Herpangina Treatment in Children Under 10
For a child under 10 with herpangina, treatment is entirely supportive and symptomatic, focusing on adequate hydration, pain control with topical oral anesthetics like benzocaine (for children ≥2 years), and fever management—no antiviral therapy is indicated as this is a self-limited enteroviral infection lasting 4-6 days.
Disease Overview and Diagnosis
Herpangina is an acute enteroviral infection most commonly caused by Coxsackievirus A serotypes (particularly A2, A4, A6, A10), as well as Enterovirus-A and Echovirus 1, 2. The infection spreads through fecal-oral transmission and respiratory droplets, predominantly affecting young children 2, 3.
- Diagnosis is clinical, based on characteristic pharyngeal lesions (vesicles and ulcers on the soft palate, uvula, and tonsillar pillars), fever, sore throat, and epidemiological context 1.
- Virological confirmation via PCR of throat swabs can identify specific enterovirus serotypes but is not required for routine management 1, 2.
- The natural course is 4-6 days with excellent prognosis and no neurological complications in typical cases 1, 4.
Symptomatic Treatment Approach
Hydration and Dietary Modifications
- Ensure adequate rehydration, as painful oral lesions reduce oral intake 5.
- Recommend soft, bland diet excluding salty, spicy, and fried foods that exacerbate mucosal pain 5.
- Monitor for signs of dehydration, particularly in younger children who may refuse fluids due to pain 1.
Topical Pain Management
- Benzocaine topical spray or gel is FDA-approved for children ≥2 years: apply to affected areas using applicator tip up to 4 times daily 6.
- Benzydamine spray (0.255 mg/dose, 6 doses 3 times daily) provides local anesthetic and anti-inflammatory effects for pharyngeal lesions 5.
- Topical anesthetics provide immediate symptomatic relief for painful oral ulcers, facilitating adequate oral intake 5, 1.
Fever and Pain Control
- Use acetaminophen or ibuprofen for fever and systemic discomfort at weight-appropriate doses 1.
- Avoid aspirin in children due to Reye's syndrome risk with viral infections 1.
What NOT to Do
- Do not prescribe systemic antiviral medications: herpangina is self-limited and no antiviral therapy (including acyclovir) is indicated or effective 1.
- Do not use antibiotics: this is a viral infection and antibiotics provide no benefit 1.
- Avoid thermal procedures (hot compresses, steam inhalation) which may worsen mucosal inflammation 5.
- Restrict physical activity during the acute febrile phase to prevent complications 5.
Monitoring and Follow-Up
- Oral lesions typically resolve within 7 days without scarring 1, 3.
- Reassess if symptoms persist beyond 7 days or if the child develops neurological signs (severe headache, altered mental status, seizures), which would suggest enterovirus 71 infection requiring urgent evaluation 4.
- Complete symptom regression is expected by day 10 from onset 5.
Special Considerations
- Herpangina frequently presents with concurrent hand, foot, and mouth disease (HFMD) features in 48% of cases, particularly with Coxsackievirus A6 and A10 4.
- Enterovirus 71, though less common (6.3% of cases), carries risk of neurological complications and requires heightened vigilance 4.
- The infection is highly contagious; implement respiratory and contact precautions to prevent household transmission 2, 4.