HFMD – Hand Foot and Mouth Disease

HFMD is a viral infection common in young children in Singapore that results in a blistered rash, commonly on the hands, feet and mouth, but also in the nappy area. It could also stand for How to Freak-out Mums and Dads.

After five years with under-fives in Singapore, I thought we had scraped through unscathed. Without infection we had survived four kindy outbreaks, three condo outbreaks and seven birthday parties with an after-party message that another guest had been diagnosed. After infection kids are contagious for about a week before the tell-tale rash is visible, therefore coming into contact with contagious kids is unavoidable.

Last week our lucky streak came to an end when we noticed a nasty rash that couldn’t be anything else. A week previous she had a few hours of fever that only required one dose of paracetemol and during the week she had complained of a sore throat a couple of times, but nothing that stopped her from eating or playing as usual. Five days after the fever I noticed one small blister under her lip which I now wish I had paid more attention to, then two days later we noticed the rash on her bottom.

From there it was a trip to the GP to confirm, then the embarrassing task of notifying the kindy and all the parents of kids we had played with in the past week. Having received these messages plenty of times myself I know how unwelcome they are, but they were received with grace and wishes for a speedy recovery.

Fortunately my daughter has contracted a very mild case, some kids we know have been much more unwell and uncomfortable, with a more prolonged fever and painful mouth and throat ulcers. After the worry that we might have infected other kids, the most unpleasant part for us is home quarantine. Playdough anyone?

Once the rash has healed we will return to the GP for a certificate stating that she is well and able to return to school.

HFMD is legally notifiable in Singapore which means that medical practitioners and schools must notify the ministry of health of HFMD outbreaks. Child care centres, kindergartens and schools should be aware of HFMD, since they can be shut down if they exceed a certain number of cases. Most conduct temperature checks and visual inspections on arrival as a precaution against HFMD.

HFMD Symptoms:

  • fever
  • sore throat
  • ulcers in the throat, mouth and tongue
  • headache
  • rash with vesicles (small blisters 3-7 mm) on hands, feet and diaper area. The vesicles are typically on the palm side of the hands the sole side of the feet and very characteristic in appearance. The rash may also be present on the buttocks, arms and legs.
  • loss of appetite
  • vomiting and/or diarrhoea

Potential Complications:

  • Dehydration due to painful ulcers preventing drinking or vomiting/diarrhoea

Complications such as brain, lung or heart infections may occur occasionally, usually due to the EV 71 virus and can be serious. Some signs and symptoms of complications include:

  • severe headache, giddiness and neck stiffness
  • disorientation, drowsiness and/or irritability
  • fits
  • breathlessness or turning blue

Source: Singapore Health Promotion Board