Is Your Child Suffering From HFMD Disease? How To Prevent It In Children

HFMD typically presents rashes on the skin, particularly on the hands, feet, hips and arms.

“Hand Foot Mouth Disease”- HFMD, is a common infection in young children under 5-7 years of age. HFMD occurs worldwide. Cases occur yearly and are more common in the monsoon in tropical countries. Large outbreaks and epidemics can occur in schools, daycares and the community, as we are witnessing in India this year. Dr Mahesh Balsekar, Sr. Consultant (Paediatric Medicine), SRCC Children’s Hospital, managed by Narayana Health, explains transmission, treatment and tips to prevent it in children.

Transmission

It is caused by enteroviruses, of which the most expected strain is Coxsackie A 16. The incubation period can range from 2-7 days, but usually 3-5 days. The virus spreads from person to person through direct contact with skin secretions and saliva. It can also spread through nasal secretions and stools. Scattered within the family is common, but most adults are immune and do not catch the infection.

Clinical Features

  • HFMD typically presents with rashes on the skin, particularly on the hands, feet, hips and arms. Rashes can be seen on the genitals but are less common on the face and trunk. It appears as rashes, often raised, but the classic feature is skin blisters, which are more common on the hands and feet. These are usually a few mm in diameter but may be more significant. They are generally not itchy but can cause discomfort and are occasionally painful. New skin eruptions can erupt for 3-4 days and dry and sometimes scabs over 3-4 days. Recovery is complete in a week but can take ten days.
  • Mouth blisters are typical in HFMD. They are commonly seen on the tongue and palate, and inner cheeks. They initially appear like small red eruptions, which can subsequently blister. Most settle in 3-4 days. Mouth blisters are sometimes severe and painful, particularly in infants. This can lead to poor intake of food, drooling and salivation, and occasionally lead to dehydration. In a variant of HFMD called Herpangina, one usually sees only mouth blisters but no skin rashes. Not all cases have a classic disease with blisters on hands, feet and mouth. You may get only skin eruptions without any mouth blisters.

  • Fever, if present, is usually below 101 F and settles in 2-3 days. However, some children may get fussy and have diarrhoea, loose motions or vomiting.
  • Fortunately, serious complications are rare. HFMD can occasionally be caused by viruses like Enterovirus 71, where infections can be more severe. However, rarely can disease spread to the heart, brain, pancreas and eye. Fortunately, complications during pregnancy are rare. Several weeks after the conditions, the shedding of nails recovers over time.

Treatment

Anti-Viral medicines and antibiotics do not work in HFMD and are not prescribed. Management is supportive and directed and relieved from symptoms causing discomfort. Fever, if high, is treated with paracetamol. Mouth ulcers can cause pain and make swallowing difficult. Severe pain is treated with paracetamol and ibuprofen. Local pain relief gels are usually ineffective. Maintaining hydration is essential. Offering cool drinks and foods makes it easier for children to eat. Occasionally, children who cannot maintain hydration are hospitalised for rehydration. Skin rashes usually do not need treatment, but soothing lotions may be applied for discomfort.

Prevention

  • Children suspected of having HFMD are usually advised to isolate themselves at home for around seven days. Unfortunately, it is often difficult to prevent infection because children often spread it before symptoms appear and even after apparent recovery from the disease.
  • Children should be sent to school during outbreaks. It is impractical and unnecessary to keep children away from schools to prevent infection. Occasionally, schools are closed for 7-10 days during severe outbreaks to avoid spreading diseases within schools.
  • Hand washing remains an essential strategy to reduce the spread of infection. Children’s hands should be washed frequently, especially after using the bathroom. In addition, cleaning surfaces with disinfectants can minimise the spread of disease.
  • Currently, there’re no vaccines available to prevent HFMD.


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