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Hand, Foot in Mouth

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“Parents of Average Town USA Academy, this is to inform you that there has been an outbreak of Hand, Foot, and Mouth Disease in our kindergarten classroom.” As I was in the midst of reading the email, I heard my phone ring…Of course, my daughter was in the nurse’s office complaining about the sores in her mouth. Already in a zombie-like state thanks to several consecutive months without a decent night’s sleep, I reacted like any 36-year-old father of two would, I curled up in a ball of self-loathing in the corner of my office…ok, not really, but it crossed my mind.

With nearly a decade spent working in public health, I’ve seen an outbreak (or 12) of hand, foot and mouth disease (HFM). Characterized by sores in the mouth and a rash on the hands and feet (hence the name), HFM is also commonly accompanied by fever, sore throat, and general lethargy. Every time a daycare provider or kindergarten teacher sees a small inflamed blister anywhere on a child, their blood pressure immediately goes up with visions of spending the rest of the evening sanitizing every inch of the facility. HFM spreads through any child-dense area like a California wildfire, leaving a wake of destruction for a week or so. After my wife picked up my daughter, I promptly walked into my boss’s office and let her know that my worksite would be my couch for the next little while.

HFM is one of those childhood maladies that is widely misunderstood. Even though I have a vast amount of professional experience with it, I admittedly made a few mistakes in dealing with our own household situation, which resulted in two for the price of one. Yep, I told my wife that we were probably alright allowing our princess to interact with her brother, and two days later, the virus reminded me how ignorant I can be. Despite my professional experience and the two letters that precede my name on my business card, I am not a medical professional, and if asked to provide guidance about any medical condition not associated with obesity, I am quite likely to open my mouth and insert foot. A few misconceptions to dispel:

1. Hand, Foot, Mouth ain’t one and done. While there is one primary viral culprit (Coxsackievirus A16), there are actually a total of 9 viruses, all of which manifest themselves slightly differently. For instance, the far less common Coxsackievirus A6 usually results in much more severe fevers and rashes on the buttocks, while those who contract Enterovirus 71 often have their lunch coming out of both ends as well. Approximately a year ago, HFM swept through our church, affecting almost every child under the age of 3, including our son. We didn’t think it was necessary to quarantine our daughter away from her brother this time around because he had already done the HFM dance—we were wrong. Lucky for us, symptomology suggested our kids got the Enterovirus 71 version. I think my boy set some kind of record for bowel movements in a 12-hour period. Proud papa here.

2. What’s in a name? The most likely place for lesions is the hands, feet, and mouth, but they can appear almost anywhere: groin, buttocks, elbows, the back of the knees. My son’s first sores manifested themselves on his naughty bits, so we mistakenly believed they were simple diaper rash until he uncharacteristically started balking at finishing his meals. Sure enough, my wife asked him to say “ahh” and the roof of his food hole looked like he had swallowed a mouthful of fire ants. We preceded to spend the rest of the evening doing laundry as he doused his bedsheets and every towel in the house with remnants of the day’s menu and what was left of his stomach bile.

3. There isn’t safety in age. Parents, you can still get it. It is certainly more prevalent in children under 5, who have developing immune systems and can spend quite a bit of time in densely populated viral incubators (day cares, schools, etc.), but unless you have been at some point introduced to all 9 viruses, you’re not free and clear just because you have a driver’s license. Because the virus can be spread through saliva and feces and (depending on the virus) can stay in the body for upwards of two months, parents are actually at pretty high risk. Luckily, contagion does significantly decrease once there are no visible symptoms. But if you wake up one morning with a high fever, it might be because you didn’t wear gloves when changing junior’s diaper.

4. Doctor Time cures all. Unfortunately, like many of the most annoying health conditions, there is nothing a pediatrician can do for your little gremlin. It’s often our first reaction to seek medical help when we see our most loved ones suffering, but because the root of HFM is viral, there is little doctors can do other than offer a few ideas about how to ease the discomfort of the symptoms until the immune system does its thing. And due to its highly communicable nature, most healthcare professionals would prefer you keep children with HFM out of their facilities. Harness every ounce of parental strength to quarantine your baby until the illness has run its course.

It’s done. Almost. While there is no standard as to when it is safe to release your animal back into the wild, the symptoms have cleared up, so I was able to send the stinkers back to school on Monday with a (semi) clear conscious. Thanks to some family help, my wife and I were able to tackle all of our adult responsibilities this week and actually got in a date and a full night’s sleep out of it (on the eve of our anniversary no less). Don’t miss the signs, don’t assume it isn’t going to get you too, and be a responsible parent and keep the HFM virus contained in your own home. Onward to the next parental trial.

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