Managing Hand, Foot, and Mouth Disease: Fever Control in Children

Enterovirus - the throat is currently not ulcerated?

Hello, Dr.
Hsiao.
I would like to ask about my child's first encounter with enterovirus, as he has been experiencing a persistent fever.
Based on my previous experience at a hospital in Taichung, the doctor advised that if my child is eating, playing, and sleeping well, there is no need to administer antipyretics.
Instead, it was suggested to give fever-reducing medication before bedtime to help him sleep.
However, during this visit to the clinic, the doctor advised continuous use of antipyretics, stating that since my child's throat is not yet ulcerated, it is best to prevent the fever from rising, as a high fever could lead to complications with throat ulcers.
Is this correct? Should we aim to keep my child’s fever down when dealing with enterovirus?

Zhichang, 30~39 year old female. Ask Date: 2015/11/10

Dr. Xiao Kaiwen reply Pediatrics

If there are no ulcers or lesions in the throat and no red rashes or blisters on the palms and soles, a diagnosis of enterovirus infection cannot be made.
Fever is a normal response of the body's immune system to enterovirus infection; it does not harm the body.
Once the immune response is fully activated, the fever will gradually subside, typically taking about three days.
Therefore, the goal is not to "avoid letting the child have a fever" during an enterovirus infection.
Antipyretics do not shorten the duration of the enterovirus infection nor prevent oral lesions; however, most antipyretics also contain analgesic components, so clinicians may prescribe these medications to alleviate pain in the mouth and throat.

Reply Date: 2015/11/10

More Info

Managing Hand, Foot, and Mouth Disease (HFMD) in children, particularly when it involves fever, can be a challenging experience for parents. The conflicting advice you've received from different healthcare providers highlights the complexity of managing fever in the context of viral infections like HFMD, which is commonly caused by enteroviruses, including coxsackievirus.

Firstly, it's important to understand that fever is a natural response of the body to infection. It is part of the immune system's defense mechanism, helping to fight off pathogens. In many cases, if a child is otherwise well, active, eating, and sleeping normally, it may not be necessary to aggressively treat a low-grade fever. However, the situation can change depending on the child's overall condition and the specific symptoms they are experiencing.

In the case of HFMD, fever is often accompanied by painful sores in the mouth and throat, which can make swallowing difficult. If the fever is high (generally considered to be above 38.5°C or 101.3°F) and the child is uncomfortable, it is reasonable to use antipyretics (fever-reducing medications) such as acetaminophen or ibuprofen to help manage their discomfort. The advice to administer fever-reducing medication before bedtime is also sound, as it can help the child sleep better, especially if they are experiencing pain from mouth sores.

The concern about allowing the fever to rise too high, potentially leading to complications such as throat ulcers, is valid. High fevers can exacerbate discomfort and lead to dehydration, especially if the child is reluctant to drink fluids due to mouth pain. Therefore, if the child is showing signs of distress, is unable to eat or drink, or if the fever persists for more than a couple of days, it is crucial to seek medical attention.

In managing HFMD, hydration is key. Encourage your child to drink plenty of fluids, even if they are reluctant. Cold fluids can be soothing, and popsicles can be a good way to keep them hydrated while also providing some relief to sore throats. Soft foods that are easy to swallow, such as yogurt or applesauce, can also be beneficial.

As for the differing opinions from healthcare providers, it is not uncommon for medical professionals to have varying approaches based on their experiences and the specific circumstances of the case. If you feel uncertain about the best course of action, consider discussing your concerns with a pediatrician who can provide guidance tailored to your child's specific situation.

In summary, while managing fever in the context of HFMD, consider the following:
1. Monitor Symptoms: Keep an eye on your child's overall condition. If they are active, eating, and drinking, it may not be necessary to treat a low-grade fever aggressively.

2. Use Antipyretics Wisely: If the fever is high or causing discomfort, using fever-reducing medications can help. Administering these medications before bedtime can aid in better sleep.

3. Hydration is Crucial: Encourage fluid intake to prevent dehydration, especially if mouth sores are present.

4. Seek Medical Advice: If the fever persists, or if your child shows signs of distress, consult a healthcare provider for further evaluation.

5. Trust Your Instincts: If you feel that your child's condition is worsening or if you have concerns about their health, do not hesitate to seek medical attention.

By following these guidelines, you can help manage your child's symptoms effectively while ensuring they remain comfortable during their recovery from HFMD.

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