See More Appropriate Topic (instead of this one):

• If NOT, try one of these: Mouth Ulcers
• If NOT, try one of these: Rash or Redness – Widespread
• If NOT, try one of these: Chickenpox

Is this your child’s symptom

• A viral infection that causes mouth ulcers sores
• Most children also get tiny blisters on the hands and feet

Symptoms of Hand-Foot-and-Mouth Disease HFMD

• Small painful ulcers in the mouth. Look for them on the tongue and sides of mouth.
• Small, thick-walled water blisters OR red spots on the hands and feet. Occurs on palms, soles, and webs of the fingers and toes. This happens in 70% of children.
• 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 of HFMD

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

Severe Form of HFMD

• In 2012, a severe form of HFMD occurred in much of the world. It’s caused by a new Coxsackie A6 virus.
• The rash spreads to the arms, legs and face. The rash is made up of many small blisters.
• Children with such a severe rash usually need to be seen. Reason: To confirm the diagnosis. Exception: Close contact with HFMD within the last 7 days.
• Treatment is the same. Drink enough fluids to prevent dehydration.
• Peeling of the fingers and toes is common. It looks bad but is harmless. It happens at 1 to 2 weeks. Use a moisturizing cream on the raw skin.
• Some fingernails and toenails may fall off. It occurs in 4% of severe cases. It happens at 3 to 6 weeks out. Trim them if they catch on things.
• Fingernails grow back by 3 to 6 months and toenails by 9 to 12 months. They will look normal.

Return to School

• Can return to child care or school after the fever is gone. Most often, this takes 2 to 3 days.
• Children with widespread blisters may need to stay home until the blisters dry up. That takes about 7 days.

Call Doctor Now or Go to ER

• Dehydration suspected. No urine in over 8 hours, dark urine, very dry mouth and no tears
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

• Red, swollen and tender gums
• Ulcers and sores also on the outer lip
• Rash spreads to the arms and legs
• Fever lasts more than 3 days
• You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

• Fingernails or toenails fall off
• You have other questions or concerns

Self Care at Home

• Hand-foot-mouth disease and no complications

Care Advice for Hand-Foot-and-Mouth Disease HFMD

1. What You Should Know About HFM Disease:
   • Most often, hand-foot-and-mouth disease HFMD is a harmless rash.
   • It is caused by a virus called Coxsackie.
   • Here is some care advice that should help.
2. Liquid Antacid for Mouth Pain Age 1 Year and Older:
   • For mouth pain, use a liquid antacid such as Mylanta or the store brand. Give 4 times per day as needed. After meals often is a good time.
   • Age 1 to 6 years. Put a few drops in the mouth. Can also put it on with a cotton swab.
   • Age over 6 years. Use 1 teaspoon 5 ml as a mouth wash. Keep it on the ulcers as long as possible. Then can spit it out or swallow it.
   • Caution: Do not use regular mouth washes, because they sting.
3. Fluids and Soft Diet:
   • Try to get your child to drink adequate fluids.
   • Goal: Keep your child well hydrated.
   • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
   • Solids. Offer a soft diet. Also avoid foods that need much chewing. Do not give citrus, salty, or spicy foods. Note: Fluid intake is more important than eating any solids.
   • For babies, you may need to stop the bottle. Give fluids by cup, spoon or syringe instead. Reason: The nipple can increase the pain.
4. Pain Medicine:
   • To help with the pain, give an acetaminophen product such as Tylenol.
   • Another choice is an ibuprofen product such as Advil.
   • Use as needed.
5. Fever Medicine:
   • For fevers above 102° F 39° C, give an acetaminophen product such as Tylenol.
   • Another choice is an ibuprofen product such as Advil.
   • Note: Fevers less than 102° F 39° C are important for fighting infections.
   • For all fevers: Keep your child well hydrated. Give lots of cold fluids.
6. Return to School:
   • HFMD is easily spread to others.
   • However, most often, it’s a mild and harmless illness.
   • After contact with HFMD, children come down with symptoms in 3-6 days.
   • Can return to child care or school after the fever is gone. Most often, this takes 2 to 3 days.
   • Children with widespread blisters may need to stay home until the blisters dry up. That takes about 7 days.
7. What to Expect:
   • Fever lasts 2 or 3 days.
   • Mouth ulcers should go away by 7 days.
   • Rash on the hands and feet lasts 10 days. The rash on the hands and feet may then peel.
8. Call Your Doctor If:
   • Signs of dehydration occur
   • Fever lasts more than 3 days
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

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.

Copyright 1994-2015 Barton D. Schmitt, MD. All rights reserved.