Hand, Foot, and Mouth Disease

Certain factors increase the likelihood of contracting HFMD:

• Age: Infants and children under five years old are at the highest risk.
• Gender: Studies suggest that males may be more susceptible to HFMD.
• Poor hygiene: Viruses causing HFMD can survive on surfaces for a prolonged period, making inadequate cleanliness a contributing factor.
• Frequent social interactions: Children regularly exposed to crowded places such as schools, playgrounds, and childcare centers have a higher risk of infection.
• Sharing toys: Contaminated toys shared among children serve as a mode of transmission.
• Rural residence: Some research suggests that children in rural areas have an increased risk due to greater community exposure.
• Lack of proper handwashing: Individuals who do not wash their hands before meals or after using the restroom are at a greater risk.

Severe HFMD Risk Factors:

• Infection in children under three years of age
• Fever persisting for more than three days
• Body temperature exceeding 39°C
• Vomiting
• Elevated neutrophil count
• Respiratory rate above 24 breaths per minute
• Limb tremors
• Difficulty breathing (dyspnea)
• Rashes on the hips
• Extreme fatigue or lethargy
• Seizures
• EV71 infection
• Low birth weight

Diagnosing HFMD is generally straightforward and based on clinical presentation, including:

• Observing characteristic rashes, mouth ulcers, and blisters.
• Evaluating symptoms alongside patient age.
• In some cases, throat and stool samples may be tested.

Additional diagnostic tests, though rarely needed, include:

• Biopsy: Examination of tissue from blisters under a microscope to distinguish HFMD from other conditions like herpes simplex or varicella-zoster virus.
• Serological testing: Used to detect antibodies against viral infections but is not highly sensitive for HFMD diagnosis. However, IgG levels can help monitor recovery progress.
• Polymerase Chain Reaction (PCR): A molecular test that confirms the presence of Coxsackievirus in suspected cases.

Specialists to Consult

Although HFMD is typically mild, medical attention is necessary if symptoms persist or worsen. Seek a doctor's advice if a child:

• Shows no improvement after seven days
• Experiences dehydration due to difficulty in swallowing
• Develops pus-filled sores
• Has trouble waking up
• Refuses to eat
• Appears constantly irritable
• Experiences a persistently high fever

Specialists who can provide appropriate care include:

• General Physician
• Pediatrician
• Infectious Disease Specialist

Currently, no vaccine exists for HFMD. However, several preventive measures can significantly reduce the risk of infection:

1. Hand Hygiene

Since HFMD spreads through direct contact, frequent handwashing with soap and water is crucial. Children should be taught proper handwashing habits, especially:

• After using the toilet
• Before meals
• After coughing, sneezing, or touching the nose
• After changing diapers
• After handling contaminated objects

If soap and water are unavailable, an alcohol-based hand sanitizer can be used as an alternative.

2. Cleaning and Disinfection

The virus can remain active on surfaces for extended periods. Therefore, it is important to regularly disinfect commonly touched objects such as:

• Toys
• Doorknobs
• Sippers
• Bedding and clothing (should be washed in hot, soapy water)

3. Avoid Touching the Face

To prevent infection, avoid touching the eyes, nose, and mouth with unwashed hands.

4. Limit Close Contact

Avoid direct contact with infected individuals, particularly through kissing, hugging, or sharing food and drinks.

5. Avoid Sharing Personal Items

Since the virus can persist on objects, refrain from sharing toys, utensils, towels, or other personal items. In childcare settings, toys and books should be sanitized frequently.

6. Stay Home When Sick

To minimize the spread of infection, keep children at home from school or daycare until their symptoms, particularly fever and blisters, subside.

7. Use Tissues When Sneezing or Coughing

Encourage children to cover their nose and mouth with tissues when sneezing or coughing. Dispose of used tissues immediately to prevent contamination.

Note: Breastfeeding does not influence the risk of HFMD transmission. Mothers do not need to discontinue breastfeeding as a preventive measure.

Currently, there is no specific cure for HFMD, and children generally recover within a week to ten days without medical intervention. Since HFMD is caused by a virus, antibiotics are ineffective. The treatment primarily focuses on alleviating symptoms and ensuring the child remains hydrated.

Researchers are actively investigating antiviral therapies targeting enterovirus 71-induced HFMD due to its potential neurological complications.

Common Treatment Approaches:

• Over-the-counter (OTC) medications like paracetamol and ibuprofen help manage fever and discomfort from mouth sores.
• Due to painful ulcers, children often refuse to drink fluids, so maintaining proper hydration is crucial.
• A combination of liquid ibuprofen and diphenhydramine can be used for gargling to ease ulcer-related pain.
• In severe cases of enterovirus 71 infection, off-label antiviral medications such as ribavirin, quinacrine, and amantadine may be administered.
• Some studies suggest that acyclovir, an antiviral drug, can reduce fever and skin symptoms within 24 hours of use.
• Hospitalization is required in cases of severe dehydration or complications affecting the nervous system or heart.

