Hand, foot and mouth disease has been prevalent in China for several years, and I believe we are all no strangers to it. As we have experienced in our outpatient clinics, it is still not uncommon for parents to have inadequate knowledge of HFMD and to handle it improperly.
There are two typical misconceptions: the first is “talk about the disease”, once the child is found to have a rash, even a red rash to see the hand, foot and mouth disease clinic late at night, some just mosquito bites; the other is “paralysis”, heard that hand, foot and mouth disease is easy to The other is “paralysis”, I heard that the hand, foot and mouth disease is easy to good, the change of condition is not found in time, sent to the hospital is already serious, and even appear pulmonary hemorrhage or shock performance.
Therefore, it is necessary to write an article to introduce to parents and friends, how to initially determine HFMD, especially how to identify serious illnesses as early as possible.
HFMD can develop in all seasons, with a high incidence in summer and autumn, and mainly affects babies within 5 years of age. Immunity can be acquired after contracting HFMD. However, there are more than 20 viruses that cause HFMD, and the antibodies produced by different viral infections lack cross-protective power, so some children can get HFMD several times.
What are the manifestations of common HFMD?
The onset of HFMD is rapid, with some children first developing a fever, or a cough or runny nose, thus resembling a cold in the early stages; a rash begins to appear 1-2 days after the fever, usually on the hands, feet and buttocks, and a herpes rash appears in the mouth. The rash is usually found on the palms of the hands, feet and buttocks, followed by the knees and elbows. The typical rash is a rash of rice-sized herpes and red rash, which may be surrounded by a halo of redness and is mostly non-itchy and non-painful.
The number of rashes is not proportional to the severity of the disease, and it has been observed clinically that the rash is rare in severe cases. It is worth mentioning that many popular science articles say that the rash of HFMD is characterized by “four no’s”: no pain, no itch, no crust, and no scar. We have learned in our work that these “four no’s” only apply to most cases, and in a few cases, the rash is accompanied by pain and itching, and after the rash recedes, it can crust over and peel off, and individual children even have nail and toenail loss.
With that said, it doesn’t seem too difficult to spot HFMD. A clinical diagnosis of HFMD can be made by oral herpes, together with the presence of the above-mentioned rash on the palms of the hands, soles of the feet and buttocks in one or more places, and is more likely if the child has been exposed to HFMD during the epidemic season.
However, atypical HFMD is easily misdiagnosed. The most common are the following 3 diseases.
1. Colds.
Fever is the most common manifestation of a child’s illness: if a child has a fever, or is accompanied by a cough or runny nose, everyone knows that a cold is present. This cold, however, can be both a simple cold and an early manifestation of many diseases, such as hand, foot and mouth disease. That is why many children with HFMD often report to the general pediatric clinic or emergency room first.
Some of them are referred to the HFMD specialist clinic because of the rash or blisters found through examination; children who do not yet have a rash or blisters are difficult to distinguish even for specialists. Usually the rash comes out in 1-2 days of fever before it can be identified. Here is a reminder to parents and friends, hand, foot and mouth disease epidemic season, children with fever should think of hand, foot and mouth disease.
2, papular urticaria: mostly mosquito bites caused by insect bites dermatitis. High temperatures in the summer and autumn, children wear less clothing, hands, feet, buttocks are often exposed, bites produce rashes, and hand, foot and mouth disease in the same area; its rash form is mostly papules or small blisters, also similar to hand, foot and mouth disease rash, so it is often treated as hand, foot and mouth disease to the clinic.
But the rash is mostly papules or papules, itchy and obvious, and the skin is dark brown after the rash has receded.
3, chicken pox: chicken pox rash is also herpes, similar to the herpes of hand, foot and mouth disease, so it is easy to confuse. The difference is that the rash of chicken pox is mainly distributed on the trunk, itching is obvious, hands, feet and buttocks rash is less; herpes is about the size of a soybean, the herpes fluid is clear and bright.
How do I know that my hand, foot and mouth disease is getting worse?
The most common question parents ask during outpatient visits is: Does it matter if their child is sick? The answer to this question cannot be generalized because the severity of the disease varies greatly, and the disease changes from time to time. In a few cases (especially those younger than 3 years old), the disease progresses rapidly and serious complications such as meningitis, encephalitis, brainstem encephalitis, pulmonary edema, and circulatory disorders appear around 1-5 days after the onset of the disease, so HFMD is a dangerous period within 5 days after the onset of the disease. Early identification of serious illnesses, especially critical illnesses, will greatly increase the success rate of rescue and treatment! There are no ideal indicators to predict the disease in medicine, and the most important thing is close observation and comprehensive analysis. The following is a description of what signs indicate an exacerbation and contains only what is accessible to parents.
Severe cases are indicated when there are the following conditions, which require immediate hospitalization.
1.Recurrent hyperthermia: body temperature over 39℃, conventional antipyretic effect is not effective, or fever is high again after 2-4 hours of fever reduction.
2, neurological manifestations: poor mental health, drowsiness, or crying and restlessness, headache, vomiting, jumping, limb shaking, weakness, unstable standing or sitting; convulsions. The term “startled jump” is commonly used to describe
”It is usually seen during sleep. Some children can also have this kind of performance, but it is not likely to be very frequent. In addition, many parents take the chills of their children when they have a fever as limb tremors, chills are seen in the early stages of fever, manifested as shivering all over the body, cool hands and feet and hot body; limb tremors caused by hand, foot and mouth disease are not directly related to fever, and can be unilateral or single limb tremors.
3. Abnormal respiration: increased, slowed or irregular rhythm of breathing; sudden increase in cough, increased sputum volume, oozing of lips and mouth, or even pink foamy sputum, suggesting the emergence of neurogenic pulmonary edema and a dangerous disease. It is easy to confuse that fever can also cause increased respiration, and pneumonia can also cause sputum and shortness of breath, but the above respiratory abnormalities in hand, foot and mouth disease are heavier and come suddenly.
4, poor circulation: cold sweat, cold extremities, skin pattern, pale, press the child’s palms and soles after turning red slowly, is the early manifestation of shock. Some children with fever can also show poor circulation, which is relatively mild.
In conclusion, most cases of HFMD are mild, a few appear to be severe and individually life-threatening; the problem is that each case of HFMD has the potential for sudden exacerbation. Knowing this knowledge will help reduce overstimulation and help keep your child safe. However, it is important to remember that this should not be used as a substitute for professional diagnosis.