Hand Foot Mouth and Butt virus 2022

 

Hand Foot Mouth has been making the rounds this month. Many of the questions I get about this illness are related to figuring out when your kids can go back to school or daycare. I address that issue at the end of this post. This is a very common illness that most kids get during childhood. The biggest window is 9 months to 7 years, with the largest cluster being 2-3 year olds. You may have heard it referred to as Coxsackievirus because that is the most common strain. This virus is a member of a family of viruses called enteroviruses. These single strand RNA viruses typically occur in the gastrointestinal tract, sometimes spreading to the central nervous system or other parts of the body. It is easily spread through saliva, respiratory secretions and stool. It can be shed in the stool for several weeks! Most doctors don’t bother to test for it because it is so easily recognized. 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.) I rarely see very young kids get a severe case. Most folks may only get it once, but there are several strains that can cause it, so I have had patients who have gotten it multiple times. I actually like to refer to it as ‘Hand Foot Mouth and Butt’, because in my experience, kids often get blisters in the diaper area as well as on their hands and feet. Some people have mild congestion, sore throat and fever as part of the package. Sometimes the rashes are a little more widespread. 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! I have seen some kids just refuse to eat, it wasn’t until parents got a peek in the mouth that they figured out what was going on. Most of the time the worst symptoms resolve in a week or so.   Every time it comes around it seems to have a bit of a different nuance. One year with an especially nasty strain, a bunch of my little patients lost fingernails. Other years it seems to impact more of the parents. This season, Oath’s Dr. Ted reports that he is seeing more widespread rashes that are coming up the arms and the legs. Treatment is all about managing symptoms. 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. Dealing with mouth sores Keeping them comfortable is the best way to get them drinking. Even if they have no fever, iIf they are in pain, 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.    To treat mouth lesions, 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 Benadryl mixed with 1/2 teaspoon of Maalox Squirt this mixture around the mouth every 4-6 hours. The goal is to apply it to the sores, but don’t worry if they end up swallowing a bit of it. Many kids get good relief from this two ingredient concoction, but if this version isn’t helping, your doctor might prescribe something called magic mouthwash that adds lidocaine to the mix. Offer cool creamy and soft foods. Avoid anything acidic or sharp, like orange juice or tortilla chips. Smoothies and popsicles are great choices, but avoid citrus flavors. Cold apricot nectar is often a hit. Breast Milk is so valuable if you have some. If your child is reluctant to nurse, breastmilk can be made into a popsicle! If popsicles aren’t enough of an incentive, this might be the time to negotiate with a sticker chart, or even some extra screen time. If you are concerned that you are losing the battle about hydration, it is worth having your child evaluated. A dehydrated child will have very low energy, decreased urine output and not a lot of tears or drool. They seem dry and droopy. If you can’t get adequate liquid in by mouth, they may need some IV fluids. This is usually done in the emergency room, but it always makes sense to start with an evaluation by your primary doctor. They might have some other tricks up their sleeve. Treating the lesions Most kids aren’t terribly bothered by the blisters, but make sure their nails are filed just in case they are scratching at them. Some kids feel comforted by an application of cream, in which case use a nice natural brand such as https://www.emilyskinsoothers.com If your child has eczema, you might see that it flares up a bit with viral syndromes (because you weren’t having enough fun with simple lesions.) Being aggressive with moisturizers is always a good thing. 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 your 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. So, when can they go back to school? 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. My general rule is that if they have a fever and are miserable, keep them home, otherwise let them go about their business. It seems excessive to expect you to keep your kids out of daycare if they are fever free, eating well and acting normally.  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.) These guidelines are supported by the AAP. Siblings are usually going to catch each other's stuff. Hopefully the youngest babies won't succumb. Good hand washing is key to avoiding this. Be especially scrupulous hand washers, especially after changing diapers. Almost all of the spread for this is from contaminated surfaces or hands, so 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 of it as a rite of passage. As always, if you look at them and you are WORRIED (not just feeling sorry for them) go ahead and get them checked. Otherwise, you can handle this at home. Give them something cool and creamy along with a big hug. 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. Dr. Ted’s tidbits I’ve been seeing massive waves of this in my practice the last couple of weeks. The main features have been fever and drooling, followed by the outbreak of the rash, like Nurse Judy described. The photo below is of one of my patients with a worse than average rash.