What parents should know about hand, foot and mouth disease

Hand Foot and Mouth Disease is prevalent among children under five. How much do you know about it, and how can you help to prevent this from spreading?

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In Singapore, Hand Food and Mouth Disease (HFMD) has been legally notifiable by law since October 2000.

Due to its infectious nature and risk of fatality, the Singapore government and health authorities are paying extra attention to the outbreaks, as they predominantly affect young children, although adults are not sparred too.

As of August 2015, there has been over 18,000 cases of HFMD in Singapore in 2015.

Though HFMD is usually not fatal, the rashes and mouth sores bring great discomfort to children who contract it.

Definition

HFMD is a contagious viral infection common in infants and children under the age of five. It is characterised by rashes in the hand and feet and painful mouth sores.

Signs and Symptoms of Hand Foot and Mouth Disease

The first signs of HFMD usually involve:

  • Fever
  • Reduced appetite
  • Sore throat
  • Feeling of being unwell

These symptoms are then followed by:

  • Painful ulcers in the mouth, throat and tongue
  • Rash or small blisters on the palms of hands, soles of feet or buttocks
  • Bouts of vomiting and diarrhea 

However, these symptoms may not apply for everyone. Some people may show no symptoms at all, but it is still possible to pass on the virus to others.

Causes and Transmission

HFMD is commonly caused by Coxsackievirus, which part of the Enterovirus group.
Coxsackievirus can spread through direct contact with nose and throat discharge, saliva, fluid from blisters and the stool of infected persons.

Risk Factors

The disease is common in kids who attend school or play centers. Being in close quarters with other children–where common areas and items are shared and not always cleaned immediately–means viruses can be easily spread.

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As children age, they usually build an immunity to Hand Foot and Mouth Disease thanks to developing antibodies. However, it is still probable for older kids and adults to contract the disease.

Complications

  • Dehydration is the most common complication of Hand Foot and Mouth Disease. The painful mouth and throat sores, that make swallowing a painful activity, can cause a child to refuse both eating and drinking. Thus, it is crucial to monitor a child’s liquid intake. As a preventative measure, talk to your pediatrician on how to avoid dehydration and what to do in case you suspect it.
  • Viral meningitis* causes the membranes and cerebrospinal fluids around the spine and brain to be inflamed. This leads to back pain, stiff neck, headache. The infected child may need to be hospitalized.
  • Encephalitis* is the inflammation of the brain caused by a viral infection. It may be life-threatening.
  • Nail loss for both fingers and toes, though temporary, has been reported. However, it is yet to be proven whether the disease, in fact, causes this.

*Note: Both rarely occur when a child has Hand Foot and Mouth Disease.

When to Call the Doctor

When the child…

  • Becomes extremely irritable
  • Refuses to eat and drink
  • Is sluggish
  • Seems to get worse
  • Looks dehydrated (dehydration symptoms: little to no tears when crying; decreased frequency of urination or dark, yellow urine; irritability; lethargy; dry, sticky mouth; dry, cool skin; fatigue in older children; sunken eyes; soft spot or fontanelle looks sunken for babies)

Your local General Practitioners (GPs) are able to diagnose if your child has contracted Hand Food and Mouth Disease. Seek medical help immediately if you suspect your child could be infected.

Tests and Diagnosis

Doctors are usually able to distinguish mouth sores caused by Hand Foot and Mouth Disease by considering the following: age of the infected child, symptoms and the appearance of the sores and/or rashes.

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The doctor may also get a throat swab and request for stool sample to be sent to the laboratory to confirm the presence of the virus.

Treatments and Drugs

There are no treatments for Hand Foot and Mouth Disease. There are, however, ways to alleviate the discomfort felt by the child:

  • Over the counter medications for pain and fever relief. Do not give children aspirin as it may lead to the development of a rare illness called Reye syndrome, a condition that causes the brain and liver to swell. The syndrome is usually common in children recovering from viral infection.
  • Mouthwash or sprays that numb pain in mouth and throat.

The fever may cause your child to be lethargic too – it’s one of the signs and symptoms of Hand Foot and Mouth Disease.

Lifestyle and Home Remedies

Aside from medication, there are other things that you can do at home:

  • To numb pain from the mouth and throat, give cold treats such as ice cream, popsicles, sherbet, shakes, especially to children who find it difficult to swallow. The child can also suck on ice chips.
  • Keep the areas with blisters clean. Wash them using lukewarm water and soap. Pat them dry gently with a towel. For blisters that pop, apply an antibiotic ointment and cover with bandage to prevent infection.
  • Keep the child hydrated by offering cold water or milk. Do not offer acidic drinks such as soda and fruit juices.
  • Offer the child soft food that don’t require much chewing such as porridge, soup dishes such as bee hoon and mee sua. Avoid giving spicy and salty food that can make the sores sting.
  • Have the child rinse his mouth with warm water after meals. If he is old enough to rinse without swallowing, put some salt into the rinse to help reduce inflammation of sores.

