Hand, Foot, and Mouth Disease (HFMD) is a common viral infection, primarily affecting infants and young children. Caused by viruses from the enterovirus family, most often Coxsackievirus A16, the illness is characterized by a distinctive rash and painful lesions. The mouth sores are often the most concerning for caregivers, as they can severely interfere with eating and drinking. Understanding the timeline of these sores is important for managing patient comfort and monitoring recovery.
Typical Recovery Timeline for Mouth Sores
The painful mouth sores associated with HFMD generally appear one or two days after initial symptoms, such as a mild fever and feeling unwell. These lesions typically develop on the tongue, gums, and inner cheeks. They start as small, flat red spots that quickly progress into small blisters and then shallow, painful ulcers.
The period of most severe discomfort and pain is usually during the first two to four days after the sores appear. During this time, the open ulcers make swallowing and consuming liquids very difficult. This intense pain often leads to a refusal to eat or drink, posing a risk of dehydration, especially in younger patients.
The lesions do not require specific treatment and generally heal spontaneously as the body clears the viral infection. The mouth sores usually begin to resolve and become less painful after about seven days. In most cases, these ulcers heal completely within seven to ten days from their initial appearance, leaving no lasting scars.
Strategies for Pain Relief and Healing
Managing the pain from these oral ulcers is a primary focus of care to ensure adequate hydration and nutrition. Effective strategies involve the use of over-the-counter pain relievers, such as acetaminophen or ibuprofen, to reduce discomfort and allow the patient to drink more easily. Administer these medications according to the patient’s age and weight, and strictly avoid aspirin in children due to the risk of Reye’s syndrome.
Maintaining fluid intake is crucial because the pain associated with swallowing can lead to dehydration. Offering cool liquids like water, milk, or diluted non-acidic juice can be soothing to irritated mouth tissues. Acidic beverages, such as orange or grapefruit juice, should be avoided as they can sting and worsen the pain.
Dietary adjustments also play a significant role in minimizing irritation to the sores. Soft, bland, and cool foods are generally well-tolerated, including:
- Yogurt
- Applesauce
- Ice cream
- Gelatin
For older children and adults, topical numbing agents, such as oral rinses or sprays containing lidocaine, may be used for temporary relief before mealtimes. These should be used cautiously to avoid accidental ingestion.
Overall Disease Progression and Contagious Period
The overall disease progression begins with a prodromal phase lasting approximately two to three days. This phase is characterized by non-specific symptoms like a low-grade fever, general malaise, and sometimes a sore throat. Following this initial period, the characteristic lesions emerge on the skin.
The full rash often appears on the palms of the hands and the soles of the feet, and sometimes on the buttocks or groin area. These skin lesions start as small, non-itchy red spots that may turn into blisters, and they typically fade over a period of seven to ten days. In some cases, the skin on the hands and feet may peel a few weeks after the illness, which is a harmless, temporary consequence of the viral infection.
The virus is most easily spread during the first week of the illness, particularly when the fever is present. Transmission occurs through:
- Close personal contact
- Respiratory droplets from coughing or sneezing
- Contact with the fluid from the blisters
While the most contagious period ends once the fever subsides and the blisters dry up, the virus can continue to shed in the patient’s stool for several weeks. A child can generally return to school or daycare once they are fever-free for 24 hours and feel well enough to participate in activities.