Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is an acute infection caused by non-polio enteroviruses. Coxsackievirus A16 and A6 are common causes; Enterovirus 71 is less common but is associated with more serious neurologic disease. Transmission occurs through fecal-oral spread, respiratory secretions, and direct contact with contaminated hands or surfaces. The clinical pattern is more useful than any single symptom: fever, painful oral vesicles or erosions, and a papulovesicular rash on the palms, soles, and often the buttocks. The mouth lesions may hurt enough to make a child refuse fluids. That pain-limited intake, rather than the appearance of the skin lesions alone, is often the nurse’s first clue that the child may be moving toward dehydration. HFMD is usually managed supportively, but the disease pattern can change quickly in a child who cannot drink. Enterovirus 71 also raises concern for central nervous system complications, so neurologic and respiratory assessment must accompany routine skin and oral assessment.