What is the management of Hand, Foot, and Mouth Disease (HFMD) in a 1-year-old patient?

Management of Hand, Foot, and Mouth Disease in a 1-Year-Old Patient

HFMD in a 1-year-old requires supportive care focused on symptom relief, with ibuprofen preferred over acetaminophen for fever control, daily lukewarm baking soda baths for skin comfort, and vigilant monitoring for rare but serious neurological complications. 1

Symptomatic Treatment

Fever and Pain Management

• Ibuprofen is superior to acetaminophen for reducing fever in children with HFMD, though dosing must be adjusted if renal function is impaired 1
• Fever typically resolves within a few days as the illness is self-limited 2, 3

Skin Care and Comfort Measures

• Administer daily lukewarm baths with baking soda (sodium bicarbonate) at 3-6 g/L concentration to soothe skin rash, reduce itching, and provide comfort 1
• After bathing, gently remove scales using soft materials like sponges or microfiber cloths 1
• Alternative bath options include colloidal preparations or normal saline (0.9%) 1
• Add moisturizing additives to prevent skin dryness 1

Oral Care

• Use mild toothpaste and maintain gentle oral hygiene for comfort with oral lesions 1
• Oral ulcers typically resolve spontaneously within less than 1 week 3

Monitoring for Complications

Red Flag Symptoms Requiring Immediate Evaluation

At 1 year of age, this child is in the highest-risk group for severe complications, as 97% of neurological complications occur in children under 15 years, with the majority in young children 4:

• Persistent vomiting - may indicate neurological involvement 4
• Myoclonic jerks, seizures, or convulsions - signs of meningoencephalitis or brainstem encephalitis, which account for 70% of neurological complications 4
• Severe headache or altered consciousness - concerning for CNS involvement 4
• Cardiopulmonary symptoms - HFMD can lead to potentially fatal cardiopulmonary complications 5

Common Pitfall to Avoid

Do not dismiss persistent fever or vomiting as typical HFMD symptoms. Enterovirus 71 (especially genotype C4a) can cause severe neurological sequelae and requires early detection for appropriate intervention 4. While most cases resolve without complications 2, the predilection for the nervous system in young children necessitates vigilance 5.

Infection Control and Return to Activities

The child should not return to daycare or group settings until:

• Fever has resolved without medications
• All blisters have dried and crusted over
• At least 7 days have passed since symptom onset 1

This strict isolation period is critical because enteroviruses are highly contagious, particularly in child populations 5.

Expected Clinical Course

• Symptoms typically last less than 1 week and resolve spontaneously 3
• The characteristic tender lesions on hands, feet, and oral mucosa are easily recognized 2
• Note: Nail shedding may occur weeks after recovery as a delayed sequela; this is benign and requires no intervention 2

When Specific Antiviral Treatment Is NOT Available

There is currently no specific pharmaceutical intervention for HFMD 5. The inactivated EV-A71 vaccine approved in China provides protection against one causative agent but does not cover the multiple circulating pathogens 5. Therefore, supportive care and hygiene measures remain the standard of care 2.