Treatment of Hand, Foot, and Mouth Disease in Infants
The best treatment for hand, foot, and mouth disease (HFMD) in infants is supportive care focused on hydration, pain management with acetaminophen or ibuprofen as needed, and proper hand hygiene to prevent transmission.
Understanding HFMD
Hand, foot, and mouth disease is a common viral illness primarily affecting infants and children under 5 years of age. It is caused by enteroviruses, most commonly coxsackieviruses, and is characterized by:
- Fever
- Painful oral ulcerations/sores
- Maculopapular or papulovesicular rash on hands, feet, and sometimes buttocks
- Self-limiting course typically resolving in 7-10 days
Treatment Approach
1. Symptom Management
- Pain and fever control: Use acetaminophen or ibuprofen as needed 1, 2
- Follow age-appropriate dosing guidelines
- Avoid aspirin due to risk of Reye syndrome
- Oral hydration: Encourage fluid intake to prevent dehydration
- Cold fluids, popsicles, or ice chips may soothe oral pain
- Avoid acidic, spicy, or salty foods/drinks that may irritate mouth sores
2. Infection Control Measures
- Hand hygiene: Most important prevention method 3, 1
- Wash hands with warm water and soap for at least 15 seconds
- Rub vigorously, covering all surfaces
- Rinse with warm water and dry with disposable towel
- Use towel to turn off faucet
- Environmental cleaning:
- 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
3. What NOT to Do
- Oral lidocaine is not recommended 2
- Antiviral treatment is not available for HFMD 2
- Antibiotics are ineffective as this is a viral infection
Return to Childcare/School
A child may return to daycare or school when:
- Fever-free for 24 hours without medication
- Child feels well enough to participate in activities
- Most lesions have dried 1
Monitoring for Complications
While rare, be vigilant for signs of:
- Dehydration (decreased urination, dry mouth, lethargy)
- Neurological complications (severe headache, stiff neck, unusual sleepiness)
- Cardiopulmonary complications in severe cases 1, 4, 5
Special Considerations
- Enterovirus A71 is associated with more severe disease and higher complication rates than other causative viruses 4
- In rare cases, intravenous immunoglobulin may be considered for severe/complicated HFMD 4
Remember that HFMD is typically self-limiting with complete recovery within 7-10 days. The focus should be on keeping the infant comfortable, well-hydrated, and preventing transmission to others through proper hygiene practices.