Desiree wrote in, “My 15-month daughter and a few other kids at her daycare were just diagnosed with hand-foot-mouth disease. I would like to hear how common it is, what treatments (or ways to soothe) you find helpful, and how you would differentiate this from measles or chickenpox. For example, my little one has blisters all over her body, not just H-F-M. What are other complications? Can she get it again?”
Hand-foot-and-mouth disease (HFM) is very common, bread and butter pediatrics. We see tons of it. It’s more common in the summer and early fall, so I’m not surprised that it’s already hit Desiree’s daycare.
HFM is caused by a virus in the enterovirus family, usually Coxsackie A16. Those same viruses, as a family, can cause a wide range of other problems that sometimes overlap with HFM, so not every child in an HFM outbreak is going to get the classic HFM picture. Some will only have a fever, and some will only have ulcers in their mouths, and some will develop no symptoms at all.
The full picture of HFM begins after a 3 to 6 day incubation period, with fevers and blistery-looking spots mostly on the hands and feet. I say mostly, but many times there are more extensive rashes other places. (I guess hand-foot-mouth-and-butt doesn’t sound dignified, but it’s true.) The spots on the hands and feet usually don’t cause any pain or other symptoms, but if they’re present in the mouth they hurt and make it difficult to eat and drink. Classically, all of the spots heal in a week or 10 days.
But: There’s a newer virus out there causing HFM, Coxsackie A6, which causes a more widespread, more severe rash that takes longer to heal. It also sometimes causes more of all of a child’s fingernails and toenails to fall off. They’ll grow back, but it can be striking and upsetting when it happens.
Most children only get HFM once, or if they get it again the later episodes are milder. However, with this new A6 going around, many children (or even parents) seem to be getting a full blown case again.
The main treatment for HFM is comfort. Give extra fluids, or popsicles, or ice cream, and painkiller/fever reducers like acetaminophen or ibuprofen. And then a milkshake, or a blueberry banana smoothie.
Desiree wanted to know how we can tell it’s not chicken pox or measles. It’s usually not too difficult. Chicken pox is really itchy, and people with chicken pox get crops of new spots, so there are usually old ones and new ones scattered all over the body. People with measles are quite ill, with a bad cough and high fevers, often with red eyes. The rash of measles doesn’t look like blisters or ulcers — it’s more just flat red spots that run together.
Since summer is just starting, I’m sure we’ll be seeing more HFM soon. You can try to prevent it with good hand washing, especially after changing diapers — but in a day care center, with toddlers putting toys in their mouths, HFM is going to be difficult to stop. There’s no vaccine to prevent this one, and no specific treatment or antibiotics are going to make any difference. Desiree can have a milkshake, too, to help her, and her kiddo make it through.
Roy Benaroch is a pediatrician who blogs at the Pediatric Insider. He is also the author of A Guide to Getting the Best Health Care for Your Child and the creator of The Great Courses’ Medical School for Everyone: Grand Rounds Cases.
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