What is the recommended treatment for hand, foot, and mouth disease (HFMD) in an 8-year-old child?

Treatment for Hand, Foot, and Mouth Disease in an 8-Year-Old Child

Hand, foot, and mouth disease (HFMD) in an 8-year-old child should be managed with supportive care, including acetaminophen or ibuprofen for pain and fever, adequate hydration, and soft diet, as the condition is typically self-limiting and resolves within 7-10 days without specific antiviral therapy.

Disease Overview

Hand, foot, and mouth disease is a highly contagious viral illness primarily affecting children under 5 years of age, though it can occur in older children and adults. It is caused by enteroviruses, most commonly coxsackieviruses A6, A16, and enterovirus 71 1, 2.

Clinical Presentation

• Fever and sore throat as initial symptoms
• Maculopapular or vesicular eruptions on:
  • Palms of hands
  • Soles of feet
  • Oral cavity (painful oral lesions)
• Symptoms typically last 7-10 days 1, 2

Treatment Approach

First-Line Management (Supportive Care)

1. Pain and fever management:

   • Acetaminophen or ibuprofen as needed for pain and fever
   • Avoid aspirin in children due to risk of Reye syndrome

2. Oral care and hydration:

   • Encourage fluid intake to prevent dehydration
   • Cold liquids, popsicles, and ice cream can soothe mouth pain
   • Avoid acidic, spicy, or salty foods/beverages that may irritate mouth sores
   • Mild toothpaste and gentle oral hygiene 3

3. Topical oral pain relief options:

   • Topical oral anesthetics (benzocaine) may provide temporary relief
   • Salt water rinses for older children who can rinse and spit

Specific Considerations for Skin Lesions

• Keep lesions clean and dry
• Avoid harsh soaps or chemicals on affected skin
• Loose-fitting clothing to minimize irritation

When to Seek Additional Medical Care

• Signs of dehydration (decreased urination, dry mouth, lethargy)
• High or persistent fever (>102°F for more than 3 days)
• Severe headache, neck stiffness, or altered mental status (rare neurological complications)
• Difficulty breathing or rapid breathing

Important Considerations

Complications

• Most cases resolve without complications
• Rare but serious complications can include:
  • Neurological complications (meningitis, encephalitis)
  • Respiratory issues (pulmonary edema) - primarily with EV71 infections
  • Nail changes (Beau's lines or nail shedding) may occur weeks after infection 4

Prevention of Transmission

• Handwashing with soap and water
• Avoiding close contact with infected individuals
• Disinfecting contaminated surfaces
• Keeping the child home from school until fever subsides and mouth sores heal

Pitfalls to Avoid

1. Unnecessary antibiotic use: HFMD is viral, and antibiotics are ineffective and may cause adverse effects.

2. Inadequate pain management: Oral lesions can be quite painful and may lead to decreased fluid intake and dehydration if pain is not adequately controlled.

3. Missing severe cases: While most cases are mild, be vigilant for signs of severe disease, particularly with EV71 infections, which can cause neurological and cardiopulmonary complications.

4. Overlooking dehydration: Painful oral lesions may lead to decreased fluid intake, making hydration a priority in management.

While intravenous immunoglobulin has been suggested for severe cases in some international guidelines 2, this is rarely necessary for typical cases in otherwise healthy children and would only be considered in consultation with specialists for severe or complicated cases.