Hand Foot and Mouth Disease (HFMD) is a highly contagious viral infection which is common in young children. Characterised by ulcers in the mouth and a rash on the hands and feet, it is caused by a group of enteroviruses, commonly known as the Coxsackie virus. These viruses spread through direct person-to-person contact, nasal discharge, saliva, faeces, and fluids from the rash of an infected person.
HFMD mainly affects children below the age of 10 and often those under five. Children at these ages are more susceptible because they have lower immunity and have the tendency to put their hands in their mouths. Caregivers in close contact with a sick child are also at risk of getting infected.
Why is my child at greater risk?
Most parents send their children to infant care centres, childcare centres and preschools where the children play, learn and socialise with their friends. The sharing of common facilities, books and even toys makes them more susceptible to the highly-infectious HFMD. With many children attending such care centres, HFMD can spread quickly. Although HFMD is present throughout the year in Singapore, an annual spike in infections has been observed around the March to May period. In 2018, the Ministry of Health reported a total of 1,249 cases of HFMD in the week from 29 July to 4 August, one and a half times higher than that of the same period in 2017.
What are the symptoms to look out for?
Dr Tan Zhen Han says, “With the prevalence of HFMD, it is advisable for parents, caregivers and teachers to be watchful and examine their children or students daily for the following symptoms:
- Fever
- Sore throat
- Lethargy
- Ulcers in the throat, tongue, and mouth
- Rashes or small blisters on the palms of the hands, soles and buttocks. They can also appear around the mouth, elbows, knees and genital area
- Poor appetite
- Vomiting and/or diarrhoea”
Symptoms may vary and may appear at different stages of the illness. The incubation period, which is the period between exposure to the virus and the appearance of the first symptoms, is usually three to five days.
What should I do when my child gets HFMD?
Consult a doctor as soon as your child shows HFMD symptoms. While there is no specific treatment for HFMD, your child can be given symptomatic treatment to manage the fever and painful mouth ulcers.
For example:
- Put your child on a soft diet like porridge or oatmeal to reduce the pain of swallowing
- Give your child plenty of fluids such as water, diluted juices, rice or barley water to prevent dehydration
- Give your child popsicles for temporary relief from painful blisters in the mouth area
It is very important that you inform your child’s school or childcare centre immediately and keep the sick child away from public places. You should also exercise good hygiene discipline to protect your family and prevent the virus from spreading.
How do I know if my child has fully recovered?
In most cases, the infection will go away without treatment in seven to 10 days. Only certain types of enteroviruses, like the Enterovirus 71, can cause serious complications that involve the heart and nervous system, and may even result in fatality.
When should I seek immediate medical attention?
Follow-up with your doctor if the symptoms persist or worsen after 7-10 days. More importantly, seek immediate medical attention if your child complains or shows the following signs:
- Poor oral intake of fluids
- Dehydration in the form of decreased urine, dry lips and/or tongue, and no tears when crying
- Abnormal behaviours like being lethargic, drowsy or irritable, or crying persistently
- A sudden headache, neck stiffness or pain
- Difficulty breathing
How do I protect my child from HFMD?
Currently, there is no vaccine to prevent HFMD, but you can help to prevent HFMD from spreading by monitoring your children closely and teaching them good hygiene habits such as:
- Washing their hands properly and frequently with soap, especially before eating and after using the toilet
- Covering their mouth and nose with tissue paper when coughing or sneezing
- Wearing a face mask when feeling unwell
- Not sharing food, drinks, utensils, toothbrushes or towels
- Not putting toys or other shared items into the mouth
You can be a good role model for your children by practicing these habits . In addition, be diligent in cleaning and disinfecting common areas, toys and appliances thoroughly.
Consultant Paediatrician, SBCC Baby & Child
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Dr Tan emphasises, “Parents, teachers and caregivers play a crucial role in detecting infections, containing the spread, and even prevention. Let us start being vigilant and looking out for our children”.
Dr Tan Zhen Han is a Paediatrician from SBCC Baby and Child Clinic, a member of Heathway Medical Group. Dr Tan is trained in Paediatric Medicine, Neonatology, Intensive Care, Children’s Emergency and Paediatric Subspecialties.
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