Hand, foot and mouth disease in children: When to be hospitalized?

The article was professionally consulted by Dr. CCII Tran Thi Linh Chi - Department of Pediatrics - Neonatology - Vinmec Hai Phong International General Hospital

Hand, foot and mouth disease in children is a very common and contagious disease that, if not treated properly, can cause many dangerous complications, even death.

Hand, foot and mouth disease is transmitted mainly by the gastrointestinal tract, from saliva, blisters and feces of infected children. The disease can be found scattered all year round, in most localities, especially in the southern provinces, hand, foot and mouth disease in children tends to increase at two times: March to May and September to May. 12.
Hand, foot and mouth disease can occur at any age, but is common in children under 5 years old, especially in the age group under 3 years old. Favorable factors for the transmission of hand, foot and mouth disease are group activities such as: children attending kindergartens, kindergartens, schools, and places where many children are concentrated are high risk factors, especially especially during outbreaks.

Incubation period: lasts 3-7 days. Usually no symptoms. The onset stage: usually 1-2 days with typical symptoms such as: low-grade fever, fatigue, sore throat, loss of appetite, diarrhea several times a day, stools without bloody mucus. Common initial symptoms are fever and sore throat. Full-blown phase: usually lasts from 3 to 10 days with typical symptoms of the disease such as: Mouth ulcers: appearing 1-2 days after fever, initially as erythematous spots, within 24 hours, developing into acne water 2 - 4mm in diameter, causing pain, salivation, poor appetite, red sores or blisters on the mucosa of the posterior part of the oral cavity, pharynx folds, uvula, anterior column of tonsils, sometimes in mucous membranes of the cheeks and tongue, the sores can last for weeks. Blister-like rash: on palms, feet, knees, buttocks... that lasts for a short time (less than 7 days) and then leaves bruises (no keloid scars, no red, no concave). Sometimes papules without vesicles, varying in size from 2 to 10 mm, round or oval, raised or hidden under the skin on an erythematous background, painless. The skin lesions clear up on their own within 1 week, dry blisters will leave skin bruises, no ulcers. Children with mild fever from 2-4 days (± 7 days) with vomiting, diarrhea, cough. If the child has a high fever and shows a lot of vomiting, there is a risk of complications such as: complications on neurological, cardiovascular, respiratory ... usually appear early from day 2 to day 5 of the disease. Remission phase: usually 3-5 days later, the child will recover completely if there are no complications.

Hospitalization criteria for hand, foot and mouth disease in children:
Grade 1
Most grade 1 cases can be treated as outpatients and monitored at medical facilities. However, grade 1 requires hospitalization when one of the severe symptoms begins:
High fever > 39 degrees C Fever for more than 3 days. Children vomit a lot. Children doze off. Blood white blood cells > 17,000 cells/mm3 Grade 2: need to be hospitalized for treatment
Grade 3 and grade 4: need to be hospitalized for treatment in the intensive care unit
Currently, there is no medicine to treat hand, foot and mouth disease, only focus on supportive treatment (do not use antibiotics when there is no superinfection). Follow up closely to detect early and treat complications as soon as there are signs. Ensure adequate nutrition, improve physical condition.