June 7, 2012

Dr. Mom: Severe form of hand-foot-mouth disease in Sacramento area

In the past few weeks, we've been seeing an increase in hand-foot-mouth disease among toddlers and preschoolers.

In the past few weeks, we've been seeing an increase in hand-foot-mouth disease among toddlers and preschoolers.

While hand-foot-mouth disease is fairly common in this age group, the symptoms in these youngsters have been more severe, with an eerie appearance.

In fact, the CDC has reported a new viral strain (Coxsackie A6 rather than the typical A16) likely is responsible for what appears to be these more- aggressive cases of the disease.

Most parents who have dealt with a child in the midst of hand-foot-mouth disease know how painful and worrisome it can be.

The viral infection affects children ages 1 through 4 years old most often, though any child can become infected, and adults sometimes come down with the disease.

It's more common in summer and early fall, but in temperate areas it can occur year-round. The onset of illness is marked by fever, muscle aches and then the inevitable appearance of painful blisters.

These red, fluid-filled blisters pop up in the throat, on the tongue, top of the mouth, and/or inside the cheeks. They are exquisitely painful, and toddlers who are unable to tell you their mouth hurts will refuse to eat or drink and suddenly start drooling a ton. When a child only has these blisters in the mouth, we call it herpangina.

Lately, however, children coming down with hand-foot-mouth disease are getting the painful, fluid-filled blisters on the palms of their hands, soles of their feet and, with this most recent strain, on their legs and arms and around their mouth.

They are getting it all, and it hurts.

Treatment is aimed at relieving pain and ensuring that children remain hydrated throughout the course of this illness, which typically lasts three to seven days.

Parents are encouraged to offer cold liquids frequently throughout the day. Ice pops and cold drinks are a must for both pain relief and hydration. I love Pedialyte pops for this purpose, but avoid citrus or salty foods, as they will sting and hurt the mouth even more.

Acetaminophen or ibuprofen may also be used as needed for severe mouth pain.

The blisters on the hands and feet may give way to peeling once the illness has passed. With this new strain, loss of fingernails and toenails has been reported.

Because of the highly contagious nature of this illness, children should be kept home while febrile and while there are open blisters on the skin and/or in the mouth. This virus is spread via respiratory droplets from sneezing or coughing, through hand-to-hand transmission from infected individuals, via the fecal-oral route, and from fluid in the blisters are possible.

The best prevention is hand washing and sanitizing play spaces and toys where infected children are known to have been.

The bottom line is that hand- foot-mouth disease will get better – typically in less than a week.

In the meantime, parents should pay special attention to their child's fluid intake and watch for signs of dehydration such as decreased urine output, diminished tears when crying, a dry mouth and a noticeable decrease in the child's activity level.

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