It starts with a blister in the mouth. Then you may notice rashes on the palms. Eventually, there are rashes on the sole of the feet, and by this time you might be a bit worried.
What you see could be the symptoms of the hand, foot, and mouth disease (HFMD). The infection causes some nasty rashes all around the palm, sole, and around the lips, and even inside the mouth and is highly uncomfortable.
But what causes the hand, foot, and mouth disease in babies and how can it be treated or prevented? Find out all about it in this MomJunction post.
What Is Hand, Foot, And Mouth Disease?
The disease, as the name suggests, is an infection that affects the skin of the hand, feet, and around the mouth. Symptoms are also visible in the inner mucous membranes of the mouth such as behind the lips, back of the cheeks, and the back of the throat too.
Back to top
What Causes HFMD In Infants?
Any of the viruses from the enterovirus genus or group can cause HFMD. The most common enteroviruses to cause this infection are the coxsackievirus A16 and enterovirus 71 (1). The coxsackievirus A16 is usually the cause of HFMD in North America while enterovirus 71 is responsible for it in East and Southeast Asia.
Back to top
[ Read: Skin Allergy In Babies ]
How Does A Baby Catch The HFMD Virus?
HFMD is extremely contagious. A baby or a toddler can quickly catch the virus through:
- Skin contact with an infected person: A baby can contract the virus if they come in contact with an infected person through handshakes and hugs. Kissing the child on the cheek can also spread the virus through the blisters around the mouth.
- Inhaling the saliva or mucus expelled during sneezing: Inhalation of the expelled mucus and saliva droplets while sneezing or coughing by an infected person, spreads the virus.
- Not washing hands after touching fecal matter: HFMD viruses also transmit through the fecal-oral route. A baby or toddler may catch the virus by playing with soil contaminated with infected feces. A toddler may get the virus from their sibling if they touch the soiled diaper and do not wash hands.
- Contaminated food and water: Food and water contaminated with fecal matter can spread the disease.
- Touching contaminated surfaces: Viruses can survive on inanimate objects too. It means HFMD can spread through objects, such as clothes, doorknobs, and toys, used by the infected person.
- Sharing utensils: A baby can get the virus if they share utensils like sippy cups with an infected person like a sibling or a parent.
Back to top
How Common Is HFMD In Babies?
HFMD mostly affects infants and toddlers, rather than older children and teens. The disease is prevalent during the summer and the winter season (2).
Back to top
What Are The Symptoms Of HFMD In Babies?
The HFMD virus has an incubation period of three to six days. It means the baby will display the first symptoms of the disease about three to six days after he/she contracts the virus (3). The following are the symptoms of hand, foot, and mouth disease in babies and toddlers (4):
- Fever: It is usually the first symptom of the disease and appears even before the development of the rash. A fever is a temperature above 100.4° F (38° C) (5) although the baby is most likely to display a low-grade fever, which is a temperature between 100° F – 100.2° F (37.7° C – 37.8° C) (6).
- Sores in the mouth: About a day or two after the onset of fever, you notice the eruption of sores all around the mouth. Clear-to-cloudy, tiny, liquid-filled blisters appear inside the mouth and cheeks, gums, tongue, the upper palate of the mouth, and even the back of the mouth, near the tonsils. Sometimes, the blisters may appear yellow, indicating pus formation.
- Rashes on the hands and sole of the feet: The rashes on the hands and feet gradually sprout over two to three days. They could appear anywhere on the hand or feet but are mostly concentrated on the palms and soles. The tiny blisters are red to pink in color, irregularly-shaped, and scattered all around without any pattern. Sometimes, you may notice rashes even on the knees, elbows, buttocks, and the groin/diaper area.
- Pain in swallowing: The baby will find swallowing painful and would pause during feeds. Older toddlers may point towards the neck while eating and drinking to tell they have pain.
- Loss of appetite: Since swallowing anything becomes painful, the child refuses to eat or drink anything.
- Fussiness and lethargy: The baby will feel fussy, and also very lethargic. Toddlers may show no interest in playing with toys or with their friends and siblings.
Several symptoms of HFMD resemble those of other diseases such as chickenpox, herpes, and even strep throat. It means you are quite likely to get confused about what is happening with the baby. For this reason, it is best to take the baby to the doctor for an accurate diagnosis of the condition.
Back to top
[ Read: Home Remedies For Hives In Babies ]
How Is HFMD In Babies Diagnosed?
The following steps help a healthcare provider to diagnose the disease:
- Visual inspection: The doctor looks for the tell-tale signs of the disease, which is the presence of blisters mostly on the mouth, palms, and soles of the feet.
- Mouth and throat swab: A swab sample from the throat and mouth is sent for laboratory analysis to determine the presence of the virus.
- Stool test: Since the HFMD virus is excreted in stool, the doctor will send a stool sample to check for the presence of the virus.
- Blood test: A blood test will help confirm the diagnosis by assessing the presence of the virus and its related antibodies in the blood.
If the diagnosis is definite, the doctor will begin the treatment.
Back to top
How Is HFMD In Babies Treated?
There is no treatment for hand, foot, and mouth disease (7). Antibiotics do not work against the illness since it caused by a virus and not a bacteria. Just like with any other viral infection, one needs to wait for the immune system to subdue the virus on its own. The baby’s doctor can suggest some medicines to ease the intensity of the symptoms:
- Pain and fever medication: The doctor can prescribe acetaminophen (paracetamol) or ibuprofen to bring down the fever and ease the pain caused by the blisters. Although these medicines are available over-the-counter, it is best to consult a doctor for the dosage based on your baby’s age and intensity of symptoms.
