I Can’t Believe It! My Child Gave Me Hand, Foot and Mouth! Dr Clare Thompson 27 February, 2017 Features, Health & Fitness, Living I’ve just had the dreaded call from the school – hand, foot and mouth is doing the rounds, again! Here’s a really informative article from last year. A must-read. One of my closest friends was meant to be coming to stay last weekend, but she called me early in the week to say how her poor little one-year-old was covered in pus spots and feeling really rather under the weather. Her doctor revealed that it was most definitely the viral infection hand, foot and mouth and that she would be contagious for the next five days. We hoped she’d get better by the weekend, but on Friday morning it was my poor friend’s turn to wake up with painfully blistered hands and feet. She’s pregnant with her second child and was obviously worried about the possible implications of this virus. I hear hand, foot and mouth has been doing the rounds in London, so I wanted to get to the bottom of what it actually is, whether it can be dangerous when you’re pregnant and if there is anything you can do if you do happen to catch it. We asked our new resident expert Dr E Clare Thompson from The Courtfield Private Practice in South Kensington to give us the low-down. Dear Parents, In the past few weeks, London has seen another outbreak of hand, foot and mouth disease. Those dreaded, pesky little spots that have had mothers in a panic over whether to cancel their weekend plans and stay home and the conundrum of whether or not to send Tarquin into nursery. What does this all mean? Do I need to see a doctor ASAP? How do I treat this and how long will it last? How on earth to know whether this is not actually something much more serious? And will I also catch it and have to call in sick at work come Monday morning? Argh! Childhood rashes. What a colossal nightmare. Panic not. I thought I would put together a little guide to this pretty harmless, and rather common, disease to help clarify a few things. What is hand, foot and mouth? Hand, foot and mouth (HFM) is a viral infection caused by Coxsackie A virus (and much more rarely by Enterovirus) that can affect any age group but is most commonly seen in young children. I have to say I have only ever seen it in kiddies aged 1-10 although adults can develop it on rare occasions and with a much milder rash. These reason that younger children tend to suffer with it is that their immature immune systems are meeting the Coxsackie A virus for the first time. Much the same reason that children who are starting nursery tend to catch absolutely everything going around during the first term. It is a self-limiting rash which usually lasts 5-7 days. In my experience it is often actually much quicker than this and your child should be getting much better at 4-5 days. I must mention that this is NOT the same foot and mouth disease that affects cattle, sheep and pigs. And there is no chance of your favourite pet at home contracting it from your child either! What are the symptoms? Usually you will notice that your child has had a low grade fever and possibly cold-like symptoms for a few days and they may be off their food, more clingy and less engaged in their play. The rash then develops and looks like little red, raised, fluid-filled spots seen on the palms of hands, soles of feet, and on the tongue. I have also seen the spots in the groin area and on the elbows, legs and buttock areas as well. The blisters can be sore and uncomfortable, especially when found on the tongue and your child may refuse to eat or drink very much as a result. It’s worth a mention that not all rashes are created equal and some children are lucky enough to get this in a very mild form on only a small surface area of their body versus other poor tikes who have very painful blistering in all of the aforementioned areas. How does HFM spread and will my other children (or me!) catch it? The incubation period is 3-5 days and HFM spreads very quickly by direct contact with contaminated droplets of fluid. This means: Coughing/Sneezing Nasal secretions and saliva Touching fluid from the blisters Faecal matter (changing nappies) Mothers and siblings are most likely to catch it as they are close household contacts and the affected child’s blisters or saliva may come into contact very easily with them. Nurseries are the classic place that your child would be likely to contract HFM due to the use of shared nappy changing areas or toileting facilities. Interestingly children can be mildly infective for weeks after the rash has died down and so the best way to prevent spread is to employ good hand hygiene measures: Children to wash hands thoroughly after toileting Aim to keep the nose and mouth covered whilst sneezing and coughing Adults should wash hands properly after handling nappies and tissues Soiled clothing to be washed thoroughly with a hot-wash Taking care not to burst the blisters as the fluid inside the blister is infectious Do I need to keep my child off from nursery? Can I go to work if I contract HFM? The Health Protection Agency has advised that children are not to routinely be kept out of school or nursery if they have HFM. However, schools and nurseries reserve the right to refuse to take your child back until the blisters have cleared. Fortunately it is a non-serious and short