Discharge Instructions for Hand-Foot-and-Mouth Disease in a 3-Year-8-Month-Old Child
Parents should be informed that hand-foot-and-mouth disease is a self-limiting viral illness that typically resolves within 7-10 days without specific treatment, with focus on supportive care including adequate hydration and pain management. 1
Disease Information
- Hand-foot-and-mouth disease (HFMD) is a common viral infection caused by enteroviruses, particularly coxsackieviruses
- Most common in children under 5 years of age, with peak occurrence in spring through fall months 1, 2
- Characterized by:
- Low-grade fever
- Painful oral ulcerations/sores
- Maculopapular or papulovesicular rash on hands, feet, and sometimes buttocks
- Symptoms typically resolve within 7-10 days 1
Home Management Instructions
Pain and Fever Management
- Use acetaminophen or ibuprofen as needed for pain or fever 1
- Do not use oral lidocaine as it is not recommended for children with oral lesions 1
- For oral discomfort:
- Cold foods (popsicles, ice cream, cold beverages)
- Soft, non-acidic foods that don't require much chewing
- Avoid spicy, salty, or acidic foods that may irritate mouth sores
Hydration
- Maintain adequate fluid intake to prevent dehydration
- Offer small amounts of fluids frequently throughout the day
- Cold fluids may be better tolerated with mouth sores
- Watch for signs of dehydration:
- Decreased urination (fewer wet diapers)
- Dry mouth or lips
- Absence of tears when crying
- Unusual sleepiness or irritability
Infection Control and Prevention
Hand Hygiene
- Hand hygiene is the single most important method of preventing transmission of infectious agents 3
- Parents should wash hands thoroughly:
- After changing diapers
- After helping child use the toilet
- Before preparing food
- Before eating
- After contact with lesions
- Proper handwashing technique:
- Wet hands with warm water
- Apply soap and rub vigorously for at least 15 seconds, covering all surfaces
- Rinse with warm water
- Dry with disposable towel
- Use towel to turn off faucet 3
- Alcohol-based hand rubs can be used when hands are not visibly soiled 3
Environmental Cleaning
- Clean and disinfect frequently touched surfaces and shared toys
- Wash soiled clothing, bedding, and towels in hot water with detergent
- Avoid sharing utensils, cups, towels, or other personal items
School/Childcare Attendance
- Child should stay home while febrile or if they have open, weeping lesions
- Child may return to school/daycare when:
- Fever-free for 24 hours without fever-reducing medication
- Child feels well enough to participate in activities
- Most lesions have dried (though some daycares may have specific policies)
When to Seek Medical Attention
- Fever lasting more than 3 days
- Signs of dehydration (decreased urination, dry mouth, no tears when crying)
- Severe headache, stiff neck, or unusual sleepiness
- Seizures or altered mental status
- Difficulty breathing
- Worsening symptoms after 7-10 days
Potential Complications
- While rare, parents should be aware that HFMD can occasionally lead to:
- Most children recover completely without complications
Prevention of Spread to Others
- HFMD is highly contagious and spreads through:
- Direct contact with saliva, nasal secretions, fluid from blisters
- Fecal-oral route
- Respiratory droplets 1
- Teach child to cover mouth when coughing or sneezing
- Properly dispose of tissues and diapers
- Avoid close contact (kissing, hugging) with siblings or other children until symptoms resolve
Remember that hand-foot-and-mouth disease is typically a mild, self-limiting illness. Most children recover completely within 7-10 days without specific treatment beyond supportive care.