What Parents Need to Know About Hand, Foot and Mouth Disease

Hand, foot, and mouth disease (HFM) is a viral illness that usually affects infants and children younger than 10 years old, specifically those 1 to 5. We spoke to Dr. Jonathan Auth, a CHOC Children’s pediatrician on what to expect with this common condition.

hand foot and mouth disease
Dr. Jonathan Auth, a CHOC Children’s pediatrician, explains hand, foot and mouth disease

Q: Is HFM contagious?

A: Yes, it can be spread through contact with feces, saliva, or mucus. The virus is common year round but tends to cluster in the summer and fall.

Q: What are the symptoms?

A: A fever is usually the first sign of the virus, followed by a reduced appetite and sore throat, which can cause a child to feel achy and irritable. After a few days, painful sores (red-yellowish blisters) develop in the back of the roof of the mouth. A skin rash with red spots may appear in the palms of the hands and soles of the feet, as well as on the knees, elbows and buttocks area.

Q: What should a child with HFM eat?

A: Make sure your child drinks plenty of fluids, such as water or milk, to stay hydrated. How much water should your child drink? At CHOC Children’s, we recommend that children drink the amount of 8 ounce cups of water equal to their age, with a maximum of 64 ounces for children over the age of 8. Most children do not have much of an appetite during this time. Cold or soft foods, such as popsicles, ice cream, yogurt or jello, are the most soothing given the sores on the throat.

Q: How is HFM treated?  

A: HFM usually clears up within a week. While there is no medical cure or vaccination for HFM, your child’s pediatrician can recommend ways to make your child more comfortable while the illness runs its course. Acetaminophen or ibuprofen can be given to ease painful mouth sores or discomfort from the fever. Download a parent’s guide to acetaminophen for children.

Children with blisters on their hands, feet or rest of the body should keep the areas clean and uncovered. Wash the skin with lukewarm soap and water, and gently pat dry.

Everyone in the family should wash their hands often, especially after using the toilet or changing a diaper, and before preparing food. Shared toys should be cleaned often, as viruses can live on objects for a few days.

Call your child’s pediatrician if your child is sluggish, can’t be comforted or seems to be getting worse.

Q: Are there any complications?

A: Complications are rare. Occasionally, some complications could arise, such as dehydration, due to a child not eating well, or not being able to swallow enough liquids because of painful mouth sores. Sometimes the rash or sores on the body can be infected if there are breaks in the skin.

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6 Things Your Pediatrician Wants You to Remember in 2017

The new year is a great time to kick start healthy habits with your children that can be practiced all year long. We spoke to Dr. Reshmi Basu, a CHOC Children’s pediatrician, who offered the following tips:

pediatrician
Dr. Reshmi Basu discusses 6 things your pediatrician wants you to know this year.
1. Get your flu shot

If you haven’t received your flu shot this season, it’s not too late. Remember, the nasal flu vaccine is not recommended this season. The flu can make you much more sick than a regular cold and can have more complications, like pneumonia, so it’s important that everyone in the household over 6 months old receives it. If there is a new baby in the family, you can protect the baby by making sure anyone in contact with the baby has received the flu vaccine.

2. Wash hands often to keep germs away

Proper handwashing is especially important during cold and flu season. And remember to wash for at least 15-20 seconds and make sure to scrub between fingers and under nails.

3. Protect your child’s skin

During the winter it’s important to moisturize frequently throughout the day, especially after baths or showers, to treat and prevent dry skin. And, if you’ll be out in the sun, don’t forget the sunscreen. It’s best to apply it 15-30 minutes before sun exposure and reapply often.

4. Make well-child appointments and stay up-to-date on vaccinations.

 When children are young, there are frequent well checks with the pediatrician and these appointments usually include vaccines. As children get older (after 5 years old) and vaccines are not a part of every visit, it is easy to forget the well checks. They are still important, however, to see how your child is growing, how she is doing in school, and discuss any concerns. It’s also a good opportunity to get the flu shot (depending on the time of year) and make sure all other vaccines are up to date. Download CHOC’s  guide to making shots less stressful for kids.

