Hand, foot and mouth: The disease with the funny name is more common than you might think

When we think of the prime time for childhood viruses to spread, we usually think of fall and winter, but there’s at least one common virus that likes to emerge during spring and early summer: the aptly named hand, foot and mouth disease.

Dr. Alia Sunderji, a pediatric emergency physician at The Hospital for Sick Children, said the virus can confound parents because it typically starts with a fever, seemingly out of nowhere. Here’s her advice on what to do if your child contracts hand, foot and mouth disease.

It’s caused by a virus called Coxsackie and is typified by fever and ulcers in the mouth and on the hands and feet — hence the name. However, other areas of the skin, such as the buttocks and upper thighs, can be involved.

Because it’s a virus, it does not need to be treated with antibiotics. Parents often want a confirmed diagnosis with a swab or blood work, but in the case of hand, foot and mouth, blood tests and other additional investigations are rarely necessary.

The rash can be quite variable. In some kids, it looks like fluid-filled vesicles; in others, it looks like raised red bumps. The thing to know is — if there’s a combination of ulcers in the mouth, a rash on the hands and feet, accompanied by a few days of fever — it’s likely hand, foot and mouth.

In most cases, yes. Typically, the fever comes before the rash, and it can be quite high — up to 40 degrees. If it’s hand, foot and mouth, after between two and four days of fever, you’ll start to see the ulcers in the mouth.

With babies, you might also see excessive drooling and general fussiness. Often your child will refuse to eat as much, due to painful ulcers evolving in the mouth.

So, if you’ve got a young, preverbal child, the important takeaway is: If your child spikes an otherwise symptom-free fever, they’re drooling a lot and are reluctant to eat or drink — check inside their mouth.

There are three main ways the virus is spread.

The first is through sneezing, coughing. In other words, infection can arise from direct contact with droplets that have been expelled. Furthermore, those droplets can also survive on objects — most commonly toys or countertops. It can also be transmitted through the stool.

The third way is through oral secretions. A young child with mouth ulcers can spread the virus through their drool. Direct contact with fluid from the oral lesions can also promote spread.

If your child isn’t improving after a week, or the ulcers haven’t disappeared after 10 days, I would suggest seeking medical attention. Also, if your child’s pain is not relieved by acetaminophen or ibuprofen, see your health-care provider.

The thing to watch out for is dehydration. Any time your child has a fever, you want to make sure they’re drinking enough. It’s especially important to pay attention to hydration with hand, foot and mouth because the ulcers inside your child’s mouth might make them reluctant to drink as much as usual. Small amounts of frequent fluids can help your child stay hydrated.

The easiest way to measure adequate hydration is by tracking the number of wet diapers. If your child has fewer wet diapers (no wet diapers in eight hours, for example), has dry lips, sunken eyes, has laboured breathing, is lethargic or has difficulty walking — those are reasons to seek emergency care. Other symptoms that would signal a trip to the emergency department include neck stiffness, neck pain, or an inability to move the neck up and down.

If your child has a fever, is in pain and is drooling excessively — keep them home. However, part of the reason hand, foot and mouth spreads so quickly is that even when kids are symptom-free, they could still spread the virus. It can be spread by children who are asymptomatic, or who no longer have symptoms.

Pain control is important

There is a lot parents can do to keep their child comfortable. Controlling your child’s pain is important to help ensure they stay hydrated. The risk with untreated mouth pain is that your child won’t drink enough.

You can treat a child who has hand, foot and mouth with acetaminophen and ibuprofen. They can be given together or spaced apart by an hour. As soon as one starts to wear off, give the other. As long as you are giving the proper dosage for your child’s weight, we advise pain relief around the clock.