are itching as these could easily become superinfected with bacteria (this is not very common with HFM whereas with chicken pox, superinfections of the skin are much more common). The virus that causes HFM can be shed through respiratory droplets for 1 week after the illness and can be shed in the stool for several weeks following symptoms, so by no means are children kept out of daycare or school for this period of time. This is again one of those times where you hope your daycare is doing a good job of wiping down toys, washing hands, and practicing very good diaper changing hygiene!
For those of you who have been “lucky” enough to experience HFM already, you may say, “Wait a minute! My daycare told me that she couldn’t return until the blisters were crusted/gone.” Well, as I said above, fever free for 24 hours is the main criteria for return to daycare or school, but child care facilities are able to set their own return policies when it comes to infectious diseases like HFM, so in many cases, their policy will be the “law of the land.”
So if the next dreaded sign on the door at daycare reads “Hand, foot and mouth disease,” take a deep breath as you are now armed and ready to deal with this unpleasant but all too common illness of childhood. And as with any illness, if you have specific questions or concerns about your child, please make sure and give your pediatrician a call…it’s what we are here for!