What is the treatment for a 6-year-old child with Hand, Foot, and Mouth Disease (HFMD) who hasn't had a bowel movement for 2 days?

Treatment of Constipation in a 6-Year-Old Child with HFMD

For a 6-year-old child with hand, foot, and mouth disease who hasn't had a bowel movement for 2 days, treat the constipation symptomatically while ensuring adequate hydration and continuing normal feeding, as HFMD itself is self-limiting and does not require specific intervention. 1, 2

Immediate Assessment

• Evaluate the child's hydration status by examining skin turgor, mucous membranes, mental status, pulse, and capillary refill time 3, 4
• Assess for signs of dehydration: mild (3-5% fluid deficit) presents with increased thirst and slightly dry mucous membranes; moderate (6-9% deficit) shows loss of skin turgor and dry mucous membranes; severe (≥10% deficit) manifests as lethargy, prolonged skin tenting, cool extremities, and decreased capillary refill 3
• Weigh the child to establish baseline for monitoring 3, 4
• Examine for oral ulcers and vesicular rashes that may be limiting oral intake 1, 2

Hydration Management

• If the child shows any signs of dehydration, administer oral rehydration solution (ORS) containing 50-90 mEq/L sodium: for mild dehydration give 50 mL/kg over 2-4 hours; for moderate dehydration give 100 mL/kg over 2-4 hours 3, 4, 5
• If the child is well-hydrated, encourage increased fluid intake through water and age-appropriate beverages to soften stool 3
• Avoid apple juice, Gatorade, and commercial soft drinks for rehydration purposes 3

Feeding Recommendations

• Continue normal age-appropriate diet without restriction, as HFMD is self-limiting and typically resolves within a few days 1, 6
• Offer soft, bland foods if oral ulcers are causing discomfort 1, 7
• Do not withhold or modify regular feeding unless severe dehydration is present 4

Constipation Treatment

• For a 6-year-old child with 2 days of constipation, consider lactulose at an initial dose of 40-90 mL daily in divided doses, adjusted to produce 2-3 soft stools daily 8
• If diarrhea develops from lactulose, reduce the dose immediately and discontinue if diarrhea persists 8
• Monitor bowel movements and adjust treatment based on response 8

Supportive Care for HFMD

• Provide symptomatic relief for fever and discomfort with age-appropriate analgesics 1, 6
• Maintain good hygiene to prevent transmission, as HFMD is highly contagious 1, 2, 7
• Reassure parents that HFMD is typically self-limiting and resolves within days without complications in most cases 1, 6

Monitoring and Follow-up

• Reassess hydration status after 2-4 hours if rehydration was initiated 3, 4
• Monitor for severe complications such as neurological symptoms (lethargy, altered mental status, seizures), respiratory distress, or persistent high fever, which would require immediate medical evaluation 1, 2, 9
• Follow up on bowel function within 24-48 hours to ensure constipation is resolving 8

Key Clinical Pearls

• HFMD has no specific pharmacological intervention and treatment remains supportive 1, 2
• Constipation in the context of HFMD may result from decreased oral intake due to painful oral ulcers or general malaise 1, 7
• Most HFMD cases resolve spontaneously, but children under 3 years have higher risk of severe complications including brain stem encephalitis 9
• Antidiarrheal agents are contraindicated in all children under 2 years if diarrhea develops 4