What is the recommended care for an infant diagnosed with hand, foot, and mouth disease?

Care of Infant with Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease in infants requires supportive care focused on maintaining hydration, managing pain and fever, and preventing transmission through meticulous hand hygiene, as there is no specific antiviral treatment available. 1, 2

Immediate Management Priorities

Hydration Assessment and Support

• Assess the infant's ability to take fluids orally at every encounter, as painful oral lesions are the primary threat to adequate hydration. 3, 1
• Offer cool, non-acidic fluids frequently in small amounts to minimize oral discomfort 1
• Eliminate citrus fruits, tomatoes, hot drinks, and spicy foods that exacerbate oral pain 1
• Monitor for signs of dehydration including decreased urine output, dry mucous membranes, and lethargy 3

Pain and Fever Control

• Administer acetaminophen or ibuprofen (if age-appropriate) for pain relief and fever reduction. 1
• Apply white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking 1
• For severe oral pain interfering with feeding, consider barrier preparations such as Gengigel mouth rinse or gel 1

Skin Care Management

Hand and Foot Lesions

• Apply intensive moisturizing care with urea-containing creams to hands and feet to soothe inflamed areas. 1
• Zinc oxide can be applied in a thin layer to itchy lesions after gentle cleansing, repeated as needed 1
• Avoid applying zinc oxide to open or weeping lesions 1
• Do not use chemical agents or plasters to remove associated skin changes 1

Foot Care for Open Sores

• Wash feet daily with careful drying, particularly between toes 1
• Avoid walking barefoot and ensure cushioned footwear protects open lesions 1
• Do not soak feet in footbaths, as this induces skin maceration and worsens open sores 1

Infection Control and Prevention

Hand Hygiene Protocol

• Hand hygiene with soap and water is more effective than alcohol-based sanitizers for HFMD prevention and is the single most important preventive measure. 3, 1
• Wash hands thoroughly for at least 15-20 seconds, covering all surfaces 3, 4
• Perform hand hygiene before and after each contact with the infant, after diaper changes, and after contact with respiratory secretions 3

Environmental Measures

• Clean and disinfect toys and objects that may be placed in the infant's mouth 1
• Avoid sharing utensils, cups, or food 1
• The infant should avoid close contact with other children until fever resolves and mouth sores heal 1

Monitoring for Complications

Warning Signs Requiring Immediate Evaluation

• Monitor for signs of neurological complications including persistent high fever, severe headache, altered mental status, or weakness, particularly as Enterovirus 71 can cause encephalitis, meningitis, or acute flaccid paralysis. 1, 5, 2
• Watch for signs of secondary bacterial infection: increased redness, warmth, purulent drainage, or worsening pain 1
• Assess for dehydration indicators if oral intake is severely compromised 3

Follow-Up Timeline

• Reassess after 2 weeks if lesions are not improving with standard care 1
• If evidence of infection has not resolved after 4 weeks, re-evaluate and consider alternative diagnoses 1

Important Caveats

Differential Diagnosis Considerations

• Distinguish HFMD from herpes simplex virus infection, as HSV has available antiviral treatment whereas HFMD does not. 1
• Rule out drug hypersensitivity reactions and Kawasaki disease, which can present with similar palmar-plantar findings 1

Expected Course and Late Manifestations

• The disease is typically self-limiting and resolves in 7-10 days without sequelae 2
• Nail changes (Beau's lines or periungual desquamation) may appear 2-8 weeks after fever onset as a delayed sequela, not active disease 1
• By the time HFMD is diagnosed, the infant has likely been shedding virus for weeks, posing limited additional transmission risk 1

What NOT to Do

• Do not use topical antiseptic or antimicrobial dressings routinely for HFMD lesions 1
• Do not exclude the infant from daycare based solely on healing skin lesions once fever has resolved and mouth sores have healed 1
• Antibacterial medications should only be used if there are specific indications of coexisting bacterial infection 3