5. Stay active.

The American Academy of Pediatrics recently lifted their rule on no screen time for kids under 2, with some limitations. Find time to be active. Make it a family activity– go on a hike, ride bikes together, or play in the park.

6. Read aloud to young children, starting at birth.

Try to read together for at least 15 minutes every day. Reading to your kids from a young age can help them with their speech development, communication skills, and even academic performance. And it’s a fun way to spend time together!

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When to See the Pediatrician This Season

As soon as the school year begins, pediatricians start seeing more infectious diseases because these illnesses are more communicable in a classroom setting. Poor weather enhances that communicability, so these ailments become even more prevalent during winter months. It can often be difficult for parents to decide which infections can be treated at home and which require a trip to the pediatrician.

We spoke with Dr. Michael Cater, a CHOC Children’s pediatrician, about what ailments parents should keep a close watch for this season, and how to tell when it’s time to make an appointment with their child’s doctor.

when to see pediatrician
Dr. Michael Cater, a CHOC Children’s pediatrician, offers advice on when to see the pediatrician this season.

Influenza season tends to pick up in late December or early January, Dr. Cater says, but its prevalence in the community depends on how many people get immunized. The Centers for Disease Control recommends that everyone over the age of 6 months receive an influenza vaccine. However, for this season, the nasal flu vaccine is not available.

Sometimes it is difficult for parents to decide which illnesses can be treated at home and which ones require a trip to the pediatrician. Dr. Cater offers tips on when it’s time to make an appointment:

  • Many infectious diseases in children are associated with a fever. If a fever of 100.4 degrees or higher lasts longer than three days, then a visit to the pediatrician is needed for future evaluation.
  • Labored breathing that doesn’t respond to home remedies. This could be an indication of a more serious respiratory infection.
  • If a child is vomiting and does not respond to dietary restriction.
  • Cases of diarrhea when the child doesn’t respond to dietary restrictions.
  • Sore throat associated with a fever and tenderness in the neck. This could indicate Strep throat, requiring antibiotics for the most effective treatment.
  • Ear pain in conjunction with an upper respiratory infection such as a cold, especially if the ear pain begins four or five days after the onset of the cold. This is highly suggestive of an ear infection, requiring antibiotics for the most effective treatment.

To avoid common infections this season, remember to get your family vaccinated against influenza, and practice proper hand washing technique. Children should wash their hands:

  • Before eating
  • After going to the bathroom
  • After blowing their nose
  • After playtime

Use hand sanitizer when you’re on the go and think your child may have touched something contaminated with germs, but use actual soap and water when you see dirt. Spend at least fifteen seconds vigorously washing hands front and back, and between the fingers.

Download this guide to personal hygiene to help prevent the spread of germs this season.

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Combating Wintertime Dry Hands in Kids

When the temperatures drop, the wind swells and the house’s heater gets cranked up each winter, dry and cracked hands are an unfortunate and common side effect in children and adults alike.

“The cold air is more drying and wind is also more drying. And then add forced-air heating, and that will dry skin out even more,” CHOC Children’s pediatrician Dr. Angela Dangvu says.

While parents can’t do much to control the weather, they can take a few steps to help protect tiny hands against dryness.

Choose soap carefully

Start by using a moisturizing hand soap. Frequent hand washing, which is critical during winter viral season, compounds the problem by the further dehydrating the skin, Dr. Dangvu says.

Look for soaps that more resemble a lotion than a traditional soap and have words like “moisturizing” or “conditioning” on the label. Avoid antibacterial or deodorant soaps.

Also, hand sanitizer gel is an effective way to clean hands that is less drying than a soap-and-water method. However, children with the beginnings of dry skin should avoid gel as its alcohol content can sting, Dr. Dangvu cautions.

