Hand, Foot, and Mouth Disease

Just so we are clear, I am not talking about foot and mouth or hoof and mouth disease in farm animals, but a mild virus in children that causes fever, mouth sores, and rash. Hand, foot, and mouth disease is caused by a virus that likes warm weather, so it is most common spring through fall in my neck of the woods (Middle America), but can occur any time of year in tropical locations. The illness is very common in young children because it is spread by direct contact with saliva and stool - think lots of drooling, diaper changing and hands in the mouth. It starts with fever and is followed by sore throat, drooling, and rash. The rash is characterized by red, raised bumps or blisters on the hands and feet. In my opinion, it should be called hand, foot, mouth and bottom disease, because I see diaper rash as a symptoms just as commonly as the rash on the hands and feet. Your child may also get fatigue, fussiness, runny nose, vomiting and diarrhea. Often, little children refuse to eat and drink. The illness typically lasts 7-10 days, with fever for 2-3 days. The most important part of hand, foot, and mouth disease for a parent, is keeping your child from getting dehydrated. Below are my tips for keeping your child comfortable and hydrated during this common illness:

• Ibuprofen or acetaminophen - give an appropriate dose for your child's weight as needed for fever and pain (including feeding refusal). If your child will not swallow medicine by mouth, there is a rectal form of acetaminophen that works well. 
• Offer fluids at all times - this includes breastmilk, formula, milk, Pedialyte, Gatorade, water, popsicles, ice cubes, ice cream (basically anything they will drink!) 
• Avoid spicy and acidic foods/drinks 
• Offer soft, easy to swallow foods 

Home remedies:

• Salt water rinses for older children - 1/2 teaspoon of salt mixed with 1 cup of warm water, swish and spit as needed for pain 
• Magic mouth wash - Maalox (Aluminum Hydroxide and Magnesium Hydroxide) and Benadryl (diphenhydramine) mixed together 1:1 and dropped in or placed in the mouth with a Q-tip. The best way to make this is to mix 5 ml of Maalox with 5 ml of Benadryl. Use 1 ml on the sores every 6 hours. 
• Gly-Oxide is another over the counter product that works well to clean and coat the ulcers  

I do not recommend mouth numbing gels (like Orajel) during this illness, because of the large amount required to numb all of the sores and the short lived relief. There are rare, but serious side effects from using too much of this medication. Unfortunately, there is no antibiotic or medication to shorten the length of the illness. Seek medical care if your child is refusing to drink, has decreased urination or wet diapers, dry mouth or you are concerned about dehydration.  

Heather Joyce, MD