How to treat severe hand, foot, and mouth disease in a child?

From the Guidelines

Severe hand, foot, and mouth disease in children should be managed with supportive care, focusing on hydration, pain relief, and monitoring for complications, as there is no specific antiviral treatment available, and the disease is typically self-limiting, lasting 7-10 days. The primary goal is to keep the child comfortable and prevent dehydration, which is the most serious complication. According to the study on enterovirus diagnostics and characterization 1, enteroviruses, including those that cause hand, foot, and mouth disease, can lead to severe disease, but supportive care is the mainstay of treatment.

Some key measures to take include:

• Offering cold, soft foods like popsicles, yogurt, and smoothies that are easier to swallow with mouth sores
• Providing pain relief with acetaminophen (Tylenol) at 10-15 mg/kg every 4-6 hours or ibuprofen (Motrin) at 5-10 mg/kg every 6-8 hours as needed
• Applying topical oral anesthetics like viscous lidocaine or over-the-counter products containing benzocaine (such as Orajel) to mouth sores for temporary relief
• Ensuring the child drinks plenty of fluids to prevent dehydration
• Watching for signs of dehydration, including decreased urination, dry mouth, lethargy, or excessive irritability

It's essential to seek immediate medical attention if the child shows signs of severe dehydration, high persistent fever above 102°F (38.9°C) that doesn't respond to medication, unusual drowsiness, or if symptoms worsen after 3-4 days. The study 1 highlights the importance of recognizing the potential for severe disease caused by enteroviruses, including hand, foot, and mouth disease, and the need for vigilant monitoring and supportive care.

From the Research

Treatment of Severe Hand, Foot, and Mouth Disease in Children

• The treatment of severe hand, foot, and mouth disease in children is mainly symptomatic and supportive 2
• Intravenous immunoglobulin should be considered for the treatment of severe/complicated hand, foot, and mouth disease 3, 2
• Glucocorticoid therapies may also be used to treat severe neurological complications 3
• There are no specific antiviral agents approved for the treatment of the disease, but drugs such as ribavirin, suramin, mulberroside C, aminothiazole analogs, and sertraline have emerged as potential candidates 2
• Pain relief can be managed with acetaminophen or ibuprofen as needed 4

Prevention of Hand, Foot, and Mouth Disease

• Good personal hygiene, such as handwashing, is important to prevent the spread of the disease 5, 4
• Disinfecting potentially contaminated surfaces and fomites can also help prevent the spread of the disease 4
• Vaccination of susceptible individuals in high-risk areas may be an effective preventative measure 6, 2

Management of Neurological Complications

• Early detection and appropriate treatment of severe neurological complications can minimize the risk of adverse health outcomes 3
• Evidence-based clinical practice guidelines for early detection and treatment would be significant in the management of these devastating neurological complications 3
• Meningoencephalitis and brainstem encephalitis are common neurological complications related to hand, foot, and mouth disease, and require prompt medical attention 3