What are the management strategies for hand, foot, and mouth disease in adults and toddlers?

Management of Hand, Foot, and Mouth Disease in Adults and Toddlers

The most effective management of hand, foot, and mouth disease (HFMD) focuses on supportive care, with hand hygiene being the single most important method of preventing transmission, while acetaminophen or ibuprofen can be used for symptomatic relief of pain and fever. 1

Disease Overview

Hand, foot, and mouth disease is a common viral illness caused by enteroviruses (primarily coxsackieviruses A6, A10, A16, and enterovirus 71) that typically affects children under 10 years of age, though adults can also contract it 2. The disease is characterized by:

• Low-grade fever
• Painful oral ulcerations
• Maculopapular or papulovesicular rash on hands and soles of feet
• Lesions that typically resolve in 7-10 days

Management Strategies

Prevention and Control

• Hand hygiene:

  • Wash hands thoroughly after changing diapers, helping with toileting, before food preparation, before eating, and after contact with lesions 1
  • Use proper handwashing technique: wet hands with warm water, apply soap, rub vigorously for at least 15 seconds covering all surfaces, rinse with warm water, dry with disposable towel 1
  • Alcohol-based hand rubs can be used when hands are not visibly soiled 1

• Environmental measures:

  • Clean and disinfect frequently touched surfaces and shared toys 1
  • Wash soiled clothing, bedding, and towels in hot water with detergent 1
  • Avoid sharing utensils, cups, towels, or other personal items 1

Symptom Management

For Both Adults and Toddlers:

1. Pain and fever management:

   • Use acetaminophen or ibuprofen as needed for pain or fever 1, 2
   • Important: Oral lidocaine is not recommended for pain relief 2

2. Hydration:

   • Ensure adequate fluid intake to prevent dehydration, especially when oral lesions make eating and drinking painful 2
   • For children: offer cold fluids, popsicles, or ice cream to soothe mouth pain and maintain hydration

3. Oral comfort measures:

   • Soft, bland foods that don't require much chewing
   • Cold foods may be better tolerated
   • Avoid acidic, salty, or spicy foods that may irritate mouth sores

Special Considerations for Toddlers:

• More frequent, smaller fluid offerings may be better tolerated
• Monitor closely for signs of dehydration (decreased urination, dry mouth, lethargy)

Return to Normal Activities

• A child may return to school or daycare when 1:

  • Fever-free for 24 hours without fever-reducing medication
  • Child feels well enough to participate in activities
  • Most lesions have dried
  • Note that some daycares may have specific policies

• Adults may return to work using the same criteria

Monitoring for Complications

While rare, be aware of potential complications and monitor for:

• Neurologic complications: encephalitis or meningitis 1, 3
• Cardiopulmonary complications in severe cases 1, 4
• Dehydration due to painful swallowing
• Onychomadesis (nail shedding) occurring up to two months after initial symptoms, particularly with coxsackievirus A6 5

Warning signs requiring immediate medical attention:

• Persistent high fever
• Severe headache
• Stiff neck
• Unusual sleepiness or lethargy
• Signs of dehydration

Important Caveats

• There is no specific antiviral treatment approved for HFMD 2, 4
• Enterovirus 71 strains can cause more severe disease with higher complication rates 4
• HFMD caused by coxsackievirus A6 may present with more severe symptoms, even in adults 5
• The disease is highly contagious and can reach epidemic levels, making prevention crucial 2, 3

By following these management strategies, most cases of HFMD will resolve without complications within 7-10 days.