Summer Sun Summer Fun
Vincent E. Pinedo, MD, MPH, FAAP. Nathaly Adolphe, PA-C
7/28/20262 min read
When Vacation Takes an Unexpected Turn: Hand, Foot and Mouth Disease.
Summer vacations are meant for sunshine, beaches, and family memories- not fevers.
In the middle of July, Nathaly and I took our five children and her sister on a summer vacation to the Jersey Shore. Uncharacteristically, Kindi slept through the entirety of the drive, which was two and a half hours. When we arrived at Wildwood, Kindi was taken out of the car seat and handed to my wife. She immediately exclaimed "Kindi is burning up!" I attributed the elevated temperature to the car ride despite having the AC on. Once we settled into our hotel rooms, we checked Kindi's temperature, which was 102.8. This was the first night of our vacation and our littlest one had a fever! Other than being clingy, she did not exhibit any other symptoms. We treated her every four hours for her fever, alternating Ibuprofen with Acetaminophen. On the second day we noticed a rash on her legs. Nathaly diagnosed Hand Foot Mouth disease(HFMD) and sure enough there was an ulcer on Kindi's tongue. Kindi was miserable. She refused to eat. She only wanted to drink milk. At night she was the most uncomfortable, only falling asleep with rocking in my arms and fever control. Over the succeeding few days, Kindi developed the rash over her whole body, hands and feet included. The fever continued until we returned home- 5 days later. We surmised that our little girl contracted the Coxsackie virus from being in a public pool prior to vacation.
Hand Foot Mouth Disease(HFMD) is a clinical syndrome presenting with high fever, ulcers in mouth and pharynx and rash to body including palms and soles. It is caused by enterovirus, mainly Coxsackie Type A. The virus is spread person to person by the fecal-oral route, oral/respiratory secretions and vesicle fluid. Treatment is largely supportive with fever control and hydration. If children are unable to tolerate liquids, consider hospitalization for intravenous hydration.
My wife and I, both experienced healthcare providers, going through it with her. Anxious and sad that our preemie had to suffer. But we both knew it would resolve, just give Tylenol and Motrin, echoing what we told parents millions of times. No-one can prepare you for that experience. But we can support you, listen to you, be empathetic. We provide guidance and even hold your hand.
Summer poem.
Hot days
That snow cone melting
Sticky hand day
Coney Island Nathan hot dog day
Salt water in your eyes day
Hydrant water
Bare feet day
ANTICIPATORY GUIDANCE
Be sure to wash your hands. That is still one of the best ways to not spread illnesses and prevent from contracting an illness like Coxsackie.
Use sunscreen. In addition to applying a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher. The American Association of Dermatologists also recommends that people seek shade and wear sun protective clothing, including light weight and long-sleeved shirt, pants, a wide-brimmed hat and sunglasses. https://www.aad.org/media/stats-sunscreen.
The most easily modifiable physiologic risk factor for heat illness is hydration status. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update.
Secure (four-sided) fencing and gating of swimming pools can exclude virtually all children under the age of four and potentially decrease swimming pool drowning by 80 percent. Prevention of drowning in infants, children, and adolescents. AU, Brenner RA, SO Pediatrics. 2003;112(2):440.
TEL: 862-298-7904
At EnteliHelth, we're dedicated to delivering high-quality, patient-centered care that fits your busy lifestyle. Our team of experienced healthcare professionals is committed to helping you feel better, faster.