- Oral anesthetic solutions: You can use oral anesthetic solutions to numb the pain in the baby’s mouth. However, do so as per the doctor’s recommendation and avoid using any over-the-counter numbing gels, mouthwashes, and sprays.
Home management is the best way to help the baby feel better and increase the speed of recovery.
Back to top
[ Read: Baby Skin Rashes Treatment ]
How To Help A Baby With HFMD Feel Better At Home?
Here are a few home remedies to help the baby feel better:
- Offer plenty of fluids: The soreness of the blisters, along with fever and the inability to feed correctly can increase the risk of dehydration. Therefore, offer plenty of fluids such as milk and water. You can give them cold beverages that help soothe the irritation inside the mouth. Do not provide juices since they have excess sugars and are not recommended by pediatricians (8).
- Switch to a liquid diet: Puree everything that you would otherwise feed as solid to the baby. You can feed a wide variety of fruit, vegetable, and meat purees. You can also give vegetable or meat broth to the baby. Continue breastfeeding the usual way.
- Feed smaller portions: Give smaller portions of liquids that are easier to gulp than large quantities in one go.
- Rest is essential: Adequate rest allows the body’s immune system to work better and recover from the illness faster. Cut down on play time and focus more on rest.
The illness usually goes away in three to five days and may, in some cases, extend to no longer than two weeks (9). The baby should start recovering within a week. Blisters on the hand and feet become dry and fall away while the sores in the mouth gradually disappear.
In very rare instances, the disease may extend beyond two weeks, but it is usually with immunocompromised babies and infants with other health problems. These babies are also at a higher risk of developing complications of HFMD.
Back to top
[ Read: Treating Fever In Babies ]
What Are The Complications Of HFMD?
Sometimes the HFMD virus may lead to a few complications, including (10):
- Dehydration: It is by far the most common complication of HFMD. Dehydration is a tangential result of sores in the mouth, which makes it difficult for the baby to drink and swallow. If the baby is urinating less frequently, with fewer than six wet diapers used a day, it is an indication of dehydration among infants. In toddlers, not urinating for more than six hours could indicate dehydration (11) (12).
- Temporary loss of fingernail or toenail: If a blister erupts beneath the fingernail or toenail, then the baby risks the loss of that nail. However, the loss is temporary, and the nail will regrow from the nailbed.
- Opportunistic infections: Since the immune system is busy fighting the virus, it could make the body prone to other opportunistic pathogens. Studies have found that HFMD may increase the risk of other bacterial and viral infections caused by the Streptococcus bacteria and dengue virus among others (13).
- Viral meningitis: It is a rare complication where the virus finds its way into the brain, infecting the meninges, which is the outer layer of tissue covering the brain. The infection leads to viral meningitis.
- Encephalitis: It is the rarest of all the complications. In this case, the virus infects the brain and causes severe inflammation of the brain tissue, a condition called encephalitis.
In most cases, the baby recovers well with no complications. However, an infected person can transmit the virus for a week or two even after the disease is cured. Prevention is thus vital.
Back to top
How To Prevent HFMD In Babies?
The following steps can help prevent HFMD in babies (14):
- Wash the baby’s hands periodically. Always wash the baby’s hands with warm and soapy water after a trip to the park or playtime in the outdoors. Wash your hands when you come back home from outside.
- Cover nose and mouth when sneezing or coughing. Cover your nose and mouth when you sneeze or cough, whether or not you are infected. Sometimes adults may have the virus but may display mild symptoms or no symptoms at all. But the baby can still get the infection and exhibit severe symptoms.
- Wash hands before touching the baby. Clean and dry your hands before holding the baby or the items. It mitigates accidental exposure to the dormant virus.
- Disinfect the baby’s personal items and household objects. Wipe the baby’s toys with a cloth dipped in diluted, baby-safe antiseptic liquid. If the toys are washable, then wash them with soapy water. Clean household objects that the baby is bound to touch like doorknobs with a cloth dipped in a disinfectant liquid.
- Do not share utensils with the baby: Use a separate set of utensils for the baby and do not let anyone else use them.
Keep reading to know more about HFMD in babies.
Back to top
[ Read: Dehydration Symptoms In Babies ]
Frequently Asked Questions
1. Can parents catch HFMD from the baby?
Yes. You are at risk of catching the infection from the baby. However, the disease mostly resolves with mild symptoms among adults. It is the baby’s siblings who are at the highest risk of developing severe symptoms. Therefore, make sure you follow all the preventive steps to protect yourself and other children in the household.
2. Can my baby get HFMD more than once?
Yes. But the baby is quite likely to develop immunity to the strain of virus that initially caused the infection. However, prevention is still better since relapse of HFMD is not uncommon (15).
3. Can a baby get HFMD from animals?
No. A baby cannot catch the virus from animals, including pets, since HFMD virus transmits only among humans. There is another disease called foot and mouth disease (FMD), which affects animals and rarely human beings. FMD is not a threat to humans and is not the same as HFMD (16).
HFMD can cause severe interference in a baby’s ability to eat properly. But the disease can resolve quickly with adequate home care. Prevention is critical for protection against all strains of the virus that can cause the illness. Preventive measures eventually keep your little one’s infancy and toddlerhood free from HFMD.