Hand, foot and mouth disease

What it is

Hand, foot and mouth disease is a common viral infection, mostly in children under five. It starts with a sore throat, a temperature and not wanting to eat. A few days later painful mouth ulcers appear, then a raised rash on the hands and feet, sometimes the bottom and groin. Spots can turn into small blisters. It is not related to foot-and-mouth disease in animals.

How it works

It is caused by enteroviruses, spread through coughs and sneezes, saliva, fluid from the blisters and poo. The virus can stay in poo for weeks after the child is better, so hand-washing after nappy changes matters.

Why it matters on darker skin

On brown and black skin the spots can look pink, red or darker than the surrounding skin, and the blisters can look grey or lighter. Look at the palms and soles, where the spots are easier to see, and inside the mouth. Some children lose a fingernail or toenail a few weeks later; the new nail grows normally.

Causes and triggers

Close contact in crèches, nurseries and families. It spreads most in the first week of illness.

What helps — and why it works

Offer cool drinks often (water or milk, not acidic juices), and soft, cool foods such as pap, yoghurt or mashed foods; avoid hot, spicy and salty food. Paracetamol or ibuprofen at the right dose for age eases mouth pain and fever. A pharmacist can suggest a mouth gel suitable for your child's age. Leave blisters to dry by themselves. Wash hands often and do not share cups, spoons or towels. Your child can return to school or crèche once they feel well; you do not need to wait for the blisters to heal. Expected timeline: 7 to 10 days.

What to avoid and why

Avoid antibiotics, which do not work on viruses. Do not pop blisters. Avoid acidic drinks and spicy foods, which sting the ulcers. Do not apply herbal pastes or alcohol to the spots.

Common mistakes

• Letting a child go without drinks because swallowing hurts.
• Keeping children home until every spot has gone.
• Not washing hands after nappy changes.

Caring for children's skin

Children's skin is thinner, loses water faster and absorbs more of what is applied to it relative to body size, so simpler is safer. For most children a short lukewarm bath, a fragrance-free soap substitute and a plain emollient are all that is needed, plus shade, clothing and sunscreen from six months of age. Avoid adult products, essential oils, antiseptics in bath water, bleaching or 'toning' creams, and cosmetic treatments such as relaxers and gel nails. Medicines and medicated creams should be used only as a doctor, nurse or pharmacist advises, and in children Melanin & Me does not offer photo checks: a clinician should see the child. Trust your instincts as a parent: a child who is unusually sleepy, floppy, not feeding, breathing fast or has a rash that does not fade when pressed with a glass needs urgent care. Keep a simple record — photos and dates — of rashes that come and go, as this helps the doctor.

Products, medicines and when to worry

When choosing products for children, look for fragrance-free formulas with short ingredient lists, and avoid adult acne, anti-ageing or lightening products, essential oils and talc. Medicated creams — including steroid creams, antifungals and antibiotics — are safe and helpful when prescribed for the right condition and used for the right length of time, but mixed creams sold over the counter can contain strong steroids that are unsafe for children. Sunscreen is suitable from six months of age; younger babies should be kept in the shade and covered. Do not give medicines intended for adults, and ask a pharmacist about the right medicine for a child's age and weight. Seek urgent care for any rash with fever and a very unwell child, a rash that does not fade under a glass, swelling of the face or lips, or blistering of the mouth or eyes.

Questions to ask your doctor or pharmacist

Useful questions include: What do you think is causing this? Is it likely to come back, and how can I prevent it? Which products should I stop? How long before I should expect improvement, and when should I come back if it isn't better? Are there side effects to watch for? Is this treatment safe if I am pregnant, breastfeeding or for my child? Writing your questions down, bringing your products (or photos of their labels) and taking dated photos of the problem make an appointment much more useful.