Hand, Foot, and Mouth Disease

Key Points

• HFMD is caused primarily by Coxsackievirus A type 16 or enterovirus, most common in children under 7 years.
• Transmission occurs via the GI or respiratory tract; outbreaks are common in daycares and camps during spring and summer.
• Oral lesions cause mouth and throat pain, which may lead to dehydration from poor intake.
• Enterovirus-caused HFMD may involve central nervous system symptoms.

Pathophysiology

The causative virus (Coxsackievirus A16 or enterovirus) enters through the gastrointestinal or respiratory tract. After ingestion, the virus replicates in the intestines and pharynx, then spreads to regional lymph nodes and other organs via viremia. Symptoms appear within 3 to 6 days of infection. When caused by enterovirus, neurological involvement (meningitis, encephalitis) is a potential complication.

Clinical Manifestations

• Initial fever, malaise, and sore throat.
• Painful oral ulcers on the tongue, buccal mucosa, and palate.
• Vesicular rash on the hands, feet, buttocks, and extremities; lesions eventually rupture to form ulcers.
• Lesions are generally not painful or pruritic.
• Decreased oral intake due to mouth pain, leading to risk of dehydration.

Nursing Assessment

• Assess oral mucosa for ulcers; evaluate ability to eat and drink.
• Monitor hydration status: urine output, mucous membranes, skin turgor, fontanelle (infants).
• Assess for fever and general comfort level.
• Evaluate for neurological symptoms if enterovirus is suspected (headache, neck stiffness, altered consciousness).
• Implement contact and standard precautions (virus shed in stool for weeks after resolution).

Nursing Interventions

• Provide supportive care: acetaminophen or ibuprofen for fever and discomfort.
• Encourage cool, soft foods and cold fluids to maintain hydration; avoid acidic or spicy foods.
• Offer oral analgesic rinses or topical oral anesthetic as prescribed for mouth pain.
• Educate families about hand hygiene, disinfection of surfaces and toys, and isolation from other children during the acute phase.
• Monitor for signs of complications: dehydration, secondary bacterial infection, neurological changes.

Related Concepts

• erythema-infectiosum - Another common viral exanthem of childhood.
• infection-control - Outbreak prevention in childcare settings.
• fluid-electrolyte-regulation-by-organs - Dehydration risk from poor oral intake.
• impaired-skin-and-tissue-integrity - Vesicular rash assessment and management.
• inflammatory-response-and-fever - Antipyretic administration and monitoring.

Self-Check

1. What are the primary causative organisms of hand, foot, and mouth disease?
2. Why are children with HFMD at risk for dehydration?
3. When should the nurse suspect neurological complications in HFMD?