Hand, Foot and Mouth Disease (HFMD) is a highly contagious viral disease endemic to many tropical areas, including Singapore. It affects children younger than 10 years old who spend time in close proximity to each other –childcare centres, kinders and playgroups are specially vulnerable to HFMD. Although the symptoms are non-life threatening, it requires attention, and that your child be isolated at home to stop infecting others. HFMD can also infect older children and adults, but the symptoms are usually mild.
For a stay-at-home-dads, HFMD is an ordeal.

Causes and symptoms

Saliva droplets from sneezing, kissing or coughing are the main route of contagion –especially threatening for little children that still do not know to cover their mouths when they sneeze, or to wash them after they do. Nose droplets and feces are also a route of contagion, as is contact with contaminated surfaces –the Enterovirus that causes HFMD can survive in the open for a week or so, but it's a fragile virus and can be killed with hand sanitizers, and regular hygiene and cleaning. HFMD is not transmissible with domestic animals. The first symptoms are a persistent headache, high fever, muscle pains and sore throat. Blisters will grow in the palms of the hands and the soles of the feet, and even in the inside of the mouth, the tongue, and other parts of the body. The blisters are very painful and may prevent the child from eating and drinking fluids. The main health risk of HFMD is dehydration and weight loss. There is no cure or vaccine for HFMD and antibiotics are not effective. The treatment is palliative care during the course of the disease -painkillers, support, food, drink and care. HFMD provides minimal immunity and you can become sick again at a later moment in life.

Managing HFMD –tough, but it can be done

If your child becomes listless and complains of a persistent headache, muscle pains and general malaise, check the hands and feet for blisters. Your child may develop a fever that can run up to 39 – 40 Celsius (103 F) and will lose appetite. If your child goes to a childcare centre, you must notify them immediately to prevent other children from becoming infected. In Singapore there usually there is a 10-day quarantine period for the sick child before returning to kinder, and you must get an "all clear" note from a registered doctor. The fever will last for the first two or three days of the infection and the recommended treatment is Paracetamol combined with Ibuprofen. A dose of Paracetamol every four hours, combined with Ibuprofen every eight hours should keep the fever below 39.5 Celsius (104 F) - if the fever is higher than this, seek medical assistance immediately.
The biggest problem with HFMD is the intake of food and liquids: your child may refuse food and drink.
Even water becomes painful to swallow, and there might be vomiting during the first couple of days of the outbreak. The vomit is highly contagious as well, as it contains saliva. To restore the fluid balance, use a syringe and feed 10 to 20 ml of water (or electrolyte fluid, like Gatorade or Calpis) every ten minutes. A mouth-ulcer gel (like Bonjela) works well to reduce the pain from the sores in the mouth area. Soft room-temperature foods like mashed potatoes, congee, purees, runny porridge and soft fruits are usually well tolerated by children with sores on their throats. Contrary to popular wisdom, ice-cream is not well tolerated, as the blisters are heat and cold sensitive. Washing your hands at all times before and after preparing food, giving medicine to your child, changing nappies and visiting the toilet is absolutely critical, as HFMD can be transmitted by contact. If you have several children, it is essential that you separate the siblings from the sick child during the first 24 to 48 hours of the disease. Use disinfectant wipes to clean all surfaces and toys during an HFMD outbreak.

When to visit the doctor

A visit to the doctor becomes necessary if any of the following conditions occur:
  • Non-stop vomiting or diarrhea for 12 hours or more. The risk of dehydration becomes too great for a child.
  • Fever higher than 39.5 Celsius (104 F) – you may have to rub your child with cold wet towels, or give a cold shower to contain the fever. Take the child to the nearest hospital.
  • Severe headache, disorientation, complains of stiff neck or drowsiness. Short breath or irregular breathing. These are signs of a more serious complication
Additionally, your child must stay isolated from other children whilst recovering from HFMD. This includes:
  • Quarantine at home: your doctor will give you a medical certificate that you will need when returning your child after the symptoms have cleared. In Singapore, HFMD is a "notifiable disease": the government will be advised by the childcare centre, doctor or hospital –and your child will not be allowed back unless you can produce an “all clear certificate” from the doctor.
  • Keep your child away from enclosed areas with other children: parks, shopping malls, public transport and indoor play areas. This also applies to water play areas and pools.
  • Put a face mask on your child to prevent saliva droplets from contaminating others. These inexpensive masks are fairly common in chemists and pharmacies in Singapore.
HFMD can be managed and it will not be the end of the world, but you must take it very seriously -wash your hands regularly and keep disinfectant wipes with you.
Hand, Foot and Mouth Disease in Singapore – a primer

Posted by Editor Amigo