The ABCs of HFMD (Hand, Foot and Mouth Disease)

With 9,822 cases reported so far in 2023, Dr Erwin Khoo, Head of Paediatrics Department at International Medical University (IMU), counsels parents on what to do when their child is affected and how to keep the rest of the family safe.

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Every parent is all too familiar with their toddler’s messy habit of putting everything in their mouths, which puts them at high risk for hand, foot and mouth disease (HFMD). This highly infectious disease is currently sweeping across the country, with 170 clusters leaving in its wake a multitude of sick children, parents struggling to care for their infected child while trying to cope with work and home matters, as well as nurseries, kindergartens and childcare centres forced to shut in order to prevent further transmission of the virus.

In spite of its frequent occurrence however, many people remain unclear about what it is and what to do about it. To set the record straight, Dr Erwin Khoo, Head of Paediatrics Department at International Medical University (IMU) presents three essential facts about HFMD and shares some handy tips for parents.

HFMD Feet Rashes

HFMD is highly contagious and the virus can stay incubated for up to 14 days

Symptoms of HFMD usually include fever, mouth sores, and rashes. HFMD and chickenpox are examples of viral exanthems. However, unlike chicken pox, the rashes are not usually on the trunk of the body but on the hands and feet and sometimes also on the knees, elbows and buttocks.

Dr Erwin Khoo, Head of Paediatrics Department at International Medical University (IMU)
Dr Erwin Khoo, Head of Paediatrics Department at International Medical University (IMU)

“HFMD is caused by viruses, with the most common being Coxsackie A16 and Enterovirus 71,” says Dr Erwin. “These viruses can be found in the respiratory tract and faeces, and in the fluid-filled blisters that form on the hands and feet. The virus can remain contagious for several days on hard surfaces. The usual incubation period is between 3-7 days and can go up to 2 weeks, which allows HMFD to spread easily amongst those in close contact and in circumstances where toys or utensils are shared, or when proper hand hygiene is not practiced after routine childcare tasks like changing diapers after a child excretes.”

While most people think of HFMD as a childhood disease – most cases affect children under the age of 6 years – the truth is that it can affect adults too. Some people think that adults get worse HFMD symptoms but studies show adults usually experience milder symptoms. Affected adults could still pass the virus on to others – for example, an adult working in a childcare centre that has HFMD cases could carry the virus home where it could affect their spouse, children and elderly parents as well. It is also possible to get HFMD more than once, as there are different strains and immunity towards enteroviruses is only temporary.

What parents can do:

Having an active HMFD case in a home means having to be extra careful and vigilant about limiting contact with the infected individual and practicing good hand hygiene – similar to the preventive measures practised during the pandemic. Parents and caregivers should wash or disinfect hands regularly, especially after caring for an infected child, wipe down common areas with disinfectant, avoid sharing of food and utensils and avoid touching the eyes or nose. These measures should continue for up to 10 days. A child with confirmed HFMD should stay home to prevent passing the infection on to others but extreme measures such as room isolation may be excessive and unnecessary because it is not typically spread through the air like some respiratory infections, says Dr Erwin.

There is no cure or specific treatment for HFMD

Unfortunately, there is no way to prevent HFMD and while there are different viruses that cause HFMD, there is no specific treatment or cure, only methods to alleviate the symptoms, says Dr Erwin.

He also cautions against certain remedies that are commonly passed around, such as the use of bathing in a solution of coarse salts or soaking in enzyme water, as they may irritate the skin instead. Furthermore, there is no evidence that these have any effect on speeding up the healing process, which usually takes between 7-10 days.

What parents can do:

  • Treat the fever with paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs), which also help to reduce the pain and inflammation of mouth ulcers. However, parents should get the advice of a paediatrician before giving their child NSAIDs.
  • Give the child foods that are easy to swallow such as soups and porridge in place of solid foods that require chewing.
  • Prevent dehydration by regularly offering the child their favourite drinks or juices.
  • Soothe mouth ulcers with cold treats like ice cream, yogurt, and jelly. Alcohol-free mouth rinses and oral gels can also help.
  • Shower or bathe regularly to soothe the sores and towel dry gently to avoid breaking the blisters (if any). Avoid harsh soaps and scrubs that further irritate the skin.
  • Avoid using air-conditioning at night (where possible), when mouth ulcers may hurt more due to reduced saliva production because of the drier environment. If air-conditioning is needed during hot weather, using a humidifier or leaving out a bowl of water to keep the air moist may help. If the pain prevents rest, speak to a paediatrician about using a pain reliever at night, even when there is no fever.

HFMD can lead to serious complications

In most cases, recovery at home with over-the-counter (OTC) treatment is sufficient to relieve the symptoms, which include fever, rash or red spots on the palms and soles as well as ulcers in the mouth. “Thought the spots are usually not itchy, ulcers in the mouth can be painful and prevent children from drinking, eating and swallowing normally. This can lead to dehydration which, in serious cases, requires medical attention,” explains Dr Erwin.

What parents can do:

  • Take note of poor urine output, dry mouth and lack of tears when they cry, as these are signs of severe dehydration that need medical treatment.
  • Seek immediate medical attention for symptoms like rapid breathing, disorientation, drowsiness, giddiness, neck stiffness, seizures, fever for more than three days and when the child is not eating and drinking.
  • Though it’s not common, HFMD can lead to viral meningitis and it’s best to check with a doctor to prevent these complications.

Overall, while it is understandable that the situation may feel overwhelming, Dr Erwin says it can help to take a different outlook. “If you can arrange to take some time off from work, maybe with a doctor’s letter for your employer, just stay home and spend this time with your kids; It is easy to overlook how quickly they grow up,” says Dr Erwin.

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