What is the assessment and management plan for a 12-month-old child diagnosed with hand, foot, and mouth disease?

Assessment and Management Plan for a 12-Month-Old with Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is typically a self-limiting viral illness that resolves within 7-10 days without specific antiviral treatment, requiring primarily supportive care focused on hydration, pain management, and fever control.

Physical Assessment

Key Clinical Features to Document:

• Vital signs: Temperature, heart rate, respiratory rate, blood pressure
• General appearance: Level of activity, irritability, signs of dehydration
• Skin examination:
  • Document distribution and characteristics of rash
  • Typical locations: palms, soles, buttocks
  • Appearance: maculopapular or vesicular eruptions
• Oral cavity:
  • Presence of vesicles or ulcers on tongue, gums, and buccal mucosa
  • Assess for signs of dehydration (dry mucous membranes)
• Hydration status:
  • Skin turgor, mucous membranes, fontanelle, urine output
  • Ability to take fluids orally
• Neurological assessment:
  • Level of consciousness
  • Any signs of irritability or meningismus

Red Flags to Document:

• Fever >39°C (102.2°F)
• Signs of dehydration
• Refusal to drink fluids
• Lethargy or altered mental status
• Respiratory distress
• Neurological symptoms

Management Plan

1. Supportive Care

• Hydration:

  • Encourage frequent small sips of fluids
  • Offer cold fluids, popsicles, or ice cream to soothe oral discomfort
  • Avoid acidic or spicy foods/drinks that may irritate oral lesions

• Pain Management:

  • Acetaminophen (10-15 mg/kg/dose every 4-6 hours) for pain and fever
  • Ibuprofen (5-10 mg/kg/dose every 6-8 hours) for children >6 months as alternative
  • Topical oral anesthetics (benzocaine) may be considered for severe oral pain

• Oral Hygiene:

  • Gentle mouth rinses with warm salt water for older children
  • Keep mouth clean to prevent secondary bacterial infections

2. Infection Control Measures

• Hand hygiene education:

  • Proper handwashing technique for caregivers 1
  • Wash hands after diaper changes and before feeding

• Isolation precautions:

  • Keep child home from daycare until fever resolves and lesions begin to heal
  • Avoid close contact with other children, especially infants and immunocompromised individuals
  • Clean toys and surfaces that may be contaminated with viral particles

3. Monitoring and Follow-up

• Home monitoring:

  • Monitor hydration status (urine output, alertness)
  • Track fever pattern and response to antipyretics
  • Watch for signs of complications

• Return precautions:

  • Return immediately if:
    • Signs of dehydration develop
    • Persistent high fever unresponsive to antipyretics
    • Unusual drowsiness or irritability
    • Severe headache, stiff neck, or seizures
    • Respiratory distress

• Follow-up:

  • Routine follow-up in 7-10 days if not improving
  • Earlier follow-up if complications develop

4. Anticipated Course and Prognosis

• Typical course: 7-10 days until complete resolution 2
• Fever typically lasts 1-3 days
• Rash may evolve over 3-7 days
• Possible sequela: nail shedding (onychomadesis) may occur 4-8 weeks after infection 3

Special Considerations

Differential Diagnosis

• Herpangina
• Varicella (chickenpox)
• Herpetic gingivostomatitis
• Erythema multiforme
• Impetigo

Complications to Monitor

• Dehydration (most common complication)
• Rare neurological complications (more common with EV71 strain):
  • Encephalitis
  • Meningitis
  • Acute flaccid paralysis
• Cardiopulmonary complications (very rare) 4

Diagnostic Testing

• Typically a clinical diagnosis
• Laboratory testing not routinely indicated for uncomplicated cases
• If severe disease or complications suspected:
  • Consider throat swab, vesicle fluid, or rectal swab for enterovirus PCR 1

Parent Education

• Reassurance about the self-limiting nature of the disease
• Instructions on supportive care measures
• Signs and symptoms requiring medical attention
• Infection control measures to prevent spread to family members
• Expected timeline for resolution of symptoms

HFMD is highly contagious but typically benign in most children. The focus of management is on supportive care, maintaining adequate hydration, and monitoring for rare complications. Most cases resolve completely within 7-10 days without specific antiviral treatment.