Relief of Mouth Pain in Infants with Hand-Foot-and-Mouth Disease
For infants with hand-foot-and-mouth disease, administer oral acetaminophen for systemic pain relief and apply white soft paraffin ointment to the lips every 2 hours to prevent drying and cracking. 1, 2
Systemic Pain Management
- Oral acetaminophen is the first-line systemic analgesic for infants with painful oral lesions from HFMD 1, 2, 3
- Ibuprofen can also be used for pain relief in infants old enough to receive NSAIDs (typically >6 months) 1, 3
- Dose these medications appropriately for weight and age, continuing for a limited duration while symptoms are most severe 1
Topical Treatments for Oral Lesions
- Apply white soft paraffin ointment to the lips every 2 hours during the acute phase to provide a protective barrier and prevent painful cracking 1, 2
- Clean the mouth daily with warm saline using an oral sponge or a clean finger wrapped in gauze soaked in warm saline 1, 2
- Topical 2.5% lidocaine ointment can be cautiously applied to accessible ulcers, but use extremely sparingly to avoid accidental ingestion and systemic toxicity in young infants 4, 2
Critical Caveat on Topical Anesthetics
Oral lidocaine is NOT recommended for routine use in HFMD due to the risk of toxicity from accidental ingestion in infants 3. If used at all, apply only tiny amounts to specific lesions, never to the entire oral cavity 2.
Feeding and Hydration Strategies
- Ensure adequate hydration is paramount, as painful mouth sores cause infants to resist drinking and dehydration is the primary complication requiring medical intervention 1, 2
- For breastfed infants, continue nursing as this provides both nutrition and comfort 2
- Offer cool (not hot) liquids, as cold temperatures may provide additional soothing 1
- Avoid citrus fruits, tomatoes, and any acidic foods that will exacerbate oral pain 1
Additional Supportive Measures
- Use a pacifier in combination with pain management, as nonnutritive sucking contributes to calming and decreasing pain-related distress in infants 5
- Consider administering 2 mL of 25% sucrose solution by syringe (1 mL in each cheek) before particularly painful episodes like feeding attempts, as this has analgesic effects in infants under 6 months 5
- Maintain gentle oral hygiene with soft cleaning to prevent secondary bacterial infection 1
What NOT to Do
- Do not use benzydamine hydrochloride oral rinse, chlorhexidine rinses, or betamethasone mouthwashes in infants, as these are recommended only for older children and adults 1
- Avoid hot foods, spicy foods, and rough-textured foods that will traumatize already painful oral tissues 1
- Do not apply topical steroids routinely to oral lesions in infants with HFMD, as the disease is self-limited and resolves in 7-10 days 3, 6
Expected Course and Follow-Up
- Oral lesions typically resolve within 7-10 days without intervention 3, 6
- Monitor for signs of dehydration (decreased urine output, dry mucous membranes, lethargy) as the primary indication for escalation of care 1
- Reassess if symptoms worsen or fail to improve after 10-14 days, considering alternative diagnoses 1