This week I have seen many children sent back from school due to fever and spots in their mouth. These children were mainly between 3-7 years old. It is the season for Herpangina and Hand-foot-mouth disease again so it is a good time to talk about this. Herpangina is an infection caused by a Coxsackie virus. It causes small fluid-filled sacs (vesicles) to appear at the back of the mouth. These vesicles quickly pop, leaving small ulcers or sores, which can be very painful and may cause your child to refuse food and water. Hand-foot-and-mouth disease (HFMD) causes the same spots and ulcers in the mouth as herpangina, but it also causes additional spots on the hands and feet. Spots may also appear in the diaper area. The incubation period (the time between infection and onset of symptoms) is from three to seven days.
Both herpangina and hand-foot-and-mouth disease are caused by Coxsackie virus. HFMD can also be caused by enterovirus-71. The virus is found in saliva and stool and spreads easily by touching or breathing. A child with herpangina and hand-foot-and-mouth disease is most infectious during the first three days of infection but can spread the virus for up to one week. The incubation period for this virus is 3 to six days. During this time, a child can spread the virus without having any signs of being sick. The virus spreads when a child touches infected stool and then puts their hand in their mouth. The virus can also be spread through the lungs by coughing and sneezing. The virus can also survive on surfaces and objects, such as counter tops and toys, long enough to spread to another person.
Both herpangina and hand-foot-and-mouth disease can start with fever, sore throat, and generally not feeling well for few days before the spots in the mouth appear. Children may not want to eat and become very irritable. Older children may complain of headache, sore throat, and lack of energy. Fever might last three or four days while the spots and ulcers in both illnesses will go away on their own within seven days. The most common complication of herpangina and hand-foot-and-mouth disease is becoming dehydrated due to the pain in their mouth. Other rare but serious complications include meningitis and myocarditis.
There is no vaccine against these viruses, and antibiotics do not work on viruses. They will not help heal herpangina or hand-foot-and-mouth disease, so the treatment for herpangina is supportive care. This means keeping your child hydrated and as comfortable as possible. This will help the body fight off the infection. To control pain, give your child acetaminophen (Tylenol, Tempra, Sara, Calpol), or ibuprofen (Motrin, Advil, or Junifen). Pain-relieving rectal suppositories of these medicines can be given if your child cannot take the medicine by mouth.
Give your child fluids frequently and in small amounts to prevent dehydration. Cold foods and soft foods such as ice cream and apple sauce are soothing and will not irritate the sores while citrus and salty or spicy foods may cause more irritation. To prevent the spread of infection, wash your hands and your child’s hands often. Be sure to do so after wiping your child’s nose, after changing a diaper, after using the toilet and before preparing food.
If your child stays well hydrated, in nearly all cases they will recover from the illness within seven days. These viruses are very contagious; having them stay away from school and not play with other children will help slow the spread of infection. Keep your child well hydrated, and come see me if your child has chest pain, shortness of breath, feels their heart is racing, or seems overly tired. It is also important to see me promptly if your child has a headache, vomiting, neck pain or stiffness, or a change in behavior.