Treatment for Painful Tongue Ulcers in Hand, Foot, and Mouth Disease
For your 7-year-old's painful tongue ulcers from HFMD, use topical anesthetic preparations (viscous lidocaine 2%) before meals combined with barrier agents and supportive care—this is a self-limited viral illness that typically resolves within 1-2 weeks with symptomatic management only. 1, 2, 3
Immediate Pain Management
The priority is controlling pain to allow your child to eat and drink:
- Apply viscous lidocaine 2% directly to the ulcers 3-4 times daily, particularly 15-20 minutes before meals 1, 2
- Note that FDA labeling for topical lidocaine indicates use for children under 12 years requires asking a doctor, so confirm with your pediatrician before use 4
- Benzydamine hydrochloride oral rinse or spray can be used every 3 hours, especially before eating 1, 2
- Oral acetaminophen for systemic pain control and fever management 5
Barrier Protection and Healing
Apply protective agents to shield the ulcers:
- Use mucoprotectant mouthwashes like Gelclair three times daily to create a protective coating over the ulcers 1, 6
- Barrier preparations (Gengigel mouth rinse/gel) can reduce pain and promote healing 2
Oral Hygiene Measures
Maintain oral cleanliness to prevent secondary infection:
- Rinse with warm saline mouthwashes several times daily 1, 2
- Use antiseptic oral rinses like 0.2% chlorhexidine digluconate twice daily 1, 2
- Ensure good oral hygiene despite discomfort 1
Supportive Care
HFMD is self-limited and requires only symptomatic treatment:
- The oral ulcers and other lesions typically resolve within 2-3 weeks without complications 3
- Most symptoms last less than 1 week 7
- Encourage fluid intake to prevent dehydration, which is the main concern with painful oral ulcers 8
- Offer cold, soft foods that are easier to tolerate 8
When to Escalate Care
While HFMD is typically benign, watch for warning signs:
- If ulcers persist beyond 2 weeks or worsen despite treatment, seek specialist evaluation 1
- Monitor for signs of dehydration (decreased urination, dry mouth, lethargy) 9
- Be aware that HFMD can rarely be associated with neurological complications, though this is uncommon 9
Important Caveats
Topical steroids are NOT indicated for HFMD ulcers - the guidelines recommending topical corticosteroids apply to aphthous ulcers and other inflammatory conditions, not viral ulcers from HFMD 1, 2, 6. Using steroids on viral lesions could theoretically worsen the infection.
Your child remains contagious until the blisters have disappeared, and the virus may be present in feces for several weeks 8. However, exclusion from school is not practical given the prolonged viral shedding 8.
The ulcers under the tongue are often the last to heal and can be particularly painful because this area experiences constant movement and moisture 3. The fact that other mouth sores are improving is a good sign that the illness is following its natural course toward resolution.