Note: Aspirin should never be given to children as it is associated with Reye’s syndrome, a life-threatening condition that can cause severe brain and liver damage, leading to vomiting, confusion, coma, or even death.

Remedies for Soothing a Sore Throat

• Throat lozenges and sprays free from benzocaine can be given to children above four years of age.
• A liquid antacid can be used as a rinse after meals.
• Gargling with warm salt water is effective for children over six who can gargle without swallowing.

HFMD is generally mild, with most patients recovering in a few weeks. However, in rare instances, complications can arise, including:

Common Complications:

• Dehydration: Due to difficulty swallowing, children may suffer from dehydration, requiring close monitoring of fluid intake.
• Persistent Stomatitis: Inflammation of the mouth lining can cause painful ulcers that interfere with eating.
• Aseptic (Viral) Meningitis: Inflammation of the brain’s protective layers, often linked to enterovirus 71 infection, can cause fever, headaches, neck stiffness, and back pain.
• Nail Shedding: In extreme cases, fingernails or toenails may fall off a few months after infection, though they typically grow back naturally.

Severe Complications:

• Widespread skin rash
• Enteritis (intestinal infection)
• Pneumonia
• Myocarditis (inflammation of the heart muscle)
• Pulmonary edema (fluid buildup in the lungs)
• Cerebral ataxia (uncoordinated muscle movements due to brain injury)
• Encephalitis (brain inflammation)
• Guillain-Barre syndrome (immune system attack on nerves)
• Intracranial hypertension (increased brain pressure)
• Paralysis

Hand, Foot, and Mouth Disease During Pregnancy

While HFMD poses minimal risk to pregnant women and their babies, a patient's medical history may influence the situation. In rare cases, if the infection occurs during the first trimester, persistent high fever could lead to miscarriage. Pregnant women should seek medical advice if symptoms appear.

Note: Adults can contract HFMD, though they often remain asymptomatic. However, they can still transmit the virus to others.

Home Remedies:

1. Coconut Water: Rich in vitamins, minerals, and electrolytes, it keeps the body hydrated and soothes mouth sores.
2. Oil Pulling: Swishing coconut or sesame oil in the mouth for 5-10 minutes helps maintain oral hygiene and reduces discomfort.
3. Cod Liver Oil: Known for its immune-boosting and antimicrobial effects, it can be consumed in capsule form or mixed into food.
4. Echinacea: This herbal remedy helps alleviate fever and infections when prepared as tea with honey.
5. Lavender Oil: Due to its antiviral and calming effects, adding a few drops to bath water can promote better sleep.
6. Liquorice Root: Forms a protective layer in the throat to ease blisters and can be consumed as tea.
7. Ginger: Has natural antiviral properties and can be given as a mild tea to children.
8. Coconut Oil: Applying coconut oil on rashes and blisters provides soothing relief.
9. Neem: With antimicrobial benefits, neem oil can be applied directly to rashes or mixed with coconut and lavender oils.
10. Aloe Vera: Applying fresh aloe vera gel to blisters can help reduce irritation and inflammation.

By following these treatment strategies and home remedies, parents can help their children recover comfortably while minimizing discomfort and complications associated with HFMD.

Although HFMD is mild and resolves on its own, painful mouth sores make eating and drinking difficult, leading to irritability in children. Parents should be aware that their child may eat less for up to ten days, so transitioning from solid foods to soft liquids is recommended.

Measures for Faster Recovery:

Dietary Recommendations:

• Encouraged Foods: Cold and soft foods like yogurt, ice cream, smoothies, shakes, mashed potatoes, oatmeal, eggs, popsicles, and hydrating fluids such as water, milk, and coconut water help maintain hydration and soothe ulcers.
• Foods to Avoid: Acidic drinks (citrus juices, lemonade, sodas, tomato-based foods) can irritate sores and should be avoided. Hot and spicy foods may worsen pain and discomfort.

Blister Care:

• Keep hand and foot blisters clean by washing them regularly with soap and water.
• If blisters rupture, clean them using an antibiotic ointment to prevent infections.

Avoiding Self-Medication:

• Many OTC medications can be harmful to infants and young children. Always consult a pediatrician before giving any medication.

Hygiene Education:

• Teach children to avoid touching their rash and ulcers.
• Encourage proper hand hygiene and teach them to sneeze or cough into a tissue or their sleeve.

Isolation Measures:

• Notify daycare centers or schools about the child’s HFMD diagnosis so that other children can be monitored for symptoms.
• Keep the child at home until mouth sores heal and blisters dry up.

Breastfeeding:

• Infants under one year should continue receiving breast milk or formula to ensure proper nutrition and hydration.