Hand-foot-and-mouth disease is a common viral infection of young children, caused mostly by coxsackievirus A16, coxsackievirus A6 and enterovirus 71. It spreads easily in child care settings through saliva, stool and blister fluid and usually resolves in 7 to 10 days.
Key symptoms
- Low-grade fever, sore throat and poor appetite for 1 to 2 days
- Painful mouth sores that make eating and drinking hard
- Rash or small blisters on the palms and soles, sometimes on the buttocks
- Drooling and irritability in young children
What you find on exam
- Small vesicles and ulcers on the tongue, gums and inside of the cheeks
- Oval gray blisters with a red rim on the palms, soles and diaper area
- Assess hydration: mucous membranes, tears, urine output, capillary refill
- Nail shedding can appear weeks later
Tests
- Clinical diagnosis
- Enterovirus PCR from throat, stool or blister fluid only if severe or atypical
- Lumbar puncture if there are signs of meningitis or encephalitis
Treatment basics
- Supportive care: acetaminophen or ibuprofen for pain and fever
- Cool fluids and soft foods; avoid acidic drinks
- Oral rehydration, or IV fluids if dehydrated
- Hand washing and surface cleaning; keep the child home while febrile or drooling
- Avoid aspirin in children
Red flags
- Signs of dehydration: no urine for 8 hours, no tears, lethargy
- Stiff neck, severe headache, jerking movements, unsteady walking or weakness
- Fast breathing or poor circulation (enterovirus 71 complications)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.