Symptom Management of Hand, Foot, and Mouth Disease
For hand, foot, and mouth disease, prioritize oral analgesics (acetaminophen or NSAIDs) for pain and fever control, combined with intensive supportive care for oral lesions and skin manifestations. 1, 2
Pain and Fever Management
- Use acetaminophen or ibuprofen for pain relief and fever reduction as first-line therapy for a limited duration 1, 2
- Avoid oral lidocaine, as it is not recommended for HFMD 2
- No antiviral treatment is currently available for HFMD 2
Oral Lesion Management
Basic Oral Care
- Apply white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking 1
- Clean the mouth daily with warm saline mouthwashes or use an oral sponge for comfort 1
- Use mild toothpaste and practice gentle oral hygiene 1
Escalation for Severe Oral Pain
- Apply benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain 1
- Use chlorhexidine oral rinse twice daily as an antiseptic measure 1
- Consider betamethasone sodium phosphate mouthwash four times daily for more severe oral involvement 1
Hydration Support
- Focus on maintaining adequate hydration, as this is a critical component of supportive care 2
- Encourage cold, soft foods and fluids that are easier to tolerate with oral ulcerations 2
Hand and Foot Lesion Management
Skin Care
- Apply intensive moisturizing creams to hands and feet, particularly urea-containing products 1
- Avoid friction and heat exposure to affected areas 1
- For itchiness, apply zinc oxide in a thin layer after gentle cleansing of affected areas 1
- For nighttime relief, apply zinc oxide followed by loose cotton gloves to create an occlusive barrier 1
Special Considerations for Open Sores on Feet
- Wash feet daily with careful drying, particularly between the toes 1
- Avoid walking barefoot and wear appropriate cushioned footwear to protect open lesions 1
- Do not soak feet in footbaths, as this can induce skin maceration and worsen open sores 1
- Avoid using chemical agents or plasters to remove corns or calluses 1
- Do not use topical antiseptic or antimicrobial dressings routinely, as these are not recommended for wound healing in HFMD 1
Monitoring for Complications
- Monitor for signs of secondary bacterial infection, including increased redness, warmth, purulent drainage, or worsening pain 1
- Treat any secondary bacterial infections that develop 1
- Reassess after 2 weeks if lesions are not improving with standard care 1
Prevention of Transmission
- Handwashing with soap and water is more effective than alcohol-based hand sanitizers for preventing HFMD spread 1
- Clean and disinfect toys and objects that may be placed in children's mouths 1, 2
- Avoid sharing utensils, cups, or food 1
- Children should avoid close contact with others until fever resolves and mouth sores heal 1
Return to Daycare/School
- Children can return to daycare once fever has resolved and mouth sores have healed, even if skin rash is still present 1
- Exclusion based solely on healing skin lesions is not necessary 1
- By the time HFMD is diagnosed, the child has likely had the infection for weeks, posing limited additional risk to others 1
Common Pitfalls to Avoid
- Do not use oral lidocaine for pain management 2
- Do not exclude children from daycare based on persistent skin lesions alone after fever and oral lesions have resolved 1
- Do not apply zinc oxide to open or weeping lesions 1
- Do not routinely use topical antimicrobial dressings on foot lesions 1
Special Populations
- Immunocompromised patients may experience more severe disease and should be monitored closely 1
- Watch for rare but serious complications including neurological manifestations (encephalitis, meningitis, acute flaccid paralysis) particularly with Enterovirus 71 1, 3
- Most cases resolve in 7-10 days without sequelae 2, 3