Red rash on child's foot

Hand, foot and mouth disease

Dr. William J. Fisher is a board certified pediatrician with Community Physician Network. To request an appointment with Dr. Fisher, visit his physician profile.

The rumors are true. Indianapolis is experiencing a very large outbreak of hand, foot and mouth disease (HFMD).

This viral infection is almost always safe and is caused by members of the enterovirus family, which are often more active in late summer. The infection usually starts with a mild to moderate fever, achiness and crankiness, followed by a small, red raised rash on the hands, feet, groin area, and eventually the inside of the mouth.

These areas are most classic, especially the palms and soles, but the rash can appear on any area of skin. The mouth sores often look a lot like “canker sores” and are usually the only part of the rash that hurts. (Sometimes kids only get the throat spots and that is called herpangina.)  

The whole illness usually lasts less than 10 days and resolves without complications.

How do we avoid getting it?
Using hand sanitizer and washing hands is the first step in stopping the spread of most illnesses. Unfortunately, kids start spreading it before they have the classic rash, and occasionally weeks after they appear completely well. 

The virus can also spread through water that is not properly chlorinated. To make matters worse, adults can transmit the disease without ever having symptoms!

Parents are often frustrated with other parents or their daycare because they “exposed” their child, but the reality is once the virus is in a childcare setting, everyone will be exposed, even with the best of intentions.

How do I treat my child if/when they get it?
No antibiotics or prescription medications can shorten this illness. A parent’s goal should be pain relief for the throat, which means ibuprofen, ice cream, popsicles, and throat sprays for children over six.

Don’t worry about the fever; treat your child’s pain/misery, not the degree on a thermometer.

Are there any complications I need to look out for?
Yes – dehydration. In 12 years, I have had only two serious cases of HFMD and that was due to the toddlers refusing to drink due to throat pain. Those kids needed to be admitted for IV fluids, but were still fine.

Rarely, a child could have finger or toenails fall off after the illness, but as scary as this sounds it is painless and the nails grow back normally!

What do I need to contact my doctor about?
For any virus, the fever should be at the beginning of the illness and not go longer than five days. If the fever goes past day five please call your doctor.

Also, kids should urinate at least six times per day, and make tears when they cry. If they don’t, this could be a sign of dehydration.

The other main reason to call is change in alertness (a little tiredness and a case of the “crankies” is normal), severe headache or severe fatigue.

A fever over 100.4 in an infant under three months old should be seen immediately. The height of fever in a toddler or child is not important; it is the child that is important. If your child is having ice cream, walking, talking and smiling with a 104.9 degree fever, do not go to the ER!