Hand, Foot, and Mouth Disease is present all year round in Singapore with seasonal outbreaks every year. Outbreaks do occur in childcare centres, kindergartens, and schools. Although usually a mild disease, it has been associated with fatalities usually due to complications involving the heart and nervous system (e.g. encephalitis).
Hand, Foot, and Mouth Disease (HFMD) is caused by certain viruses. Among them, it is the EV71 virus that can give rise to serious complications.
(Courtesy of KK Women’s and Children’s hospital.)
How it is spread
HFMD is spread from person to person by direct contact with the nasal discharge, saliva, faeces, and fluid from the rash of an infected person. Both adults and children can be affected, but young children below five years of age are particularly susceptible.
Related: Hand, Foot, and Mouth Disease
Signs and Symptoms
A child with HFMD may suffer from some of the following symptoms:
- Fever
- Sore throat
- Ulcers in the throat, mouth, and tongue
- Headache
- Rash with vesicles (small blisters 3-7 mm) on hands, feet, and diaper area
- The vesicles are typically on the palm side of the hands, and the sole side of the feet and are very characteristic in appearance. The rash may also be present on the buttocks, arms, and legs
- Loss of appetite
- Vomiting and/or diarrhoea
However, symptoms may vary between individuals, and at different stages of the disease.
E.g. some may only have a rash, or some individuals may show no symptoms at all.
Complications
Severe ulcers in the mouth can be very painful and this may interfere with how well a child can take in food and drink resulting in dehydration. Dehydration may also be caused by persistent vomiting/diarrhoea coupled with reduced fluid intake.
Complications such as brain, lung or heart infections may occur occasionally, usually due to the EV 71 virus and can be serious. Some signs and symptoms of complications include:
- Severe headache, giddiness, and neck stiffness
- Disorientation, drowsiness and/or irritability
- Fits
- Breathlessness or turning blue
Related: Skin Disorders in the Mouth/Lips
Screening and Diagnosis
Laboratory testing is available to isolate and identify the causative agent. However, testing is usually not necessary as diagnosis of HFMD is typically based on clinical grounds.
Related: Health Screening for Primary School
Treatment
There is no specific treatment for the infection other than symptomatic relief of symptoms. Treatment with antibiotics is not effective on viral infection and is not indicated. If you suspect your child has HFMD, please bring him/her to see the family doctor.
Ease your child’s discomfort and help your child recover by:
- Encouraging your child to drink plenty of fluids
- Changing to a soft diet (e.g. porridge, pureed fruit) if mouth ulcers are a problem
- Giving medications as prescribed by the doctor, e.g. paracetamol syrup to relieve fever and pain
- Ensuring your child gets plenty of rest by keeping him/her at home
Related: Why Are Clean Hands Important for Children
Keeping Others Safe
If your child has HFMD, please help to prevent the spread of HFMD to others by:
- Keeping him home from school, kindergarten, or childcare centre
- Keeping him away from all public places including restaurants, playgrounds, and shopping centres
- Looking out for signs and symptoms in other family members, both children and adults
- Keeping his toys, books, eating utensils, towels and clothes separate from others
- Informing the school, kindergarten, or childcare centre as soon as possible. They can monitor other children closely and take additional precautions to prevent the spread of HFMD
- Keeping him at home until all the blisters have dried up and he has fully recovered, after the expiry of the medical certificate (MC) given by the family doctor
Related: Keep Germs Away
Prevention
Advice for Parents
Help protect your children from HFMD. Teach them good hygiene practices like:
- Wash your hands with soap and water for at least 20 seconds before eating and after going to the toilet
- Covering your mouth and nose when coughing or sneezing
- Not sharing eating utensils
- Ensuring that toys or appliances that are contaminated by nasal or oral secretions are cleaned thoroughly before they are used again
- Putting on a face mask when feeling unwell and staying home until recovered
In addition, do follow these four steps before sending your child to the childcare centre every day
- Take your child’s temperature (either orally or via the ear)
- Look for mouth ulcers
Ask your child to open his mouth and say “Ah”. Shine a torch in the mouth and look for ulcers on the tongue, inner sides of the mouth and on the lips
- Look for blisters on the hands
Ask your child to hold out both hands and show his/her palms. Look for small pinkish/reddish bumps or tiny blisters with fluids. Then check for the same on the back of the hands
- Look for blisters on the feet
Check for bumps/blisters on the upper part of the feet first then the soles
Related: Blisters
If you suspect any of the above, DO NOT send your child to the centre. Take him/her to a family doctor for a thorough examination. If your child is diagnosed with HFMD, please keep him/her at home until fully recovered. Your child should return to the centre only after the expiry of the MC given by the family doctor when he/she is well.
