Luke Voytas is a pediatrician and author in Portland, Oregon. His posts combine research and common sense to help parents be calm and confident in raising their kids.

Hand, Foot, and Mouth Hysteria

Hand, Foot, and Mouth Hysteria

Oh the humanity! Hand, foot, and mouth disease sounds like a medieval plague, or something that crosses over to people from animals (probably because there’s an unrelated “hoof and mouth” disease that only affects livestock). This is a really common illness, and it rivals the dreaded pink eye in terrorizing daycares and pre-schools. Because of the name and the potential nastiness of the rash, it usually terrifies parents as well. Let’s demystify it a bit.

Hand, foot, and mouth is usually caused by various types of coxsackie virus. Egyptian hieroglyphics described the illness way back in 1400 B.C. (the oldest record of any virus), but it wasn’t officially “discovered” until 1957. Coxsackie is unusual because it’s one of the only viruses that peaks between spring and fall, just when you feel like you’ve escaped the onslaught of winter illness. The vast majority of victims are under 5 years old. Most kids start with a fever (which can be high, like 103 or 104) and feeling crummy. At first, since there aren’t usually any cold symptoms, the fever can be a mystery to parents. But after one or two days kids develop small red spots throughout their mouth that quickly progress to painful little ulcers (similar to canker sores). Your kid’s not going to be excited about eating at this point and usually will drink just enough to get by.

Some kids, especially as they get older, will only get the fevers and mouth sores. We call this herpangina – parents often bring these kids in concerned about strep throat. But most toddlers start to get a rash 2-3 days into the illness. The pattern and appearance of the rash are unique, and being familiar with it will let you make your own diagnosis most of the time. Nearly all other viral rashes are most noticeable on the trunk. But the hand, foot, and mouth rash starts out as red spots on the palms and soles and can trickle up towards the elbows and knees. Many kids also get spots around the mouth and in the diaper area. The spots usually turn into blisters, sometimes a bit purplish, over the next few days. The rash can be mild or look BAD, but it’s not usually painful or itchy.

The fever usually lasts from 3-5 days, and the rash and mouth sores can linger for about a week. Kids usually do great at home – this is a time to lean pretty heavily on the ibuprofen, which will help the mouth pain more than Tylenol. When do you need to bring her in to the doctor? If she’s having trouble swallowing even water. It’s fine if she doesn’t eat much for 3-4 days, but the hydration is crucial. You should also bring her in if the sores around her mouth are getting goopy or crusty – that can mean a bacterial infection called impetigo which needs to be treated.

Hand, foot, and mouth can spread like wildfire to classmates or young siblings through saliva, blister fluid, or poop. It’s usually contagious for about a week, and you’ll get a call within about 5 minutes if you try to send her back to school before that. Even when the illness is gone, it can leave a final calling card – a few weeks later many kids mysteriously get peeling and nail damage at the tips of their fingers and toes.

That's about it - now when your friends post their kids' nasty rashes, you can stop the panic and say, "Oh that's just a little coxsackie virus infection."

 

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