What is the recommended management for Hand, Foot, and Mouth (HFM) disease in a child?

Management of Hand, Foot, and Mouth Disease in Children

Hand, foot, and mouth disease (HFMD) in children is primarily managed with supportive care, including oral analgesics for pain and fever control, intensive oral hygiene, and skin care measures, with most cases resolving spontaneously in 7-10 days. 1, 2

Supportive Care Measures

Pain and Fever Management

• Use acetaminophen or NSAIDs for pain relief and fever reduction for a limited duration 1
• Adequate analgesia is essential for comfort, particularly when oral lesions cause significant pain 1

Oral Care Protocol

• 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 gentle cleansing 1
• Apply benzydamine hydrochloride oral rinse or spray every 2-4 hours, particularly before eating, to reduce inflammation and pain 1
• Use mild toothpaste and maintain gentle oral hygiene practices 1
• For severe oral involvement, consider betamethasone sodium phosphate mouthwash four times daily 1

Skin Care for Hand and Foot Lesions

• 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, which can be repeated as needed 1
• Avoid applying zinc oxide to open or weeping lesions 1

Management of Open Sores on Feet

• Wash feet daily with careful drying, particularly between the toes 1
• Avoid walking barefoot and ensure 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
• Monitor for signs of secondary bacterial infection including increased redness, warmth, purulent drainage, or worsening pain 1

Prevention and Infection Control

Hand Hygiene

• Thorough handwashing with soap and water is the most important preventive measure and is more effective than alcohol-based hand sanitizers 1

Environmental Measures

• Clean toys and objects that may be placed in children's mouths 1
• Avoid sharing utensils, cups, or food 1

Isolation Guidelines

• Children should avoid close contact with others until fever resolves and mouth sores heal 1
• Children can return to daycare once fever has resolved and mouth sores have healed, even if skin rash is still present - 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

Recognition of Severe Disease

High-Risk Features Requiring Close Monitoring

Children under 3 years with EV-A71 infection and disease duration less than 3 days require particular attention 3. Warning signs of potential deterioration include:

• Persistent hyperthermia 3
• Involvement of nervous system 3
• Worsening respiratory rate and rhythm 3
• Circulatory dysfunction 3
• Elevated peripheral WBC count 3
• Elevated blood glucose 3
• Elevated blood lactic acid 3

Severe Complications

• Neurological complications such as encephalitis/meningitis, acute flaccid myelitis, and acute flaccid paralysis can occur, particularly with EV-A71 1
• Circulatory failure secondary to myocardial impairment and neurogenic pulmonary edema secondary to brainstem damage are the main causes of death 2
• Immunocompromised patients may experience more severe disease and should be monitored closely 1

Treatment of Severe Cases

• Most mild cases can be treated as outpatients 3
• Intravenous immunoglobulin should be considered for severe/complicated HFMD and has been recommended by several national and international guideline committees 2
• Intense treatment modalities including mechanical ventilation should be given for severe cases 4

Common Pitfalls to Avoid

• Do not use chemical agents or plasters to remove corns or calluses associated with HFMD lesions 1
• Do not use topical antiseptic or antimicrobial dressings routinely for HFMD foot lesions 1
• Reassess after 2 weeks if lesions are not improving with standard care 1

Diagnostic Confirmation

• Reverse transcriptase PCR (RT-PCR) targeting the 5' non-coding region is the preferred diagnostic method due to its sensitivity and specificity 1
• Vesicle fluid samples have high viral loads and are ideal for testing 1
• Respiratory samples and/or stool specimens can also be used for diagnosis 1