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Pediatrician’s word: Parents alert! Hand-foot-mouth disease returns to daycare centers

Why, sir? Because? It’s time to talk about mouth-hand-foot, a very current disease and, if you have children of preschool age, it will be strange that the vesicles of this virus do not proliferate around you like the songs of the cantajuegos.

It is a disease of viral origin, like almost all infections in pediatrics. It can be caused by different viruses, but the most famous is ‘Coxakie A16’. Take note of this information. The fact that there are up to 15 viruses involved in this condition will explain why the disease can occur several times. So if you were wondering: yes, this can happen again. Take a deep breath. It is more common in spring/summer and autumn, which is why we are now ‘on fire’ with it.

How is hand-foot-mouth disease transmitted?

The disease is transmitted through feces (which is why it spreads like wildfire in a nursery school where diapers are changed), mucus and saliva. And something very interesting, it will also affect objects that are contaminated with these products (play mats, toys, clothes, chairs, tables…) since the virus can survive on these surfaces for a long time.

So the first thing to keep in mind is that proper handwashing of caregivers and also cleaning of objects that may become contaminated will be essential.

How does mouth-hand-foot work?

After coming into contact with the virus, there is an incubation period that lasts 4 to 6 days on average in which the child is still without symptoms and yet transmits the disease! This will explain why it is so contagious, since during this period they continue leading a normal life and yet they are already mouth-hand-foot transmitters. After this time, fever, general malaise, odynophagia (pain in the mouth) and the famous papules or vesicles may appear.

In an infant, it is common that before the appearance of the most obvious symptoms, you notice that they drool a lot, that they avoid swallowing, that they put their hands in their mouth and that they are very irritable.

Typical mouth-hand-foot injuries are more aggressive in the mouth.


Typical mouth-hand-foot injuries will have this distribution: around the mouth, on the fingers and toes, and on the palms and soles. But not only that. And although it receives that name, it is very common for it to appear in other locations such as the buttocks. In fact, it is so common that perhaps it should be called mouth-hand-foot-ass, but this name would still sell less. Furthermore, they can appear – and sometimes do – on extremities.

The lesions are not usually particularly bothersome, and in fact we are not going to apply anything on them, they will dry in an average period of 7-10 days. Yes, canker sores inside the mouth will be painful, which can spread to the lips, cheeks, gums, tongue and pharynx.

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What is the treatment of mouth-hand-foot?

First of all, not ‘panda el cunico’. In general, it will be a self-limiting disease and will tend to resolve itself in a week or a week and a half. There is no specific treatment and what we will do is use drugs and measures aimed at reducing the discomfort that arises from the condition.

• Analgesia: If necessary, we will prescribe it every 4 hours using different analgesics when there is a lot of pain.

• Antipyretics: If fever appears

• Relieve the pain of canker sores: Here I tend to use spray presentations better as they allow for easier administration and wider distribution. Imagine having to put gel on all the injuries of a 15-month-old child! Almost like brushing a crocodile’s teeth; best sprays.

• Pay attention to the diet: we are going to select rather cold or warm foods, soft textures, we will avoid very natural (citrus), spicy or spicy foods. And, even if they feel well and have an appetite, a sandwich and an orange are going to be very complicated to eat.

Can children go to class?

Two things happen in this disease that will explain why the outbreaks are impossible to control:

• It is contagious before symptoms appear

• You can continue to infect people long after they disappear.

This particularity makes it useless for children to stay at home during the illness since it will not be able to stop transmission. That is why the Spanish Society of Pediatrics states that they can go to school if they are without fever (at least 24 hours), without pain, and eat normally.

The Spanish Society of Pediatrics states that children can go to school without fever


Can they get the disease more than once?

Yeah! Because as we have mentioned, there are up to 15 different viruses involved in this condition, so maybe the one from 6 months ago was a ‘coxakie’ and this one is a ‘herpes virus’.

Wait, I’ll tell you something else…

Sometimes weeks or months after having had a mouth-hand-foot problem, a phenomenon known as onychomadesis occurs in which a detachment of the nail bed occurs. What does this mean? That the child is going to lose his fingernails and toenails.

It is completely painless and does not require any type of treatment. Don’t worry, a perfectly healthy nail will grow later.

I hope this article is useful, reassuring and helps you cope with this disease. Remember, everything passes: even this first year of kindergarten.