Treatment of Hand, Foot, and Mouth Disease in a 6-Year-Old
Hand, foot, and mouth disease in a 6-year-old requires supportive care only—no antiviral medications or corticosteroids should be used. 1, 2
Primary Treatment Approach
Symptomatic pain and fever management:
- Use oral acetaminophen or NSAIDs for a limited duration to relieve pain and reduce fever 1
- These are the cornerstone of treatment for constitutional symptoms 3
Management of Oral Lesions
The oral lesions are often the most bothersome symptom and require specific attention:
- Apply white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking 1
- Use benzydamine hydrochloride oral rinse or spray every 3 hours, particularly before eating, to reduce inflammation and pain 1
- Clean the mouth daily with warm saline mouthwashes 1
- Use mild toothpaste and gentle oral hygiene practices 1
- For more severe oral involvement, consider chlorhexidide oral rinse twice daily as an antiseptic measure 1
Management of Skin Lesions
For hand and foot lesions:
- Apply intensive moisturizing care with urea-containing creams to hands and feet 1
- Avoid friction and heat exposure to affected areas 1
- For itchy lesions, apply zinc oxide as a protective barrier in a thin layer 1
- Wash feet daily with careful drying, particularly between the toes 1
- Ensure the child wears appropriate cushioned footwear and avoids walking barefoot if foot lesions are present 1
Critical Pitfalls to Avoid
Do not prescribe corticosteroids for HFMD. Despite the presence of inflammation or fever, corticosteroids suppress the immune response necessary for viral clearance and may increase the risk of severe complications and death 2. This is a critical error that must be avoided.
Do not use topical antiseptic or antimicrobial dressings routinely for HFMD foot lesions, as these are not recommended for wound healing 1
Do not use chemical agents or plasters to remove any associated corns or calluses 1
Monitoring for Complications
While HFMD is typically self-limiting and resolves in 7-10 days without sequelae 3, monitor for:
- Signs of secondary bacterial infection: increased redness, warmth, purulent drainage, or worsening pain 1
- Neurological complications (rare but serious): encephalitis, meningitis, acute flaccid paralysis—particularly with Enterovirus 71 1, 4
- Dehydration from poor oral intake due to painful mouth sores 5
Reassess after 2 weeks if lesions are not improving with standard care 1
Return to School/Activities
The child can return to school once fever has resolved and mouth sores have healed, even if skin rash is still present. Exclusion based solely on healing skin lesions is not necessary 1. By the time HFMD is diagnosed, the child has likely been shedding virus for days to weeks 1.
Prevention Measures for Household
- Emphasize thorough handwashing with soap and water (more effective than alcohol-based sanitizers) 1
- Avoid sharing utensils, cups, or food 1
- Clean toys and objects that may be placed in children's mouths 1
- Other household members should practice good hand hygiene, as intra-familial transmission is common 5
Expected Course
The disease typically resolves spontaneously within 7-10 days without complications in immunocompetent children 3, 6. Nail shedding may occur 3-6 weeks after infection as a late sequela, which is benign and self-resolving 7.