Hand, Foot and Mouth Syndrome or Disease

Hand, Foot, and Mouth Syndrome is a viral disease that causes ulcers in the mouth and blister-like lesions on the hands, feet, and sometimes buttocks and groin. It mainly affects children under 5 years old, and less commonly older children and adults, as immunity is acquired with age. This disease usually occurs in the summer and early fall. The incubation period is 3 to 5 days, and the symptoms can last up to 10 days.

Transmission

The highest contagious period is from just before the onset of symptoms until the child starts to feel better. It can be transmitted through direct contact or contact with contaminated surfaces. The virus is found in:

Secretions from the nose and mouth (saliva, sputum, nasal mucus)
Fluid from the blisters
Stool

That is why it is important to maintain good hand hygiene, especially after diaper changes or cleaning the child after using the bathroom.

Having the disease does not provide immunity since it can be caused by different viruses from the enterovirus family (the most common being the Coxsackie virus). This means that a person can experience the disease more than once. As we get older, we develop immunity.

Even after a child has recovered from the disease, they can still shed the virus in their stool for several weeks, potentially infecting others. However, since it is a mild illness, the child can resume their activities once they feel better.

Symptoms

Symptoms appear between three and five days after being exposed to the infection.

The initial symptoms include:

Fever
General discomfort
Loss of appetite
Cough
Abdominal pain
MOUTH: After one or two days, red lesions appear on the tongue and the lining of the mouth. These turn into yellow-gray ulcers with red borders. The ulcers are often very painful, causing the child to stop eating and drool excessively because swallowing is difficult. The ulcers can also extend around the lips.
HANDS AND FEET: Shortly after, raised lesions appear on the skin, especially on the hands and feet, and sometimes on the knees, elbows, buttocks, and genital area. These lesions can develop into small blisters with a gray center. The lesions can cause itching or pain and can last up to 10 days.

These symptoms usually appear in stages, not all at once. Additionally, not all individuals will experience all these symptoms. Some may have no symptoms but can still transmit the virus to others. It is common for the fever to subside within three or four days, and the mouth, hand, and foot lesions to disappear within a week.

Complications

This disease is considered mild and resolves on its own without medical treatment within a maximum of 7 to 10 days. Complications are extremely rare and can include meningitis, encephalitis, or myocarditis.

Treatment

Since it is a viral illness, there is no specific cure, and the disease must run its course. However, measures can be taken to relieve symptoms.

Home rest during the period of general discomfort.
Do not force the child to eat, but offer plenty of fluids to prevent dehydration.
Offer soft foods at room temperature or cold. Avoid hot, acidic, or spicy foods and beverages.
If the child experiences pain, irritability, or fever, administer ibuprofen or paracetamol every 6-8 hours.
Apply oral gels or sprays for mouth ulcers, such as viscous lidocaine, before meals.
If there are lesions in the diaper area, apply a cream with zinc oxide to prevent maceration of the wounds and possible infection.

When to Consult a Doctor

If there is doubt about the diagnosis.
If the child refuses to drink fluids and shows signs of dehydration: urinating infrequently and with concentrated urine, absence of tears when crying, dry mouth, etc.
Weakness or decreased level of consciousness.
Infants under three months of age with a temperature above 38°C.
If the skin lesions become very painful, inflamed, warm, with or without pus discharge.
If symptoms worsen or do not improve after 7 to 10 days.