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Should Your Child See a Doctor?

Hand-Foot-Mouth Disease

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Definition

  • A viral infection that causes mouth ulcers and tiny blisters on the hands and feet

Symptoms 

  • Small painful ulcers in the mouth, especially on tongue and sides of mouth (in all children)
  • Small, thick-walled water blisters (like chickenpox) or red spots located on the palms, soles, and webs between the fingers and toes (70%)
  • 1 to 5 water blisters per hand or foot
  • Small blisters or red spots on the buttocks (30%)
  • Low-grade fever less than 102° F (39° C)
  • Mainly occurs in children age 6 months to 4 years

Cause 

  • Coxsackie A-16 virus
  • Not related to animal disease

Return to School 

  • Can return to child care or school after the fever is gone (usually 2 to 3 days). The rash is not contagious.

When to Call Your Doctor for Hand-Foot-Mouth Disease

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Signs of dehydration (e.g., very dry mouth, no tears, no urine in more than 8 hours)
  • Stiff neck, severe headache or acting confused (delirious)
 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • Red, swollen and tender gums
  • Ulcers and sores also present on outer lip
  • Fever present for more than 3 days
 

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
 

Parent Care at Home If

  • Probable hand-foot-mouth disease and you don't think your child needs to be seen
 

Home Care Advice for Hand-Foot-Mouth Disease

  1. Reassurance: Hand-foot-mouth disease is a harmless viral rash.
  2. Liquid Antacid for Mouth Pain:
    • Use a liquid antacid 4 times per day.
    • For younger children, put ½ teaspoon (2 ml) in the front of the mouth 4 times per day after meals.
    • Children over age 4 can use 1 teaspoon (5 ml) as a mouthwash after meals.
     
  3. Soft Diet:
    • Encourage favorite fluids to prevent dehydration.
    • Cold drinks, milkshakes, popsicles, slushes, and sherbet are good choices.
    • Avoid citrus, salty, or spicy foods.
    • For infants, give fluids by cup, spoon or syringe rather than a bottle. (Reason: The nipple can cause pain.)
    • Solid food intake is not important.
     
  4. Fever Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen for fever above 102° F (39° C) or severe mouth pain.
  5. Contagiousness: Quite contagious but a mild and harmless disease. Incubation period is 3-6 days. Can return to child care or school after the fever is gone (usually 2 to 3 days). The rash is not contagious.
  6. Expected Course:
    • The fever lasts 2 or 3 days.
    • The mouth ulcers resolve by 7 days.
    • The rash on the hands and feet lasts 10 days. The rash on the hands and feet may then peel.
     
  7. Call Your Doctor If:
    • Signs of dehydration develop
    • Fever present over 3 days
    • Your child becomes worse
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.


References

  1. Adler JL, et al. Epidemiologic investigation of hand-foot and mouth disease. Am J Dis Child. 1970;120:309.
  2. Slavin KA and Frieden IJ. Picture of the month: Hand-foot-and-mouth disease. Arch Pediatr Adolesc Med. 1998;152:505-506.
  3. Thomas I and Janniger CK. Hand, foot, and mouth disease. Cutis. 1993;52:265-266

Disclaimer

This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 9/15/2010 11:39:42 AM

Copyright 1994-2011 Barton D. Schmitt, M.D.

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