What is the natural course of Hand, Foot, and Mouth Disease (HFMD) in a toddler?

From the Guidelines

Hand, foot, and mouth disease (HFMD) in toddlers is a self-limiting illness that typically resolves on its own within 7-10 days without specific treatment. The natural course of the disease begins with mild fever, sore throat, and reduced appetite, followed by the characteristic rash of small, blister-like lesions appearing in the mouth, on palms, soles, and sometimes buttocks within 1-2 days after fever onset 1. The mouth sores can be painful and may cause difficulty eating or drinking. Fever usually resolves within 3 days, while the rash gradually crusts over and disappears within a week without scarring. Some key points to consider in the management of HFMD in toddlers include:

• Treatment is supportive, focusing on pain management with acetaminophen or ibuprofen, maintaining hydration with cold fluids and soft foods, and using oral numbing rinses like diluted liquid antacid for mouth pain.
• The condition is highly contagious through contact with saliva, respiratory secretions, and fluid from blisters, with children remaining contagious for about a week.
• Most children recover completely without complications, though rare cases may develop neurological issues or dehydration requiring medical attention, as enteroviruses can occasionally cause severe disease including meningoencephalitis, myelitis, paralysis, myocarditis, sepsis-like syndrome, respiratory disease and acute hepatitis 1.
• The disease is caused primarily by coxsackieviruses and enterovirus 71, and children can develop immunity to the specific virus strain but may contract different strains in the future. It is essential to note that while most cases of HFMD are mild, certain enterovirus types, notably EV-A71, have been associated with outbreaks and rare but severe cases of rhomboencephalitis, emphasizing the importance of monitoring for severe symptoms and seeking medical attention if necessary 1.

From the Research

Natural Course of Hand Foot Mouth Disease in Toddlers

• The natural course of hand foot mouth disease in toddlers is typically self-limiting, with symptoms resolving in 7 to 10 days without sequelae 2, 3, 4.
• The disease is characterized by a painful oral enanthem and asymptomatic exanthem on the palms and soles, with children younger than 5 years being most commonly affected 2.
• The incubation period of hand foot mouth disease is 3 to 10 days, after which fever and sore throat appear, followed by maculopapular or vesicular eruptions on the palms and soles and in the oral cavity 4.
• In most cases, the disease is benign and resolves without complications, but in rare cases, patients may experience neurologic or cardiopulmonary complications 3, 4, 5.
• Severe cases of hand foot mouth disease can be caused by enterovirus A71, and may result in circulatory failure, neurogenic pulmonary edema, and other serious complications 2, 5.

Symptoms and Treatment

• Symptoms of hand foot mouth disease include low-grade fever, maculopapular or papulovesicular rash on the hands and soles, and painful oral ulcerations 3.
• Treatment is mainly symptomatic and supportive, with a focus on hydration and pain relief using acetaminophen or ibuprofen 2, 3.
• Intravenous immunoglobulin may be considered for severe or complicated cases of hand foot mouth disease 2.
• There are currently no specific antiviral agents approved for the treatment of hand foot mouth disease, but several potential candidates are being researched 2, 4, 5.

Prevention and Epidemiology

• Hand foot mouth disease is highly contagious and can be prevented through good personal hygiene, such as handwashing and disinfecting potentially contaminated surfaces and fomites 3, 6.
• The disease is mainly spread through fecal-oral, oral-oral, and respiratory droplet contact 3.
• Outbreaks of hand foot mouth disease can occur in the spring to fall and are common in North America, with most cases occurring in patients younger than 10 years 3.
• A vaccine against hand foot mouth disease is not yet available, but several novel agents with good in vitro and in vivo activity against enteroviruses are being developed 4, 5.