What are the management and contagion period for a confirmed case of hand, foot, and mouth disease (HFMD) in a 7-year-old child?

Management of Hand, Foot, and Mouth Disease in a 7-Year-Old

Symptom Relief

For a confirmed case of HFMD in a 7-year-old, provide oral analgesics (acetaminophen or NSAIDs) for pain and fever relief, along with intensive supportive care for oral and skin lesions. 1

Pain and Fever Management

• Administer acetaminophen or NSAIDs for a limited duration to control pain and reduce fever 1
• These medications address the constitutional symptoms and discomfort from oral and skin lesions 1

Oral Lesion Care

• Apply white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking 1
• Use warm saline mouthwashes or an oral sponge for daily mouth cleaning 1
• 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
• For severe oral involvement, consider betamethasone sodium phosphate mouthwash four times daily 1
• Maintain gentle oral hygiene with mild toothpaste 1

Skin Lesion Management

• Apply intensive moisturizing care to hands and feet with urea-containing creams or ointments 1
• Avoid friction and heat exposure to affected areas 1
• For itchiness, zinc oxide can be applied as a protective barrier in a thin layer after gentle cleansing 1
• Zinc oxide application can be repeated as needed when itchiness returns 1
• Avoid applying zinc oxide to open or weeping lesions 1

Foot Care for Open Sores

• 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
• Treat any secondary bacterial infections that develop 1

Contagion Period and Return to Activities

Children with HFMD can return to daycare or school once fever has resolved and mouth sores have healed, even if skin rash is still present. 1

Transmission Dynamics

• By the time HFMD is diagnosed, the child has likely had the infection for weeks and poses limited additional risk to others 1
• Exclusion based solely on healing skin lesions is not necessary 1
• The typical duration of illness ranges from 7-10 days, though CVA6 strains may cause longer duration of disease 2, 3

Prevention Measures During Illness

• Hand hygiene with soap and water is the most important preventive measure and is more effective than alcohol-based hand sanitizers for HFMD 1
• Avoid sharing utensils, cups, or food 1
• Clean toys and objects that may be placed in children's mouths 1
• Children should avoid close contact with others until fever resolves and mouth sores heal 1

Monitoring and Follow-Up

• Reassess after 2 weeks if lesions are not improving with standard care 1
• Watch for rare but serious neurological complications (encephalitis, meningitis, acute flaccid paralysis) particularly with severe cases, though these are more commonly associated with EV-71 strains 1
• Note that nail dystrophies (Beau's lines or nail shedding) may occur weeks after initial symptom onset 4

Common Pitfalls to Avoid

• Do not use chemical agents or plasters to remove corns or calluses associated with HFMD lesions 1
• Do not routinely use topical antiseptic or antimicrobial dressings for HFMD foot lesions, as these are not recommended for wound healing 1
• Distinguish HFMD from herpes simplex virus, as the latter has available antiviral treatment options while HFMD does not 1