Hand, Foot and Mouth Disease

Hand, foot and mouth disease is a frequent illness among young children that is caused by the coxsackievirus. Characterized by red, painful blisters in the mouth and on the palms of the hands and soles of the feet, outbreaks usually occur during summer and early fall. Kids under age 5 are most prone to the disease which spreads in places like childcare centers and schools.

Hand, foot and mouth disease usually starts off with a fever, sore throat and loss of appetite followed a few days later by the appearance of painful mouth blisters. Blisters are red with a small bubble of fluid on top. The soles of the feet and the palms of the hands also may be affected with a rash that can look like flat red spots or blisters. Sometimes a pink rash develops on other areas of the body like knees, elbows, buttocks, genitals and thighs. Recognizing the disease can be difficult for parents of young children who have yet to start talking and can’t tell you they are in pain. If your child decreases the amount he is drinking or refuses liquids altogether, it should be a signal that something is wrong.

Symptoms can include:

Physicians can usually diagnose hand, foot and mouth disease through a physical exam.

While there is no vaccine or treatment for hand, foot and mouth disease, your physician can prescribe some home remedies to ease your child’s pain or discomfort. Acetaminophen or ibuprofen can be given to reduce a fever and relieve pain. Do not give aspirin to children or teens as it may cause Reye’s syndrome.

Keep blisters on the hands, feet or other parts of the body clean (wash with lukewarm soap and water, pat dry) and uncovered. Ruptured blisters can be treated with an antibiotic ointment and covered with a bandage.

Cold foods like ice cream and popsicles numb the area and should go down easy for kids who are having swallowing difficulties. It is very important to make sure kids are drinking enough so that they do not become dehydrated. Call your child’s doctor if he is lethargic, irritable or can’t be consoled as these could indicate dehydration. Other signs of dehydration include:

Since hand, foot and mouth disease is contagious and can spread through contact with feces, saliva, mucus from the nose, or fluid from the blisters—hand washing is the best protection. Remind everyone in your family to wash their hands frequently with soap and water, particularly after using the toilet (especially in public places), after changing a diaper, before meals, and before preparing food. Shared toys or equipment in schools and childcare centers should be cleaned daily with a bleach-based disinfectant because the virus can live on these objects for days. Keep kids home from school and childcare while they have a fever or open blisters on the skin and mouth.

The disease usually resolves within several days to a week and kids recover completely. 

Bronchiolitis Spread via respiratory droplets through sneezing or coughing  2 to 10 days  Onset of cough until 7 to 10 days 
Chickenpox (Varicella) Airborne or via skin contact with lesions  10 to 21 days  2 days before rash appears until all sores have crusted 
Colds Spread via respiratory droplets or direct contact with infected person or object  2 to 4 days  Onset of runny nose until fever is gone

Croup (viral) Spread via respiratory droplets or contact with infected person or object  2 to 6 days  Onset of cough until fever is gone
Diarrhea Contact with feces  Depends on causative agent (bacterial 1 to 7 days; viral 1 to 4 days)  Depends on causative agent; usually until stools are formed. (See specific agents)
Fifth Disease (Parvo virus) Spread via respiratory droplets  Usually 4 to 14 days, but can be as long as 21 days  7 days before rash until rash begins 
Hand-foot-mouth (Coxsackie) Spread via respiratory droplets, fecal/oral contact or fluid from blisters  3 to 6 days  Onset of mouth ulcers until fever is gone (respiratory tract shedding usually 1 week; fecal can be several weeks)
Hepatitis A Fecal contact  15 to 50 days  1 to 2 weeks before jaundice begins until 1 week after onset of jaundice
Hepatitis B Contact with infected blood/body fluids  45 to 160 days  Indefinite period. If Hepatitis e antigen is positive, at risk for transmission 
Herpes Simplex Oral/genital skin contact  2 days to 2 weeks  Initial infection: 1 week to several weeks (oral/genital). Recurrent infection: 3 to 4 days
Impetigo Direct skin contact with lesion and contact with infected objects  7 to 10 days  Onset of sores until 1 day on antibiotics
Influenza Spread via respiratory droplets or contact with infected person or object  1 to 4 days  24 hours before onset of symptoms until fever is gone, about 7 days
Lice Spread via contact with skin or hair  10 to 14 days  Onset of itch until 24 hours after first treatment
Meningococcus Spread via respiratory droplets  1 to 10 days  7 days before symptoms to 24 hours after treatment begins
Mononucleosis Contact with infected saliva  30 to 50 days  Undetermined, but usually 6 weeks
MRSA Spread via contact with infected person, person who is a carrier of the disease, or contaminated surface.  One to 10 days  Varies depending on whether infection is active and if person is seeking treatment 
Pertussis (whooping cough) Spread via respiratory droplets  Five to 21 days  Two weeks after onset of cough or until five days on antibiotics
Pink-eye or Conjunctivitis (bacterial) Spread via contact with eye drainage
2 to 7 days  Onset of pus until symptoms have resolved
Rotavirus Direct or indirect contact with infected people  2 to 4 days  Before onset of diarrhea until 10 to 12 days after onset
Salmonella, Shigella, Campylobacter Fecal contact  Salmonella - 12 to 36 hours
Shigella & Campylobacter - 1 to 7 days 
Contagious until diarrhea is resolved; sometimes with prolonged excretions with salmonella
Scabies Contact with clothing, bedding or skin of infected animal or person  4 to 6 weeks (previous exposure 1 to 4 days)  Onset of itch until one treatment completed
Scarlet fever Spread via airborne respiratory droplets and direct contact  1 to 2 days  Onset of fever or rash until 1 day on antibiotics
Sore throat (viral) Spread via respiratory droplets  2 to 5 days  Onset of sore throat until fever is gone 
Strep throat Spread via respiratory droplets  2 to 5 days  Onset of sore throat until 1 day on antibiotics 

2006 Red Book, Report of the Committee on Infectious Disease, American Academy of Pediatrics

Airborne - droplets nuclei that remain suspended in the air for long periods
Respiratory droplets - droplets propelled for a short distance, such as talking, sneezing, coughing, etc.

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