What is the management for hand, foot, and mouth disease?

Management of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is a self-limited viral illness that typically resolves within 7-10 days with supportive care focused on hydration and pain relief using acetaminophen or ibuprofen.

Disease Overview

• Caused by human enteroviruses and coxsackieviruses
• Most common in children under 5 years of age
• Characterized by low-grade fever, oral ulcerations, and maculopapular or papulovesicular rash on hands, feet, and sometimes buttocks
• Transmission occurs via fecal-oral, oral-oral, and respiratory droplet contact

Supportive Management

1. Hydration

   • Ensure adequate fluid intake
   • Offer cold liquids, popsicles, or ice cream to soothe oral pain and maintain hydration
   • Avoid acidic, spicy, or hot foods/beverages that may irritate oral lesions

2. Pain Relief

   • Acetaminophen or ibuprofen for fever and pain management 1
   • Dosing based on patient's weight and age
   • Important: Oral lidocaine is NOT recommended 1

3. Oral Care

   • Gentle mouth rinses with warm salt water
   • Soft diet to minimize discomfort from oral ulcers

Special Considerations

• Monitor for rare but serious neurologic or cardiopulmonary complications 1, 2
• Red flags requiring immediate medical attention:
  • Persistent high fever
  • Altered mental status
  • Severe headache
  • Respiratory distress
  • Unusual lethargy

Prevention Measures

• Handwashing is the most effective prevention method 1
• Disinfection of potentially contaminated surfaces and fomites
• Isolation of infected individuals, especially from schools or daycare centers
• Avoid close contact (kissing, hugging, sharing utensils) with infected individuals

Management of Severe Cases

• Intravenous immunoglobulin should be considered for severe/complicated HFMD 3
• Hospitalization may be necessary for:
  • Inability to maintain hydration
  • Neurological complications
  • Cardiopulmonary involvement

Follow-up

• Most cases resolve without sequelae in 7-10 days
• No specific antiviral treatment is currently available 1, 3
• Enterovirus A71 infections may have higher risk of complications and should be monitored more closely 3, 2

Patient Education

• Reassurance about the typically benign and self-limited nature of the disease
• Instructions on prevention of transmission to others
• When to seek medical attention if symptoms worsen

The management of HFMD focuses primarily on supportive care, as there are no specific antiviral treatments approved for this condition. Prevention through good hygiene practices remains the cornerstone of controlling HFMD spread.