Hand, Foot, and Mouth Disease (HFMD) is a highly contagious viral illness, typically caused by the coxsackievirus, that commonly affects young children. This condition is generally mild and self-limiting, meaning the body’s immune system clears the infection without specific antiviral medication. Since there is no cure, management focuses entirely on providing supportive care to alleviate uncomfortable symptoms. The most distressing symptoms are the painful ulcers that form inside the mouth and the characteristic rash and blisters that appear on the palms, soles, and sometimes the buttocks and thighs.
Immediate Relief for Painful Sores
Systemic pain relief is the primary method for managing generalized discomfort, fever, and localized pain from the sores. Over-the-counter medications like acetaminophen or ibuprofen can be administered to reduce both fever and body aches. Avoid giving aspirin to children or teenagers with a viral illness due to the rare but serious risk of Reye syndrome.
For localized pain within the mouth, which often makes swallowing difficult, a soothing mouthwash or spray can provide direct analgesia. Older children may find relief by rinsing with a liquid antacid, holding it over the ulcers briefly before spitting it out or swallowing. These methods aim to coat the painful ulcers, which often appear as yellow-grey sores with reddish edges.
To soothe the rash and blisters on the skin, a lukewarm bath mixed with colloidal oatmeal can provide widespread relief. If the rash is accompanied by uncomfortable itching, a topical application of calamine lotion or hydrocortisone cream may help manage the sensation. The blisters on the hands and feet should be kept clean and uncovered to promote natural healing.
Maintaining Hydration and Nutrition
Preventing dehydration is a major concern, as painful mouth ulcers can cause patients to refuse to drink, especially if they are very young. Small, frequent sips of fluid are more effective than trying to consume large amounts all at once. Cold liquids are preferable because the low temperature can temporarily numb the painful area, offering brief relief that encourages drinking.
Beverages like water, milk, and oral rehydration solutions are the best choices for maintaining fluid balance and replacing electrolytes. Sucking on ice chips, popsicles, or eating sherbet or ice cream can be an effective way to deliver both fluids and a temporary soothing effect. Strictly avoid acidic drinks, such as citrus juices or sodas, and salty broths, as these will irritate the exposed tissue of the mouth sores and intensify the pain.
The strategy for food shifts entirely to soft, bland, and easy-to-swallow items that require minimal chewing. Cold foods like yogurt, applesauce, and mashed bananas are well-tolerated and provide necessary nutrients without irritation. Warm, non-spicy soups and soft-cooked foods like rice porridge or well-mashed potatoes are also good options. These dietary adjustments ensure the patient receives adequate nutrition and energy to support recovery without exacerbating the oral pain.
Preventing Secondary Infection and Contagion
The fluid within the skin blisters contains the virus, making them a source of contagion. It is important to avoid scratching or deliberately popping them. Breaking the skin barrier releases infectious material and creates an entry point for bacteria, increasing the risk of a secondary bacterial infection. If a blister ruptures accidentally, clean it gently with soap and water, and cover it with a small bandage and antibiotic ointment.
Strict adherence to hygiene protocols is the most effective way to prevent the virus from spreading. Handwashing with soap and water for at least 20 seconds is mandatory for the infected individual and caregivers, particularly after using the restroom or changing a diaper. Since the virus can survive on surfaces for days, frequent cleaning and disinfection of commonly touched objects is necessary.
To limit community contagion, the infected person should stay home from school or daycare while they have a fever. Isolation should continue until they are fever-free and the open blisters have dried and crusted over. While the virus can remain in the stool for weeks, the risk of transmission is highest during the first week of illness when symptoms are active.
Monitoring Healing and Knowing When to Seek Medical Help
In most cases, HFMD is a self-resolving illness, with symptoms typically clearing completely within seven to ten days. The fever usually subsides after a few days, and the mouth ulcers and skin rash will dry, crust over, and fade. A common, though harmless, late symptom is the peeling of skin on the palms and soles, which can occur one to two weeks after the rash first appeared.
Monitoring for signs of dehydration is paramount, especially when oral pain is severe. Several signs of dehydration signal a need for medical intervention:
- Reduced urination, indicated by no wet diapers for eight hours in infants.
- Dark urine.
- A very dry mouth.
- An absence of tears.
Severe lethargy, marked irritability, or a high fever that persists beyond three or four days also warrant immediate medical evaluation. Though rare, complications such as viral meningitis or encephalitis can occur, presenting with symptoms like a severe headache, neck stiffness, confusion, or unusual drowsiness. Consult a healthcare provider if skin blisters show signs of bacterial infection, such as increasing redness, swelling, or pus discharge. Any concerns about the severity of the illness or a lack of improvement after ten days should prompt a medical visit.