Hand-foot-and-mouth disease(HFMD) is an infection of young children (under the age 10 years old) in which characteristic fluid-filled blisters appear on the hands, feet, and inside the mouth. The throat and tonsils develop small ulcers while the hands, feet, and diaper area develop a rash with characteristic vesicles (very small blisters). This is usually a mild illness with the rash healing in 5 to 7 days.

HFMD is caused by virus (enterovirus group). HFMD is spread from person to person by direct contact with the nasal discharge, saliva, faeces and fluid from the rash of an infected person. Both adults and children can be affected, but young children below five years are particularly susceptible.

HFMD often occurs in clusters of children who are in centres together. It is spread through poor hand-washing after a diaper change or contact with saliva (drool) which allows the virus to be passed from one child to another

Signs and Symptoms

The incubation period is 3 to 7days.

The clinical features includes:-

• fever
• sore throat
• ulcers in the throat, mouth and tongue
• Rash with vesicles (small blisters 3-7 mm) on hands, wrist, feet and diaper area. The vesicles are typically on the palm side of the hands and the sole of the feet and very characteristic in appearance.
• headache
• loss of appetite

Complications

• Usually not serious but few cases can worsen when it involves nervous system and heart.

Treatment

Diagnosis is made by most practitioners solely on the basis of the unique appearance of blisters of the mouth, hands, and feet, in a child not appearing very ill.

There is no specific treatment for the infection other than symptomatic relief of symptoms.

Treatment with antibiotics is not effective and is not indicated. Acetaminophen can be used to treat fever. Aspirin should not be used in viral illnesses in children under 12 years old.

Salt water mouth rinses (1/2 teaspoon of salt to 1 glass of warm water) may be soothing if the child is able to rinse without swallowing. Ensure an adequate fluid intake because swallowing may be painful. Extra fluid is needed when fever is present.

Advice for parents

Parents are advised to consult a doctor early if their child has symptoms of HFMD. They should also be alert to any change in their child’s normal behaviour, e.g. irritation and sleepiness. Should they refuse to eat or drink, have persistent vomiting or drowsiness, parents should bring their child immediately to the hospital.

Avoid sending child with symptoms to school, pre school or nursery . Wipe and clean nose and mouth and dispose soiled tissue properly.

Prevention

Prevention involves careful attention to hygiene. Family members are advised to follow good hygiene practices, including frequent hand washing, to limit the spread of the infection.

• consistent hand-washing practices with clean water and soap before preparing food, after going to toilet, after changing diapers and cleaning faeces.
• to cover mouth and nose when coughing and sneezing
• discouraging the sharing of clothes, towels, eating and drinking utensils and stuffed toys.
• parent should ensure that they are clean before handling children’s or babies
• to clean toys, chairs and tables if contaminated by children saliva
• children should be kept away from crowded public places (such as schools, preschools, play groups, markets and public transport) if they show signs of infection.

Reference

1. Hand, Foot and Mouth disease (HFMD) Guidelines