What is the treatment for a 6-year-old child with hand, foot, and mouth disease (HFMD) and mouth sores?

Treatment of Hand, Foot, and Mouth Disease in a 6-Year-Old Child with Mouth Sores

The treatment for hand, foot, and mouth disease (HFMD) in a 6-year-old child with mouth sores is primarily supportive care, focusing on pain relief, hydration, and fever management until the illness resolves spontaneously within 7-10 days.

Supportive Care Measures

Pain and Fever Management

• Administer oral analgesics such as acetaminophen or NSAIDs for pain relief and fever reduction 1
• Dose appropriately for age and weight to manage discomfort from oral lesions 1
• Avoid aspirin in children due to risk of Reye syndrome 2

Oral Lesion Management

• Provide cold, soft foods and beverages that don't require much chewing 1
• Avoid acidic, salty, or spicy foods that may irritate mouth sores 1
• Use mild toothpaste and gentle oral hygiene techniques to minimize discomfort 1
• Consider topical oral anesthetics (such as viscous lidocaine) for severe oral pain, but use with caution to avoid numbing the gag reflex 2

Hydration

• Ensure adequate fluid intake to prevent dehydration, which is a common complication due to painful oral lesions 3
• Offer cold liquids, popsicles, or ice chips which may soothe oral lesions while providing hydration 2
• Monitor for signs of dehydration (decreased urination, dry mouth, lethargy) 2

Management of Skin Manifestations

• Apply moisturizing creams to hand and foot lesions 1
• Avoid friction and heat exposure to affected areas 1
• Monitor for any signs of secondary bacterial infection of skin lesions 1

When to Seek Additional Medical Care

• If the child is unable to drink enough fluids due to painful mouth sores 3
• If high fever persists beyond 3 days 2
• If there are any neurological symptoms (headache, neck stiffness, irritability, altered consciousness) which could indicate rare but serious complications 1, 3
• If symptoms worsen after 3-5 days instead of improving 2

Return to School Guidelines

• The child can return to school once fever has resolved and mouth sores have healed 1
• Exclusion based solely on healing skin lesions is not necessary 1
• Emphasize good hand hygiene to prevent spread to other children 1

Important Considerations and Pitfalls

• HFMD is typically self-limiting and resolves without specific antiviral treatment within 7-10 days 2
• Avoid unnecessary antibiotic use as HFMD is viral in nature 3
• Be aware that nail changes (shedding or Beau's lines) may occur weeks after initial infection 4
• The disease is highly contagious, so emphasize hand hygiene and avoiding sharing of utensils or food to prevent household transmission 1, 5
• Different viral strains (particularly Enterovirus A71) can cause more severe disease, so monitor for any unusual or worsening symptoms 3, 2