Creams, not lotions

As a preventative measure, parents can apply moisturizer to their child’s hands after hand-washing or bath time. Look for products described as creams rather than as lotions: These are richer and have more staying power than thinner products like baby lotions, Dr. Dangvu says.

“They tend to stay on and be a better moisture barrier,” she says. “Parents should use them right after children wash their hands. If skin is still a little moist, the cream will trap that moisture. Apply it after bath time too.”

A three-step approach

If a child’s little hands still become dry, Dr. Dangvu recommends a three-step approach:

  1. Start by regularly applying cream to the hands.
  2. If dryness doesn’t improve after a few days, move on to a petroleum-based ointment. Parents can intensify the therapy by applying ointment to hands before bed, and asking children to wear cotton gloves or even socks over their hands to lock in moisture while they sleep.
  3. If the condition doesn’t change after a few more days, parents can try an over-the-counter hydrocortisone cream.

If these steps don’t yield improvement, it’s time to take children to the pediatrician to rule out a bacterial infection or other condition, Dr. Dangvu says.

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Antibiotics Aren’t Always the Answer

By Tuan Tran, infectious disease pharmacist at CHOC Children’s

The Centers for Disease Control’s annual recognition of Antibiotics Week, November 14- 20, is a good opportunity to review basic safety practices of antibiotics and educate yourself so that you can protect yourself and your family. Don’t forget:

  • Antibiotics can have reactions and side effects. Harmful effects from antibiotics, such as side effects and allergic reactions, cause 1 in 5 emergency department visits for adverse drug events and lead to 50,000 emergency department visits in children each year
  • Antibiotic resistance is growing. An estimated 2 million illnesses and 23,000 deaths occur each year in the U.S. due to antibiotic-resistant infections. Overuse and misuse of antibiotics are the main drivers of resistance.
  • Antibiotics can only cure infections caused by bacteria. For example, cough and cold illnesses caused by viruses would not be cured by an antibiotic

Parents are an essential part of a child’s care team. You should feel comfortable asking the following questions to your child’s provider when considering an antibiotic:

  • What is the best treatment for my child’s illness? Antibiotics aren’t needed for common illnesses like colds, most sore throats, the flu, and even some ear infections, which are often caused by viruses and do not respond to antibiotics. Sometimes the best treatment is over-the-counter symptom relief.
  • Is this the right antibiotic for the type of infection my child has? If an antibiotic is needed, it’s important to use an antibiotic that is designed to fight the bacteria causing your child’s specific illness. Ask your healthcare professional if it’s the most targeted drug to treat the infection while causing the least side effects
  • What can I do to help my child feel better? Pain relievers, fever reducers, saline nasal spray or drops, warm compresses, liquids, and rest may be the best things to help your child feel better. Ask your healthcare provider or pharmacist what symptom relief is best for your child.
Illness Usual cause: virus Usual cause: bacteria Antibiotic needed?
Cold/Runny nose  NO
 Bronchitis/Chest cold* NO 
 Whopping cough YES 
Flu NO 
 Strep throat YES 
 Sore throat (except strep) NO 
 Fluid in the middle ear** NO 
 Urinary Tract Infection YES 

*In otherwise healthy adults

**Otitis media with effusion

When your doctor prescribes an antibiotic, it’s essential that you take it exactly as prescribed. Follow the directions of your physician and pharmacist, do not skip doses or share the medication, and finish the prescription even if you feel better. Do not save it for later.

There are several things you can do to help prevent infections- starting with receiving an influenza vaccine every year. Aside from getting your flu shot, hand washing is the single most effective way to prevent the spread of pathogens. Scrub for at least 15 seconds when using soap and water. When necessary, cough into a tissue or elbow.

Clinicians at CHOC are committed to optimizing antibiotic use. A multidisciplinary team reviews and monitors antibiotic use to ensure optimal selection, dosing and duration. This reduces adverse events and improves patient outcomes, and slows an emergence of resistance.

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