Can Traditional Chinese Medicine (TCM) relieve Hand Foot and Mouth Disease?

Relief for mouth ulcers are available at local personal care stores and pharmacies such as Guardian and Watsons. Image credit: Guardian.sg

Many local parents take to TCM to send relief to their children with Hand Foot and Mouth disease.

While there’s no known vaccines or cure at the moment, TCM may be able to help alleviate the discomfort that comes with the disease.

As recommended by the Ministry of Health of China, TCM has been widely used in the treatment Hand Foot and Mouth Disease, and it includes Chinese herbal formulations and injections.

Parents in Singapore can purchase the watermelon powder/watermelon frost spray (or “Xi Gua Shuang” in Chinese) or aloe vera gel to help relieve ulcers in the mouth. Both are available at Chinese medical halls and personal care stores.

Studies have shown that the Jinzhen Oral Liquid has provided benefits to children with Hand Foot and Mouth Disease too. While some parents prefer to prepare “cooling foods” such as green bean soup and barley water for their children, especially when they have poor appetite during this period.

Note: It is recommended to check with your TCM physician or practitioner about the use of TCM and herbs for your children, prior to feeding them.

Prevention

Unfortunately, there is no vaccine for Hand Foot and Mouth Disease. However, there are simple things that the whole family, school or daycare center can do to prevent the contraction and spreading of the disease:

  • Wash hands frequently with water and soap, especially after coming from the bathroom, changing diapers and before and after handling food. If water and soap is unavailable, use alcohol or hand sanitizers.
  • Clean and disinfect common areas or shared items (toys, for example) to prevent the spread of the disease as some viruses can live in areas or items after a few days.
  • Teach proper hygiene. Explain why kids should keep themselves clean frequently and why they should avoid putting their fingers or other objects in their mouth.
  • Stay away from others infected with Hand Foot and Mouth Disease. Avoid using their utensils or drinking glasses as well.

Practicing proper hygiene by starting with hand washing, helps to reduce the spread of Hand Foot and Mouth Disease. Image credit: Health Promotion Board

Practice community responsibility

If your child is a school go-er, parents should practice community responsibility by taking the below steps upon the diagnosis of Hand Foot and Mouth Disease in your child.

  • Inform your child’s school e.g. childcare, preschool, kindergarten and enrichment classes so they can take necessary precautions and monitor the children
  • Keep your child at home and away from public places
  • Look out for signs and symptoms in the family to monitor if there’s any spreading within the unit
  • Ensure proper hygiene habits such has handwashing after using the toilet and before meals, covering the mouth when sneezing or coughing, not sharing food/drinks, toothbrush, cups, towels with others, using separate cutlery for meals, diligent disinfection of toys or appliances contaminated by nasal or oral secretions.

The Ministry of Health takes cases of HFMD and the potential outbreaks especially among young children as a serious concern. Updates on childcare and kindergarten closures are updated on their site to keep public aware of prolonged HFMD cases, so parents can take precautions and make necessary arrangements as necessary.

Is your child ready to return to school after a bout of Hand Foot and Mouth Disease?

As the incubation period of HFMD is between 3 to 5 days (with a range from 2 days to 2 weeks), each child should be observed and monitored to ensure that the signs and symptoms have declined and that the child certified by a doctor that he is well enough to return to school.

Practise these four steps to check if your child is ready to go back to school:

  1. Take your child’s temperature (either orally or via the ear) on a daily basis, or more frequently, should he been experiencing fluctuating temperatures.
  2. Check for mouth ulcers by shining a torch in the mouth, and look out for ulcers on the tongue, inner sides of the mouth and lips.
  3. Look for blisters on the hands. Scutinise for small pinkish/reddish bumps or tiny blisters with fluids on the hands, palms and back of the hands.
  4. Check for blisters on the Feet. Look out for bumps/blisters on the upper part of the feet and soles.

HFMD can be a difficult time for caregivers as it is for the infected child. Do ensure that adequate measures are taken to help your child feel better during this time. As this is a contagious disease, it is important for individuals to be responsible for their health and the welfare of others in the community. Ensure proper hygiene even if your child has recovered from HFMD, and together, we can help to contain the outbreaks.

Republished with permission from: theAsianparent Philippines

Has your child contracted Hand Foot and Mouth Disease? Share with fellow parents some food recipes to help alleviate your child’s discomfort during that period.