Hand, Foot and Mouth disease


Hand, foot and mouth disease is a viral illness that is caused primarily by Coxsackie virus strain A16.  This viral illness occurs in infants and children under the age of 5 years but can occur in adolescents and adults.  As with most childhood illnesses, the virus is more severe in older individuals.  The disease is seen year round but occurs mostly in the summer and fall months. 

The illness will usually occur about 4-5 days after exposure.  The Coxsackie virus is part of the enterovirus group and thus, lives in the gut (entero) and is transmitted by contact with contaminated feces or salivary contact as the mouth is connected to the gut.  Good hand washing hygiene will prevent the transmission and spread of this illness. 

Symptoms begin with a low grade fever and a sore throat, often with ulcers in the mouth.  Skin blisters on the hands, feet and diaper areas will often follow. The illness will last about 5-7 days.  The contagious period is for about a week.  Children should return to school and daycare only when they are fever free and skin lesions are healing.  The greatest concern in young children is dehydration as the mouth lesions can be painful. 

Avoid acidic foods e.g. oranges, orange juice, tomato based foods
Ice chips and fruit popsicles are great for mouth cooling and hydration
Oral rehydration solution popsicle e.g. Pedialyte or Gatorade.  Gatorade has more sugar and food coloring but in the short term to keep a child hydrated, this is just fine as long there are no bad reactions to food dyes.  Flavored Pedialyte has artificial sweeteners to make it palatable for children.  
Pedialyte can be mixed with formula, breastmilk or apple juice. 

Conventional treatment

Ibuprofen or acetominophen for fever and pain
Benadryl (diphenhydramine) or other antihistamine for itching
Benadryl can be mixed with plain Maalox (1 oz each, mixed well) and the child can be given a dose every 6 hours as needed.  The benadryl and maalox mixture reduces the inflammation and pain of the mouth ulcers.  Please consult your doctor for the recommended dose based on your child's weight and age.

Integrative treatment 

Peppermint oil for fever: can be diluted or applied directly to feet and neck every 2-3 hours as needed.  Does not seem to be as effective with fevers >102.
Coconut oil to skin blisters:  Natural anti-inflammatory oil; helps skin lesions heal.
Ginger root tea (with honey only if child older than 1 year of age): 1" peeled ginger simmered in boiling water for 20 minutes; cool and strain.  Ginger is a great anti-inflammatory herb and helps decrease nausea as well. 

Call your doctor if your child is not drinking well, not urinating well, the lesions are getting worse or look infected and/or fever lasts for more than 3-4 days.

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