Introduction

HFMD, all parents dread these 4 letters & with good reason. It’s the chicken-pox of the 2010s, where your child cannot go to childcare or school and there’s no cure and no vaccine.

In Singapore, MOH has declared it endemic and there’s a good chance it’ll infect your kids like it happened to my (then) 4yo daughter.

As an insurance professional, I’ve handled many HFMD claims for StarShield babies so far this year (2015) and heard many horror stories regarding the pain & suffering of their toddlers and themselves. My kids are 6 & 5 so I understand their pain and I was somewhat prepared when my 4yo (at that time) daughter got HFMD. So I’m here to share how to be prepared to handle the situation if this happen to your child.

What is HFMD?

Hand Foot Mouse Disease is caused by 2 different families of virus, and like flu, your immune system is only primed for that particular strain in that particular sub-family. If you’re infected by a different virus strain, your prior infection isn’t going to help you.

The symptoms appears 3-4 days after infection and the most common ones are lesions around the joints & mouth, a low level fever and most painful of all, many many ulcers in the mouth. It’s seriously scary to see so many ulcers in your child’s mouth if you’re unprepared so I’d prepare you by showing my daughter’s. 😉 13-14 ulcers in total!

The ulcers are the worse part of the disease. That’ll take about 5-6 days to clear before the doctor can declare your child healthy and non-infectious. HFMD affect different children differently because there’re so many virus that can cause it and these virus particles can survive even when the mucus is dried up. So the best defense against HFMD is to ensure your kids washes their hands before eating anything. Since there’s no vaccine & no treatment available, it’s a waste of time & money to see pediatrician unless your child is below 2 years of age.

Just see a normal GP for liquid Paracetamol or acetaminophen to manage the fever & pain from the ulcers. Some GP prefer to prescribe Ibuprofen and that’s fine because it’s more effective as a painkiller, but the dosage MUST be strictly followed because liver damage is a known effect even with a light dosage. This is why I opted for Paracetamol.

If you want more detail on HFMD, click here.

What to do?

1. First of all, don’t worry, most HFMD in Singapore don’t result in death. Hospitalisation may be needed if you can’t manage it properly so I’m here to help you manage it properly!
2. Be prepared to take 1 week leave if you cannot find someone willing to take care of your child. Please don’t ask your parents to take care of your sick child. Elderly has a weaker immune system & if they catch HFMD, they’ll suffer badly!
3. ENFORCE hand washing for everyone at home if you don’t want everyone to be infected! Also, no kissing and reduce touching to minimize the chance of contaminations and increasing the itch to those blisters.
4. DO NOT share food! Always pass the food to the child so that his/her utensils never touches what the rest of the family is eating.
5. Wash your child backside or ensure he/she washes his/her hands after using the toilet because HFMD is passed from feces to the mouth.
6. Prepare some topical (non-steroid) cream to reduce itching.
7. Prepare the following if ulcers start appearing. (Painkiller, ulcer cream, watermelon plant powder)
8. If ulcers becomes bad, prepare plain porridge everyday with some salty or sweet condiments. Everything that goes into the mouth is going to hurt like hell for your child. Sympathise with the pain but ensure your child gets the food down because he/she really needs the nutrients to fight off the infections! (Contrary to many advise, ice cream hurts!) High salt or sugar content hurts the ulcers so plain and warm is good.
9. Use alcohol swaps to wipe down all the child’s regular toys + surfaces he/she touches everyday like door knobs to minimize cross-contamination. Sterilising the whole house is frankly impossible and since HFMD viruses are not air-borne, just ensuring everyone washes their hands before food and you’d be fine. My 6yo son has close contact with his sister but by following our instructions, he never contracted it.

What NOT to do

1. Do Not Let your child play in public & spread the virus.
2. Do Not Bring you child to childcare & expect them to take care of your sick kid.
3. Do Not Eat all sort of medicine, western or traditional. It’s not going to help. Just ensure your child is well-fed & hydrated.
4. Do Not Use steroid based cream or medication. (It hinder the child’s development.)
5. Do Not Punish the child for not following your instructions or being cranky. Trust me, the ulcers are driving him/her crazy enough.
6. Do Not Overdose your child with painkiller.
7. Do Not Give lots of kisses & hugs. If you go down, it’ll take twice as long for YOU to recover! Then WHO’s going to take care of you & your child?

Dealing with the ulcers

1. The most painful ulcers are those at the back of the throat & mouth. Those under the tongue will make it hard for your child to eat anything.
2. Give painkiller. Follow dosage carefully especially with Ibuprofen. For very young toddlers, watch out for these side-effects & stop the medication immediately and see your doctor.
3. For Paracetomol or acetaminophen, you can safely increase Paracetomol dosage slightly if needed.
4. If you believe in Watermelon plant powder, you can spray 2-3 times to the back of the tongue. My girl didn’t like it because it’s so bitter.
5. Personally, I prefer the ulcer gel because there’s no restriction on dosage.
6. Clean your hands and carefully apply a dot of ulcer gel on your little finger.
7. Dap or rub the dot on the ulcer. Repeat until you’ve covered all the ulcers.
8. For those ulcers at the back of the throat, I squeeze a liberal amount under my daughter’s tongue and ask her to mix it with saliva, gargle & swallow.
9. If you do all 3, most of the pain will be gone enough for you to feed your child!

Feeding

1. Since there’s no cure for HFMD, it’s important your child is able to fight off the infection him/herself. This means he/she must eat or at least drink formula milk that can fulfill the daily nutritional needs.
2. Plain, bland, soft & warm food is the best. I found plain porridge is the best for my daughter, together with those Taiwanese mock duck or glutten which is not too strongly flavoured. After a few initial tentatively swallows, my daughter manages to finish her porridge in record time! Just remember to spread the porridge in a big plate so it cools down fast!
3. We’ve tried different food, milo, cold milk & ice-cream. All hurt her badly especially cold stuff.
4. After food, I find that another round of ulcer gel helps to take the edge off the pain enough for her to sleep soundly.
5. For hydration, I found that plain water is the best because the sugar in flavoured beverage hurts the ulcers for a long time. If your toddler is young, you can try to thin the milk a bit if he/she is rejecting the milk.

Fever

I generally wouldn’t worry about the fever unless your child becomes listless and lethargic, or worse, have a seizure. If you follow the dosage of the painkiller & the fever stays high, quickly seek medical help.

Recovery

By following these rules, my girl recovered nicely with no weight loss or lasting effects. I hope this article helped you if your child got HFMD.

Insurance

Most insurers don’t comprehensively cover all aspects of managing childhood disease like HFMD. Fortunately, I know one that does that. From outpatient GP/Specialist costs, to taking care of the taxi fare or parking fees shall your child be hospitalized, to the actual hospital bill. It’s very affordable to boot.

For more information, please email me! erictay_et@aia.com.sg

Errors? Comments? Questions? Use the comment box below!

(PDPA: Note that by emailing me, you consent to allowing me to email you back regarding HFMD information shared in this article. Don’t sue me later saying your email is in the DNC ah!)