Hand, Foot and Mouth Disease Is Back
Sue Hubbard, M.D.
I've been seeing a lot of cases of "hand, foot and mouth disease" (HFM) in the office lately. This illness is usually caused by a Coxsackie virus A-16, a member of the enteroviral family. These viruses are typically seen in the summer and early fall. (Don't worry, this illness is not related to "hoof and mouth" disease seen in animals.)
Hand, foot and mouth disease is most common in younger children and often is seen in the toddler crowd. You can see "hand, foot and mouth" in older children, but most kids contract it at younger ages and are immune as they get older. It's not unusual to have outbreaks of HFM in child-care centers and pre-schools.
How is Coxsachie virus transmitted? Person-to person contact, as well as from contact with contaminated surfaces. The incubation period from time of exposure is three to seven days.
Typically, a child with HFM will present with fever, which is often fairly high. If seen early in the illness, they may not have any other physical findings but over several days will develop a sore throat with painful sores on the tongue and throat.
Several days later, patients may develop the classic small, red, blister-like lesions on their palms, the soles of their feet and often in the diaper area. When they have all of the symptoms it's an easy diagnosis, but not everyone who gets Coxsackie virus will have every symptom.
Sometimes you see a child with the classic rash on palms and soles, but they've never had fever or even felt badly. One of the most common complaints may be drooling and irritability in a child with fever, as the mouth and throat are sore, even before the classic lesions appear.
Because this is yet another viral infection, there's no specific treatment and antibiotics won't help. Keeping your child comfortable with Tylenol or Motrin/Advil will help with both fever and pain. This is a good time to try things that would help soothe a sore throat, such as ice cream, Popsicles, pudding, Jell-O, even Slurpees, especially for children refusing fluids. The main concern is keeping your child hydrated during the illness.
Once a child is fever free for 24 hours and feeling better, he or she may return to child-care or school. The small lesions on the palms and soles will clear over the next five to seven days. The best way to prevent others from getting sick is with good old hand washing.
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