Friday, March 25, 2016

Hand/Foot/Mouth Update

We have been seeing a steady stream of Hand Foot Mouth this month. Many of the calls are related to figuring out when your kids can go back to school or daycare. I will address that issue at the end of this post.

Hand foot mouth is a very common illness that most kids get during childhood. It is easily spread through body secretions such as saliva, respiratory secretions and stool. The virus can be shed in the stool for several weeks! Although the virus most commonly associated with it is called coxsackievirus, there are other strains that sometimes circulate.

Most folks may only get it once, but I have seen some patients who don't seem to hold the immunity and have gotten it multiple times. As with most childhood illnesses, most of us got this out of the way when we were young. Adults who are unfortunate enough to come down with this tend to be quite miserable. Young infants are usually protected up to a point from maternal immunity (assuming mom has had it.) Of all the kids that we see with this, it is unusual for our youngest patients to be afflicted.

I actually like to call it Hand Foot Mouth and Butt, because in my experience, kids often get blisters on their butts as well as on the hands and feet. Some people have mild congestion, sore throat and fever as part of the package. Sometimes the rashes are a little more wide spread.

It is a very variable illness, meaning that one child will not look very sick and another can feel wretched. The lucky ones might simply have a mystery blister on the hand and that is the extent of it! Most of the time the worst symptoms resolve in a week or so. Every time a wave of this virus sweeps through it has some nuances.

Last fall when it was going around it seemed like it was a rougher strain. Many of the kids had mouth involvement and some of the blisters on the hands seemed to last a bit longer. Sometimes we will have waves of kids losing their fingernails; other times more of the parents seem vulnerable

There is no treatment for this virus. You simply support your child through it and of course call the doctor if something is causing you alarm.

Your goal is to keep your little one hydrated and comfortable. I have found that the kids with more mouth involvement are the most miserable. In extreme cases the mouth sores are so awful that they don't want to eat or drink and can face a risk of dehydration.

Controlling the pain is the best way to get them drinking. Even if they have no fever, it is appropriate to dose them up with Tylenol or Ibuprofen (Motrin/Advil). Tylenol comes in a suppository form if they are resistant to taking medicine by mouth.   

Offer cool creamy and soft foods (hooray if you have breast milk). Avoid anything acidic or sharp, like orange juice or tortilla chips. Smoothies and popsicles are great choices, but avoid citrus flavors.

I like an over the counter medication called Glyoxide that can be applied by Q-tip to affected areas (if your child lets you anywhere near them!)

For older kids with mouth sores try this:
1/2 teaspoon of Benedryl mixed with
1/2 teaspoon of Maalox
Squirt this mixture around the mouth every 4-6 hours.
Many kids get quite a bit of relief from this.

If you are worried about hydration it is worth having your child seen. A dehydrated child will have very low energy, decreased urine output and not a lot of tears or drool. They seem dry and droopy. As with any case of dehydration, if the oral route is failing, they may need some IV fluids. This is usually done in the emergency room.

If your child is running around, has normal activity level, and reasonably wet diapers, then they are "managing" and I wouldn't be too concerned.

The exposure period for this illness is usually from three days to a week. In other words, if your child was exposed on a Monday, they may start to show symptoms as early as Thursday but if a week goes by without anything happening you are probably out of the woods.

On the other hand, If you child has the illness, they are contagious as long as they still have blisters or a fever and perhaps can shed the virus for a week or two afterwards or longer.

If your child is happy and eating and has no fever but has a few blisters I would try to keep them away from a newborn or someone with a compromised immune system, but it seems excessive to expect you to keep your kids out of daycare if that is the only symptom. My general rule is that if they have a fever and are miserable, keep them home, otherwise let them go about their business.

Things to keep in mind:

  • They are likely contagious before you know they are sick and may have already spread it
  • They got it from somewhere. It is more than likely that someone at daycare already had it and started the spread
  • If you are a careful reader, as I mentioned, they can shed the virus in their stool for weeks!

Unless a school is going to absolutely quarantine every child for a month until they are all clear (which isn’t likely), as much as we would like to keep our daycare and schools virus free I don’t think it is possible, so instead I choose to move forward with as much common sense as possible. Here is my simple rule. Keep your fussy, febrile kids at home. (If you are not up on your Latin, febrile means having a fever)

Siblings are usually going to catch each others stuff. Hopefully the youngest babies won't succumb. Good hand washing is key to avoiding this.

Make sure the shared toys are cleaned frequently. If your child gets this (I should say when, not if) don't freak out. Time will fix it. Think about it as a rite of passage.

Give them something cool and creamy along with a big hug. As always, if you look at them and you are WORRIED (not just feeling sorry for them) call for an evaluation.

The beautiful little lady below is Nurse Kenlee's daughter Gillian. Kenlee assures you that all those lesions completely cleared up.

1 comment:

  1. Thank you Nurse Judy for spreading awareness via your blog. I am sure for many readers it may have offered some key takeaways. Keep spreading love