HAND, FOOT AND MOUTH DISEASE

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WHAT IS IT? Hand, Foot and Mouth disease (HFM) is the combination of sores in the mouth and rash. The sores vary in size from that of a pin head to half of the size of a pencil eraser head (2 to 7 mm), will be a white shallow ulcer (like a divot or a small chunk of skin was removed), will have some bright red skin around it and will be painful. A good example of what they look and feel like is the " aphthous ulcer " or sores that we all have had from biting our lip. There are usually anywhere from a half to several dozen sores that can be anywhere in the mouth and even on the lips. The sores usually only last 3 to 7 days and more rarely show up after the 3rd day. The rash on the body looks like pinhead sized blisters that have popped and left a pink to light red spot. Children with this rash usually do not itch, while adults may itch intensely. The rash can be anywhere on the body, but HFM disease is one of very few illnesses that have a rash on the palms or soles. The rash usually only lasts 7 to 10 days, but can last weeks. HFM may have a high fever (103 to 105) for 3 to 5.

 WHAT CAUSES IT? Most sores in the mouth are caused by a virus called Coxsackie virus (CSV). There are many different strains of CSV only some of which give a rash. Echovirus, Herpes and many other viruses can also cause sores in the mouth. Herpes is the cause of fever blisters. All of these viruses are very contagious and are caught by getting the oral secretions of others in the mouth. Some strains of these viruses are contagious up to a few days before to about 5 days after symptoms start. The incubation period is about 4 to 6 days. Adults can get this virus also, but most either have immunity from childhood or simply don't develop the illness.

 WHAT ARE THE COMPLICATIONS? The most common complication is dehydration, because the sores hurt so much that the child won't drink. The high fever can sometimes cause a febrile seizure in those whom are susceptible (but remember this is usually in the first 24 hours of the illness and is usually more dependent on how fast the temperature rises rather than how high). CSV may also cause some children to vomit from the fever or have mild stomach flu symptoms, some children may have a headache and some may have minor cold symptoms.

 HOW DO I TELL IF MY CHILD IS DEHYDRATED? Normally physicians would instruct you to look for a dry mouth as a sign of dehydration. In the case of HFM, though, your child may not swallow and will drool from the pain until badly dehydrated. A child may tear with mild dehydration and you should not look for this as a sign of dehydration either. Therefore, the best way to look for dehydration is to look for decreased urination. If a child below a year does not urinate for more than 6 to 8 hours or a child over a year of age does not urinate for more than 12 to 14 hours, then that child is probably dehydrated and you should call your physician immediately.

                To prevent dehydration, your child should drink the regular liquids he or she is used to (formula, milk, etc.). If your child is not eating anything and will not take formula or milk, then give Pedialyte (any oral rehydration solution for children, not plain water, flat sodas or Gatorade). When a child gets nothing except clear liquids, they will lose essential electrolytes (sodium, potassium, chlorides, sugars) and that may make them ill itself. Therefore, children getting clear liquids only should replace those electrolytes with these special solutions. If your child is eating some foods, though, then that probably is giving them enough electrolytes and you may give the other liquids. The chart below will give you an estimate of how much fluids your child should drink in a 24 hour period. This is just an estimate and drinking less is o.k. so long as your child does not have the signs of dehydration yet.

Weight in pounds Daily fluid requirements to prevent dehydration
8 12 oz
16 24 oz
24 36 oz
32 40 oz
48 50 oz
64 56 oz

 HOW CAN I MAKE MY CHILD FEEL BETTER? The rash usually won't bother your child, but if it does itch simply give Benedryl orally or Benedryl, Calamine, Caladryl or Cortaid topically. The fever is present for a purpose and will help your child fight this infection. Therefore, unless your child is very uncomfortable leave the fever alone. If you do chose to lower the temperature, use Motrin (ibuprofen) as it will help the inflammation in the mouth better than Tylenol (acetaminophen).

  1. Dab the mixture on the sores with a Q-tip.

  2. Brush their teeth with the mixture.

  3. Dip a "toothette" (I believe its a brand name) into the mixture and rub it around the mouth. A toothette resembles a sucker with a sponge on the end of the stick instead of candy and should be available at most drug stores. This cleans the mouth as well as leaves the medicine where it is needed.

HOW LONG WILL IT LAST? The length and severity of the illness varies considerably between strains of different viruses and between different people. The fever lasts 2 to 5 days and may be just as high the last day as the first. The rash may last 7 to 21 days, but is not contagious. The sores last 2 to 7 days with 4 being the average.

HOW LONG IS MY CHILD CONTAGIOUS? Some of theses viruses are contagious a few days before the onset of symptoms. Most of these viruses are contagious for 3 to 5 days. If your child is sicker for longer than average, then I would consider them contagious until they feel better.

MEDICINES: For topical pain relief, please see the section entitled "HOW CAN I MAKE MY CHILD FEEL BETTER?". Acetaminophen (Tylenol) may be used up to every 4 hours in the doses listed in the table below, can be used with ibuprofen (Motrin), but does not help inflammation like ibuprofen does. Ibuprofen (Motrin) can be used up to every 6 hours in the doses listed in the table below, can be given acetaminophen safely, and helps the aches and pains and inflammation much better than acetaminophen. Please read the package insert that comes with these medicines for any contraindications and restrictions.

Medication

8 lbs

16 lbs

24 lbs

32 lbs

48 lbs

64 lbs

>80 lbs

Tylenol Drops 80mg/.8cc

0.4cc

0.8 cc

1.2 cc

1.6 cc

2.2 cc

3.2 cc

 

Tylenol Elixir 160mg/tsp

1/3 tsp

1/2 tsp

3/4 tsp

1 tsp

1.5 tsp

2 tsp

3 tsp

Tylenol Suppository Dose

40 mg

80 mg

120 mg

160 mg

240 mg

320 mg

500 mg

Motrin Drops 40mg/cc

0.4 cc

0.8 cc

1.2 cc

1.6 cc

2.2 cc

3.2 cc

3.2 cc

Motrin Elixir 100mg/tsp

1/3 tsp

1/2 tsp

3/4 tsp

1 tsp

1.5 tsp

2 tsp

2 tsp

Motrin 50mg chewable

 

 

1

2

3

4

4

Motrin 100mg chewable

 

 

 

1

1.5

2

2

Benedryl Liquid 12.5mg/tsp

tsp

tsp

1 tsp

1.5 tsp

2 tsp

2-3 tsp

2-4 tsp

Triaminic Nitelite (decongestant, antihistamine, cough suppressant)

 

1/3 tsp

tsp

tsp

1 tsp

1.5 tsp

2 tsp