Treatment of hand, foot and mouth disease

By Dr Ananya Mandal, MD

Hand foot and mouth disease is a viral infection commonly affecting children below 10 years. It rarely affects teenagers and adults who usually show milder symptoms.

Causes and symptoms of hand, foot and mouth disease

The infection is commonly caused by Coxsackie A16 strain of virus from the enterovirus family.

The infection leads to symptoms of fever, sore throat, skin rashes over hands, feet, buttocks, genitalia and also leads to ulcers in the mouth, throat, tonsils and tongue. (1-8)

Relief of symptoms of hand, foot and mouth disease

Treatment for the condition is usually aimed at relief of symptoms. Patients and parents of the child are reassured that HFMD is different from foot and mouth disease seen in cattle, sheep and pigs.

The symptoms of HFMD usually take around 3 to 7 days to appear. Once the patient manifests the symptoms the disease runs its course for 7 to 10 days and resolves by itself.

Antibiotics are ineffective for hand, foot and mouth disease

As antibiotics are ineffective, their use is not recommended. Antibiotics mainly act upon bacterial infections. Since HFMD is a viral illness they are not effective.

Antibiotics are only required if secondary infection of skin lesions occurs.

Treatment of children with hand, foot and mouth disease

Children with the infection are given fever mediation for pain and fever. This includes Acetaminophen and Ibuprofen. These are available over-the-counter.

Aspirin should not be given to children under 12 years. Aspirin given to any viral infection if children under 12 may lead to life threatening complications affecting the liver and the brain called Reye’s syndrome.

Salt water rinses for hand, foot and mouth disease

Symptomatic relief includes salt water rinses and gargles. The gargles are prepared with 1/2 teaspoon of salt to 1 glass of warm water. This soothes the ulcers within the mouth.

It is helpful in children who are able to rinse without swallowing.

Fluids for patients with hand, foot and mouth disease

Plenty of fluids are recommended. Fever usually may lead to dehydration and fluids are recommended particularly if there are high peaks of fever.

The most soothing fluids are cool, milk products. Soft cool foods also help.

Most children complain of pain on taking juice or soda due to their acidic content leading to burning sensation over the mouth ulcers.

For mouth ulcers a pain reliever ointment or gel may be given. This contains benzydamine or lidocaine oral gel that numbs the pain over the ulcers.

How long does recovery take?

Complete recovery is seen in 5 to 7 days. Treatment may be continued at home unless there are complications.

When to seek medical attention

Children with dehydration, high fever and those with fever induced convulsions or seizures may need medical attention in the hospital.

Dehydration is characterized by:

  • dry skin and dry mouth
  • loss of weight and listlessness
  • irritability
  • decreased and dark colored urine output

If a pregnant woman is infected with the virus there is a risk of abortion (in cases of infection during early pregnancy) or infection of the fetus (in cases of late pregnancy infections). These patients may need hospital care.

Prevention of hand, foot and mouth disease

Prevention of HFMD revolves around avoidance of infected individuals. Children with the infection are isolated and prevented from attending school or day care centers especially the first week to prevent spread.

Those handling children with infection especially at child care centers need to practice frequent hand washing and through cleaning of surfaces after disposal or change of nappies and diapers, before and after eating and after sneezing or coughing and handling tissues etc. with throat or nasal discharges.

Toys and surfaces should first be washed with soap and water, and then cleaned with a dilute solution of bleach.

Reviewed by , BA Hons (Cantab)

Further Reading

Sources

  1. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001961/
  2. http://www.bbc.co.uk/health/physical_health/conditions/handfootmouth.shtml
  3. http://www.patient.co.uk/doctor/Hand-Foot-and-Mouth-Disease.htm
  4. http://www.cdph.ca.gov/HealthInfo/discond/Documents/HFMD.pdf
  5. http://www.tchd.org/pdfs/hand_foot_mouth_disease_fact_sheet.pdf
  6. http://www.healthlinkbc.ca/healthfiles/pdf/hfile64.pdf
  7. http://www.mhcs.health.nsw.gov.au/publication_pdfs/7130/DOH-7130-ENG.pdf
  8. http://www.nhs.uk/Conditions/Hand-foot-and-mouth-disease/Pages/Treatment.aspx

Last Updated: Feb 24, 2014

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