Hand, foot and mouth disease – the name is enough to strike fear into the hearts of farming families especially, but this is generally a mild childhood virus and has nothing whatsoever to do with animal foot and mouth disease. Nevertheless, it can be worrying if your child gets it.

You notice that your young child has bubbly blisters on his hands. Examining the rest of his body you discover other blisters as well. His temperature has gone up too, and he may also have a sore throat and ulcers in his mouth. What on earth is happening? What is this virus he has picked up?

A visit to a GP will give you a precise diagnosis, but more than likely your child has picked up hand, foot mouth disease: a mild, viral illness.

Hand, foot and mouth disease is an enterovirus infection, according to the HSE. It is most common in children and is usually caused by coxsackie viruses, they say. Symptoms appear three to six days after you’ve come into contact with the virus. The condition usually lasts for seven to 10 days and usually resolves spontaneously (without outside help).

It is associated with fever, painless bubbles and a rash on the hands, feet and buttocks, they state. “Painful ulcers in the mouth and on the tongue can cause difficulties eating and swallowing.”

how long is it in Ireland?

It has always been around, a public health doctor told us, but crèche notifications mean that younger parents are probably just more aware of it. “Older parents would have been less likely to have had their children in crèches or playschools,” the HSE explains.

Irish Country Living asked the Health Protection Surveillance Centre for incidence figures for this illness each year in Ireland, but was referred back to the HSE, which gave this response: “Hand, foot and mouth disease is not a notifiable infectious disease, so the HSE has no data on numbers of cases. This is generally a mild viral illness, with a fever and rash with blisters, which appear especially in the mouth and on the hands and feet.

“Younger children less than 10 years are more susceptible to infection, due to close contact. However, adult cases are not unusual. This infection is spread by direct contact with nose and throat discharges of those infected and by coughing and sneezing. It is also spread by contact with the faeces of infected people.

“Frequent handwashing – especially after contact with secretions from the nose or throat or contact with faeces – reduces the risk of transmission. When a child is unwell with this infection they should be kept away from school/nursery.”

Crèche/PLAYSCHOOL COMMENT

We also asked Early Childcare Ireland what the procedure is in crèches and playschools if there is an outbreak of this virus:

“Hand, foot and mouth disease and incidence of same in an early years setting would be covered by the setting’s policy on infection. This policy is set using guidelines from Túsla and the HSE/Health Protection Surveillance Centre.

“Túsla lists the criteria that must be covered by a setting’s infection control policy. The policy must cover concerns such as handwashing, nappy changing, cleaning, and dealing with outbreaks of infectious disease.

“The HSE/HPSC guidelines in childcare facilities and other settings can be found on the www.hpsc.ie website (link: HSE/HPSC guidelines on management of infectious disease).Specific information on hand, foot and mouth is listed on page 38 of the document. Exclusion recommendations for this and other illnesses, where applicable, are detailed on pages 78 to 80 of the document.

“The appendices include a sample letter to parents/guardians which settings can use to notify families of an incidence of the illness.

“The HSE/HPSC guidelines categorise hand, foot and mouth as a mild illness. However, younger children are more susceptible to infection due to close contact.

“The guidelines advise frequent handwashing, especially after contact with secretions from the nose or throat. It is not normally advised that the child be excluded, so long as they are well. If a child is unwell, s/he should be kept at home.

“If there is evidence of transmission within the day centre, it may be necessary to exclude children until the spots have gone from their hands. (Page 38)

“The guidelines also advise that a setting contact the local Public Health Department if a large number of children are affected (page 78).

“Early Childhood Ireland is the largest organisation in the early years’ sector. We represent almost 3,800 childcare members, who support over 100,000 children and their families through preschool, afterschool, and full day-care provision nationwide.

“We have a sample policy on infections that members can access via our website. This can be used in conjunction with the above Túsla and HPSC advisories as a guide for settings in preparing infections policy.” CL

Dear Parent or Guardian,

There has been a case of hand, foot and mouth disease within your child’s crèche/pre-school and your child may have been exposed.

What is hand, foot and mouth disease? This is a disease caused by a group of viruses which usually affects young children. It causes blisters on hands and feet, and mouth ulcers inside the cheeks and on the tongue. Also they may have a sore throat and high temperature. These symptoms last for seven to 10 days.

Is it dangerous? No. Complete recovery is the rule.

How is it spread? The virus is spread by coughs and sneezes, and is also found in the faeces of infected children. Some children infected with the virus do not have symptoms but can still pass it to others.

Is there any treatment? There is no specific treatment for hand, foot and mouth disease – it is usually a mild and self-limiting illness. If a child feels unwell paracetamol may help. Antibiotics and creams or ointments for the blisters are not effective. Children recover just as quickly without them.

How long are children infectious? Children who are ill are infectious. They can carry the virus in their faeces for many weeks after they have recovered and so may continue to pass it on.

How long should children stay away from crèche/preschool? Children who are unwell should be kept off school until they are feeling better. Keeping children off school for longer than this is unlikely to stop the virus spreading. There may be other children in the school who appear well but are spreading the virus.

How can spread be prevented? Since the virus is found in faeces, scrupulous attention must always be paid to hand washing after using the toilet.

Can you catch it more than once? Yes, but children who are ill during an outbreak at school or nursery are unlikely to get it again during the same outbreak.

Thank you for giving this your attention. Your family doctor will be able to answer any further questions that you might have about hand, foot and mouth disease.

Yours sincerely,

_______________________________________

Crèche Owner/ Manager

>> A father’s story

Pat is a young dad whose 18-month-old son recently picked up hand, foot and mouth disease during an outbreak in crèche. He tells us about the experience:

“He had a bad dose of it all right. We had seen a sign a few months earlier that there was an outbreak in the crèche, but he didn’t get it that time. We weren’t as lucky second time round, though.

“We had gone up the country to a family wedding, bringing him with us, and blisters on his face seemed to spring up overnight. We called a doctor and he confirmed the diagnosis and prescribed penicillin, but we weren’t inclined to give that as there is a family history of allergy to penicillin.

“The wedding wasn’t exactly a joyful occasion and he was getting worse. He was distressed with it, particularly at night. He just wanted to be comforted all the time.

“When we got home our own GP said he had never seen as bad a case and referred us to hospital. Penicillin was prescribed there, but thankfully there was no bad reaction to it. We also got creams for him to help relieve the discomfort. His whole body was covered in blisters, really.

“I don’t think any of us had any sleep for about 10 days. Every child in his room in crèche got it this time. It seems to be very common, but older people don’t appear to have heard of it. Although we were told he could go back to crèche quickly we didn’t do that, as we didn’t think he was well enough.

“Even when we did he still had some scabs on his face, and you’d see other parents looking at you as you went in. It hasn’t been easy, but we’re glad it’s over now and that he’s well again.”