What is the recommended treatment for hand, foot, and mouth disease in children?

Treatment for Hand, Foot, and Mouth Disease in Children

The recommended treatment for hand, foot, and mouth disease (HFMD) in children is primarily supportive care focused on hydration and pain relief with acetaminophen or ibuprofen, as the condition is self-limiting and typically resolves within 7-10 days without specific antiviral therapy. 1

Clinical Presentation and Diagnosis

• HFMD is caused by human enteroviruses and coxsackieviruses, most commonly Coxsackievirus A6, Coxsackievirus A16, and Enterovirus 71 1, 2
• Typical presentation includes:
  • Low-grade fever
  • Maculopapular or papulovesicular rash on hands and feet
  • Painful oral ulcerations/lesions
  • Symptoms typically appear in children under 5 years of age 2

Treatment Algorithm

1. Supportive Care (First-Line Treatment)

• Hydration

  • Ensure adequate fluid intake
  • Offer cold fluids, popsicles, or ice cream to soothe oral pain and prevent dehydration 1

• Pain Management

  • Acetaminophen or ibuprofen as needed for pain and fever 1
  • Important: Oral lidocaine is NOT recommended 1

2. Oral Lesion Management

• Soft, bland diet to minimize discomfort from oral lesions
• Cold foods and liquids may provide relief
• Avoid acidic, salty, or spicy foods that may irritate lesions

3. Skin Lesion Care

• Keep skin lesions clean and dry
• No specific topical treatments are required

Infection Control Measures

• Hand Hygiene

  • Proper handwashing with soap and water for at least 15 seconds 3
  • Use of alcohol-based hand sanitizers when soap and water are not available 3

• Environmental Cleaning

  • Disinfect frequently touched surfaces and shared toys 3
  • Wash soiled clothing, bedding, and towels in hot water with detergent 3

• Isolation Precautions

  • Children should be kept home from school or daycare until:
    • Fever-free for 24 hours without medication
    • Child feels well enough to participate in activities
    • Most lesions have dried 3

Monitoring for Complications

While HFMD is typically mild and self-limiting, parents should monitor for rare but serious complications:

• Neurological complications:

  • Encephalitis
  • Meningitis
  • Signs include: severe headache, stiff neck, unusual sleepiness 3, 2

• Cardiopulmonary complications:

  • More common with Enterovirus 71 infections 2
  • Signs include: rapid breathing, respiratory distress

• Dehydration:

  • Decreased urination
  • Dry mouth
  • Lethargy

Special Considerations

• Atypical Presentations:

  • Children with atopic dermatitis may develop "eczema coxsackium," which can resemble herpetic infection 4
  • Nail changes (shedding) may occur after HFMD resolves 4

• Severe Cases:

  • EV-A71 infections, especially in children under 3 years, may have higher risk of complications 5
  • Warning signs of severe disease include:
    • Persistent high fever
    • Neurological symptoms
    • Abnormal respiratory rate/rhythm
    • Circulatory dysfunction
    • Elevated white blood cell count, blood glucose, or lactic acid 5

Prevention

• Handwashing is the most effective preventive measure 3, 1
• Disinfection of potentially contaminated surfaces and objects
• Avoiding close contact with infected individuals
• No specific vaccine is widely available, though an EV-A71 vaccine has been approved in China 2

HFMD is highly contagious but generally follows a benign course with complete recovery. The focus of treatment should be on symptom management and prevention of dehydration, while monitoring for the rare but serious complications that may occur.