With the beginning of summer well underway, I have seen many kiddos in the office with a very typical summer rash. It’s a rash that usually appears on the hands, feet, and around the mouth, giving it the name Hand, Foot, and Mouth Disease (HFMD). It’s caused by a group of enteroviruses that are common in the summer months. While this big group of viruses can cause more serious illnesses, this presentation of illness is typically mild and commonly infects infants and toddlers. While it can affect older children and adults, it is less common and these individuals typically have milder symptoms of the disease, if any. 

The most common symptom of HFMD is the rash for which the disease is named. The rash usually begins as tiny little red dots that get bigger and then look like small blisters. The areas that are typically affected include the skin around the mouth, mucous membranes inside the mouth (including tongue/back of throat), hands (including the palms) and feet (including the soles), as well as buttock and diaper area.

Other symptoms of HFMD include fever, runny nose and sore throat. Like all other viruses, treatment involves supportive care and caring for symptoms, including the use of fever-reducing medications as well as pain control. While rash is typically not bothersome or painful, the lesions in the mouth can cause sore throat or mouth pain. There is no particular treatment necessary for the rash, as it will typically self-resolve within two weeks. It is important to watch for any spots that look like they are oozing or not healing well because secondary bacterial infections can occur. If you have any worries, call your pediatrician as we can usually diagnose this by examining your child and getting a history of the symptoms. 

For starters:

1. No, it's not that cattle disease with a similar name. Heehee. 
2. Yes, it's super contagious. 
3. Nope - no reason to freak out. We see it all the time. You probably had it when you were a kid.
4. Go get some popsicles. I'm gonna prescribe them.

Hand Foot and Mouth Disease (HFM from here on out) is caused by a virus. What does that mean? Come on - I know you're sick of hearing me say it - that means no antibiotics needed! Woo hoo! This is a virus which your strong kiddo can clear on his own!

Most of the time this happens in kids under 5. They catch it from day care or school classmates. Usually they catch it by getting oral secretions or fecal secretions in their mouth or airway from a buddy. I'll let your imagination run wild on the methods kids go through to experience this fun transfer of germs. It's really contagious.

People with HFM are most contagious during the first week of their illness. However, they may be contagious for weeks after symptoms go away. Some people, especially adults, may not develop any symptoms, but they can still spread the viruses to others.

This is a common SUMMER virus! But can happen any time of year.

Soon after catching it (like 3-5 days), kids start with a fever and a new rash. The fever is usually low (under 101) but can be high at times. Sometimes they have a runny nose, or other cold symptoms.

The rash is unique. They're red spots with/without thick bubbles of fluid.

Usually, they're on or in the mouth, and on the palms of the hands and soles of the feet. Hence the name. However, I joke with parents that it should be called "Hand-Foot-Mouth-Butt-Arms-Legs" because you can see the spots in other places, too.

HFM is commonly mistaken for other things. Often, parents worry about chicken pox. Remember - chicken pox is itchy and tender. HFM is not. People also mistake these for bug bites - again, not itchy like bug bites are.

The mouth sores hurt. They're typically the main complication I see with HFM - they hurt so much kids don't want to eat or drink. The eating I don't mind -but it's important that they drink. Load up on popsicles. All my "sugar rules" go out the door when a kiddo has HFM. Sometimes if it's really bad we will prescribe a mouthwash for pain.

Something else you should know - more than one strain of virus causes this bad boy. So kids can get it more than once. And if an older child/adult catches it? It can be more troublesome/painful than in a younger person.

It'll go away on its own. This can typically take 7-10 days. The fevers usually last just a couple of those days. Kids typically are just fine. It's actually adults that can experience the worst of it!

Hope this helps!

Hugs,

Dr. Diane

With so many things to consider how will I know when my baby is ready? Where should my baby sit for feedings? What should I offer my baby to eat first? How do I do this anyway? Should I try the spoon or just go for the squeezy pouches?

As a feeding therapist these are questions we hear a lot. When your baby is ready for the introduction of pureed foods around 4-6 monhts, it's time for the messy fun to begin! If your baby is showing the following signs, it might be time to give it a go:

• Takes a bottle or breast feeds with ease.
• Watches with interest when caregivers eat.
• Brings objects to his mouth.
• Sits comfortably in a bouncy or infant seat.

Here are a few questions you may have when you are ready to take the plunge:

1. Where should my baby sit for the feedings?

• Stable seating is best for your baby. Babies should not be bobbing, leaning or lounging on their back. In the beginning, babies should be in a semi-upright position, like they would sit in a bouncy seat or infant feeding seat. As babies become more stable sitting up, a booster seat or highchair can be used.
• Position baby at caregiver's eye level.
• Remember, as babies grow their seating will need to be adjusted.

2. What should I offer my baby to eat first?

Start with thin baby food cereals. Rice cereal by spoon is a good choice. Gradually increase the thickness of the cereal as your baby tolerates. Alternatively, Stage 1 or homemade single ingredient purees may be offered.

3. How do I offer these foods?

• Show your baby with your expression and tone of voice that this is going to be fun and enjoyable.
• Show the baby the spoon; a small plastic toddler spoon works well.
• Dip the spoon into the puree wiht a small taste on the end of the spoon.
• Offer the spoon slowly. Place small taste on lower lip.
• Caregiver should model smacking lips.
• Continue to give small tastes of puree modeling "Aaahhh" for baby to open mouth and "Mmmm" for baby to close mouth and use lips to clear the spoon.
• Follow the cues of the baby to continue offering more bites and bigger bites. Hint: If he pushes your hand away or turns his head, he's most likely done. However, if he opens his mouth, he's letting you know he's ready for more.
• Keep mealtimes short and sweet. End feeding in a positive way.
• Let baby get messy, messy, messy! While we're at it, don't scrape food off of baby's face during the meal. Save the cleaning up for after all the bites are done and baby is out of the feeding seat. Washing off at the sink works well.

4. Why should I start with the spoon and NOT the pouch?

Here are all of the wonderful things your baby is learning when you offer pureed foods from a spoon:

• Practice getting the tongue and jaw to move in more coordinated and controlled movements getting them ready for harder solids.
• A chance to work on lips clearing the spoon rather than just sealing as they do for breast and bottle.
• A chance for baby to begin working on moving tongue from side to side and biting on a firm object.
• A chance to build a feeding routine that fosters skills and confidence.
• A chance to work on building trust and incidental feeding experiences as they see someone they love and trust offer and explore foods with them.
• A chance to begin working on the co-feeding stage, redefining the parent role and the child role in feeding as babies move toward independence with finger feeding and spoon holding and licking while still needing help from their caregiver.

5. While we are on the subject, how about pureed from pouches?

Pouches are so convenient. They offer parents an easy way to expose their little ones to a variety of flavors, they're easy to transport and easy to offer on the go. For those times when you simply can't pass on the pouch, remember these tips:

• Consider squeezing onto a spoon.
• Remember to get face to face with your baby when using a pouch.
• Offer pouch foods that are more single ingredient or just a few ingredients so that the pouch is an added food, not the whole meal. 
• Offer the pouch when seated in a stable highchair with a tray, offering some of the puree on the tray for the baby to touch and practice licking from the fingers.

About the author

Melissa Smith is a speech pathologist at Cook Children's. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Click here to find the closest Cook Children's Rehabilition Services near you.