Argh… the phrase that strikes dread into every parent of a child in childcare: ‘Hand, Foot and Mouth Outbreak’. Unfortunately this was the case at our childcare centre in the weeks leading up to Christmas and my youngest was one of the early victims of this very common and very contagious virus. In all I think he needed a whole week off childcare and none of us got much sleep in that very long week!
So, for those of you who haven’t yet had the pleasure of experiencing it, what is Hand, Foot and Mouth, how is it spread and what do I need to know if my child gets it?
Not some weird livestock disease
Some of you may be familiar with the Foot and Mouth disease that sheep, cattle, and pigs can get, but let me assure you that the Hand, Foot, and Mouth Disease (HFMD) that I am talking about is not the same and in fact is in no way related to this. HFMD is a human illness caused by a number of different viruses which fit into the Enterovirus family, most of which come from the smaller group of Coxsackieviruses. As there are multiple viruses that can cause the same illness, it is unfortunately possible for someone to have Hand, Foot, and Mouth more than once, sometimes multiple times in the same year.
So what is it then?
HFMD is a common infection in young children though it can affect people of any age. Its name comes from the characteristic distribution of lesions often seen in the condition which seem to localise preferentially to the soles of the feet, the palms and the areas around and even inside the mouth. Though this is the ‘typical’ distribution, HFMD can have many variations, and a child may present with lesions only in one or two areas rather than all 3. There is also commonly involvement of the nappy area, and in some cases this is in fact the most significantly affected area with very mild involvement elsewhere. The lesions themselves typically present as blisters on the skin or ulcers on the mucus membranes in the mouth. Sometimes they may just be red spots that do not progress to blisters.
Most children who get HFMD will experience fever and a runny nose progressing to a sore throat and mouth as the rash appears. The rash itself may last for 5-7 days before the blisters crust over and eventually disappear. For many children this is a rather mild illness, but some may find themselves really very unwell with high fevers, quite a lot of pain and discomfort from the lesions, and sometimes dehydration – usually where the lesions in the mouth are so painful that they prevent drinking adequate fluids.
A little quirk of HFMD is that after recovery you may find that your child’s fingernails or toenails fall off with new growth coming through underneath. Occasionally this allows us to make the retrospective diagnosis of HFMD in cases where it wasn’t entirely clear at the time. Please don’t be alarmed if this happens to your child even up to 3 months after an infection with HFMD. It is common, and the nails will regrow normally.
Very occasionally HFMD can have more serious consequences such as meningitis, though thankfully this is very rare.
How is HFMD spread?
HFMD, like many viruses, is highly contagious. It can be spread through multiple ways, usually through contact with:
– fluid from the blisters
– saliva, nasal secretions, or sputum
In hand, foot and mouth disease the infectious period usually starts before the symptoms are entirely apparent, and certainly before the rash is evident. Children are most infectious in the first week of the illness. The blisters themselves are no longer infectious once they have dried up and crusted over, though the virus may still be shed for up to several weeks in faeces.
What if my child gets Hand, Foot, and Mouth?
If you are worried about the possibility of HFMD in your child then it is wise for you to check in with your GP. There are no specific tests to diagnose HFMD, the diagnosis is usually made after examining your child for the typical signs of the illness. Sometimes the diagnosis isn’t clear until the rash appears a few days later.
The treatment of HFMD is purely supportive in nature, which means giving regular Paracetamol and Ibuprofen if needed to keep your child comfortable, and encouraging them to take regular fluids to prevent dehydration. Often their food and drink intake will drop off, especially if there are painful blisters throughout the mouth. Sometimes offering fluids and/or food about half an hour after a dose of Paracetamol or Ibuprofen means it will be at maximum effectiveness and they may be more likely to accept something. Also sticking to cool soothing fluids can be helpful. If appropriate, your GP may be able to prescribe a numbing gel to use in your child’s mouth to help increase their oral intake. If you are at all concerned about the possibility of dehydration in your child, then please seek medical review with your GP or local emergency department.
Once HFMD is identified your doctor will usually recommend that your child be excluded from school or child care until the blisters have all dried and crusted over which may be up to a week. It is also recommended to notify your centre of the diagnosis so they can monitor for cases and inform other parents if an outbreak is identified. I would also encourage lots of handwashing within the household until your child is recovered to try to limit spreading the infection within the family. Where kids often experience only a mild illness, adults can find HFMD quite a bit more unpleasant and it would be worth avoiding if possible. We were very lucky in our house that only my youngest was affected this time around, though I may have become a bit fanatical on the hand washing front!
Most of all, don’t panic if you think your child has HFMD. It is very common, mostly mild in nature, and your child is likely to recover completely within a few days.
Well, that’s all from me folks.
‘Til we meet again,