HELP! I’m seeing spots
Understanding and preventing hand, foot and mouth disease
T’IS the season for…viral illnesses, the common cold, the bad flu, dengue. Among the many viral illnesses circulating this time of year is hand, foot and mouth disease (HFMDZ). It affects mostly young children and causes fever and rash.
Transmission
Hand, foot and mouth disease is caused primarily by the coxsackie virus, and spreads through close contact and it is very contagious especially within the first week. It is spread by contact with an infected person’s nose drippings from a runny nose, air droplets from sneezing/coughing, contact with their spit/saliva and stool then touching another person’s eyes, mouth or nose, by touching their blisters, kissing and hugging an infected person, through sharing utensils, and contact with infected toys and other surfaces (think counters, door knobs, switches, etc). Children are most infectious at the beginning of the illnesses; even before the rash develops. Even though the illness lasts only seven to 10 days, the virus can survive in stool for many weeks. It affects mainly young children, age five years and under, but it can affect older children and rarely adults. Children in basic school/pre-school/kindergarten are more susceptible to being infected.
Symptoms
First, there is a fever; usually a high fever (101-103 degrees Celsius) which lasts one to two days. The child will be fussy, appetite is little to none, and they will likely have a sore throat. Your child may tell you their throat is hurting, and not want to eat because it may be painful to swallow. They could also have a stomach ache, vomiting, and runny nose. After a day or two, these symptoms will subside.
Then, an itchy rash develops to the hands, feet, elbows, knees, palms (hand-middle) and soles (foot bottom), groin and buttocks. The rash can occur anywhere — I’ve even seen it on a patient’s earlobe. It starts as tiny bumps, then turn into blisters that may burst/rupture and eventually a scab will form. The rash can be INCREDIBLY itchy causing significant discomfort to the little ones, and may be painful when they rupture.
They also develop painful sores in and around the mouth, so your child may not want to eat and prefer drinking.
For parents and caregivers, it’s hard to watch your baby be so uncomfortable.
Treatment
As with most viral illnesses, there is no specific treatment to get rid of or cure the illness. It has to run its course and the body’s immune system will do its work. The illness is usually mild, although uncomfortable and distressing for baby and parents, and will clear up in seven to 10 days on its own, We can treat the symptoms to alleviate pain and discomfort.
For fever and pain; give paracetamol/acetaminophen (that is Panadol or Tylenol). Follow the dosage chart on the side of the box or as directed by a doctor. Panadol should be given no more than every four hours. Tepid sponge baths can also help to reduce the fever. Ensure lots of hydration and rest. Even if they aren’t eating, make sure they drink — water, fruit juices, coconut water, etc. Include foods/liquids rich in vitamin C and zinc which can help in boosting our immune system.
Of note, do NOT give any NSAIDS like Diclofenac (brand name Cataflam). During this time, any illness with fever could be dengue, and NSAIDS can lead to very severe dengue symptoms. Also, do not give aspirin as this may lead to Reye’s syndrome.
For the mouth sores, if your child can swish and spit, let them do a warm salt water rinse. This can help to soothe the sores. Eating cold foods like popsicles, jello, yoghurt, etc can reduce their discomfort as well. Because the sores are usually painful, they may not eat, so ensure that they are at least drinking. Avoid salty, spicy and acidic foods. Those may irritate the mouth sores and cause more pain.
For the itchy rash, antihistamines (eg DPH, Histal, Aerius or Zyrtec) can alleviate itching. Calamine lotion may help as well. If you apply a cold object to the skin — like holding a bottle with frozen liquid to the foot bottom — it can ease the discomfort for a short while. Diaper cream with zinc oxide can help to “dry up” the rash as well. Oatmeal baths can soothe skin irritation. If the rash is extremely itchy, you can mix hydrocortisone cream with an antibiotic ointment and apply to the affected areas, but wait a few days after its onset. I have found good ol’ aloe vera helps to soothe irritated skin.
Keep kids out of school and away from others for seven to 10 days, and until the rash is healed/ dried up.
HFMDZ is usually a mild illness, but there can be complications. Because of the painful mouth sores and decreased appetite, your child may not eat or drink much, which means they are at risk of becoming dehydrated. It is important that your child drinks enough fluids to prevent this.
There have been accounts of fingernails and toenails falling out after the virus, but they grow back. VERY rarely, a small number of people may develop an infection in the brain or spinal cord (meningitis and encephalitis). If your child is severely dehydrated, lethargic or very droopy, or has a fever longer than three days, or having symptoms longer than 10 days, please seek medical attention.
It is important to remember that the virus that causes HFMDZ is very contagious, and spreads at the very onset of the disease, even before you realise the children are sick. We can minimise the spread by ensuring effective and proper hygiene. Caregivers, including schools and daycares, should disinfect toys and frequently touched surfaces regularly, ensure hand washing for 20 seconds after taking care of babies — especially after diaper changes and cleaning up a runny nose or vomit, etc. Separate sick children from others and teach your children to cough and sneeze in their elbows, not their hands, followed by hand washing or using a hand sanitiser, encourage them not share food and drinks or utensils with others (this one will be hard, especially for toddlers), and teach them when and how to properly wash their hands.
Dr Tal’s Tidbit
Hand, foot and mouth disease is a viral illness that brings fever and rash lasting about a week. The rash affects the hands and feet, including the palms and soles, but can affect the entire body. It is usually mild, but can cause lots of discomfort for your little one. It is very contagious so ensure good hygienic practices to limit and prevent its spread.
Dr Taleya Girvan has over a decade’s experience treating children at the Bustamante Hospital for Children, working in the Accident and Emergency Department and Paediatric Cardiology Department. Her goal is to use the knowledge she has gained to improve the lives of patients by increasing knowledge about the health-care system in Jamaica. Dr Tal’s Tidbits is a series in which she speaks to patients and caregivers providing practical advice that will improve health care for the general population. E-mail: dr.talstidbits@ gmail.com IG @dr.tals_tidbits