lived illness but I would employ the policy of notifying the nursery/school and keeping your child out of contact from others until the fever has settled, mostly because it is good practice to try and limit spread to others where possible. Similarly the same principle should apply with your own workplace. Although adults are really quite unlikely to catch it and would usually suffer only a very mild form of the illness. What if I’m pregnant? Good question indeed. Something I was asked this week by a mother who was in her second trimester already and had brought her 2 year old boy to see me covered in the little blisters. Ultimately, adults are often already immune to the virus as they are likely to have been exposed in their own childhood. If you are unlucky enough to get HFM as an adult it is usually very mild. If you contract it in early pregnancy then there is an increased risk of miscarriage so it is something you should escalate to your obstetrician. Equally if you contract it at the end of your pregnancy then there is a small chance that your newborn baby could also contract it. Babies born with HFM will usually experience only very mild symptoms. As a precaution in pregnancy you should employ strict hand hygiene if you have been in contact with anyone with HFM. How do I treat this? HFM is a self-limiting illness and is caused by a VIRUS. This means that there isn’t a medicine (antibiotic) that you can give your child to make it clear off any faster. Viruses are the bane of my life and I wish I had the panacea with which to cure them all. Antibiotics will clearly not work here at all. So the best thing you can do is to keep your child comfortable. Children’s Calpol and Ibuprofen for discomfort and fever Mouth gels used for teething to soothe a sore tongue Keeping your child well hydrated Doctors Tip: HYDRATION IS KEY Your child will probably refuse food and be even more fussy at mealtimes than usual because their tongue is so sore. The most useful thing you can do is to keep their fluids topped up to stop dehydration setting in. Most kids have enough reserve to not eat for a few days. But dehydration is potentially dangerous and difficult to combat once it starts. So the trick is to offer small amounts of fluids and frequently. I would even offer up an ice lolly to soothe on this occasion! If you are still breastfeeding your child, then continue to do so and also consider topping up feeds if your child is refusing or slow to take the breast milk. Doctors Tip: DO NOT COLD SPONGE A CHILD WITH A FEVER Research has shown that blood vessels under the skin actually become narrower (constrict) if the water is too cold. This reduces heat loss from the skin and so can drive the fever up even further. Equally do not wrap up a feverish child. The aim is to prevent overheating here. Can my child get HFM twice? Once they have been exposed to the virus their immune system will start to mount an immune response and they will ‘learn’ that virus and create antibodies which recognise it if they are ever exposed again. Viruses are very clever and often mutate ever so slightly which means that you CAN get a virus twice (perfect example being the flu which is annoyingly a new strain every winter as the virus mutates). If your child is unlucky enough to contract HFM twice then the second time they have it the rash is usually much milder. A 3 year old I reviewed yesterday was suffering with HFM for the second time and only his feet were affected versus his first exposure which was much more widespread. Could this rash be anything else? Well yes, it could! The chickenpox rash can look very similar to HFM in its early stages and also presents with a fever and common cold symptoms. However, you do NOT see chickenpox on the palms, soles of feet or the tongue. And the chickenpox rash is intensely itchy and the spots are larger than those of HFM. So the distribution, size of spots and the itch can help us to differentiate between the two conditions. If in doubt I think it would be prudent to call your family doctor to discuss it on the phone and see what they think first. If in doubt then they should offer to review the rash in person that same day. If the diagnosis is still unclear then a throat swab and stool culture can be taken to identify the virus on a culture. Complications Dehydration is the biggest threat to your young child because of the pain from the mouth ulcers. I discussed keeping fluids up earlier. I can’t impress this enough. REHYDRATE YOUR CHILD. Watch out for the blisters becoming infected. If you notice that your child is picking at them and the surrounding skin is becoming more red and angry see your family doctor for further treatment. Very rarely the Enterovirus 17 strain of HFM has been associated with serious brain, lung and heart infections but this really is very unlikely and has historically been limited to HFM outbreaks in the Asia-Pacific region. Symptoms of meningitis include high fever, neck stiffness, photophobia (difficulty looking at bright light), headache, vomiting and should be assessed urgently by a doctor. By Dr E Clare Thompson, The Courtfield Private Practice, South Kensington. The Courtfield Private Practice’s head partner is Dr Tim Ladbrooke, the GP in Tatler’s Best Doctor Guide. The practice is expanding and and concentrating its focus on mothers and children.