Parents' guide to hand, foot and mouth disease

January 01, 2019 by Dr Sophie Genoni

About the author: Sophie is a General Practitioner who has previously worked with Night Doctor and now based in the South West, WA. She has an interest in women’s and children’s health and has completed additional training in obstetrics and gynaecology, sexual health and skin cancer surgery. Aside from her clinical work she also teaches medical students at the University of Notre Dame, was formerly a co-opted member of the RACGP WA Faculty Board, and is a current delegate for the RACGP Future Leaders Program.

What is Hand, Foot and Mouth Disease?

Hand, Foot and Mouth Disease (HFMD) is a common illness caused by viruses in the enterovirus group, mainly a strain called the coxsackie virus. It usually causes a mild illness with the characteristic symptom of blisters on the hands, feet and mouth - which is where the name comes from.^1,2,3,4,5,6

The illness usually begins with non-specific symptoms such as fever, runny nose and sore throat.^1,5 A day or two after these symptoms start, blisters begin to appear on the lips, tongue and inside the mouth, soon followed by blisters on other areas of the body. The most common areas affected are the hands and feet, but the blisters can also appear on the legs, arms and in the nappy area. These blisters can be painful, and children with HFMD are often tired, irritable and off their food.^1,2,4,6

HFMD usually affects young children, and outbreaks can occur in daycares and schools.¹

How do I know if my child has HFMD?

If your child has a blistering rash, it is important to be seen by your GP.

Your GP will make a diagnosis of HFMD based on the symptoms your child has. Your child will not usually require any tests, but very occasionally swabs may be taken if the diagnosis is not clear.²

What treatment does my child need for HFMD?

HFMD does not require any specific treatment, as it will get better on its own. However, treatment of the pain and fever can help reduce your child’s discomfort and help them to maintain their intake of food and fluid.^1,2,5 If your child has a fever or you think they are in pain, you can give paracetamol at the correct dosage for their age and weight. You can read more about giving your child paracetamol in our previous blog.

If your child has blisters in their mouth, the pain may affect their eating and drinking.² There are pain-relieving (topical anaesthetic) liquids/gels available that can help to numb the pain of the blisters in the mouth, however we recommend that you discuss these with your GP if you think your child needs them.

Can my child spread HFMD to other children or myself?

HFMD is easily spread by contact with the fluid from blisters, saliva, mucous from the nose or in faeces. Therefore good personal hygiene is important to prevent the spread of the virus to others.^1,2,5 This includes:

Washing hands or using alcohol based hand gel
Avoid your child sharing toys, eating utensils, towels or toothbrushes
Thoroughly wash any toys, clothes or surfaces that they come into contact with
Teach your child to wash their hands, cover their mouth and nose when sneezing or coughing, and to throw away their used tissues²

HFMD usually occurs in children under 10 years of age, but it can also occur in adults. Most adults, however, are already immune to the viruses that cause HFMD as they have encountered them when they were a child.²

The blisters are infectious until they are crusted over and dry. This usually takes 7-10 days after the illness begins. The virus can also be shed in the saliva and faeces for several weeks after the blisters resolve.^1,2,4

How long does my child need to stay off school or daycare?

If your child attends school or daycare, it is important that you keep them home to avoid spread of the virus to other children. The Western Australian Department of Health recommends to exclude a child with HFMD from school or daycare until the blisters have formed crusts that are completely dry.³

Adults are not required to exclude themselves from work if they are in contact with a child with HFMD.³

Can my child get HFMD again?

Infection with a virus that causes HFMD results in immunity to that specific virus. As there are several viruses that cause HFMD, a second episode can occur if your child encounters a different virus in the coxsackie or enterovirus group. However, most children will not have a repeat infection.¹

Can HFMD cause more serious illness?

Whilst HFMD usually causes a mild illness that gets better on its own,^2.6 it can less commonly cause more serious complications. These include:

Dehydration due to lack of fluid intake. You can read our previous blog on Gastro to find out more about determining if your child is dehydrated and what treatment they may need.
Infection of the blisters. If your child’s blisters have redness and heat around them, or yellow coloured discharge/crusting, you should see your GP.⁷

Very rarely the virus can affect the lining of the brain and spinal cord, leading to severe symptoms such as seizures, confusion, unsteadiness and weakness.²

References

This information is general and may not apply to you or another person. If you have any concerns about your health or the health and wellbeing of a child, consult a doctor or other healthcare professional. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.