a suspicious rash

Ethan has been sick for the past three days with a runny nose and a fever running 102 to 102.3. He has been playful and drinking fluids okay, but I am at the point of concern. I go to work in the morning after leaving a list for Jeff about medications, dosages and timing, when he last ate and when I changed diapers so that he could watch his fluid intake and urine output. I run through the list of differential diagnosis. I still think the infection is likely a viral “cold” but I am hoping it is not flu or RSV. He received both doses of his flu shot this year, as had the rest of the family, but there is still some risk.

I call Jeff at lunch... happy to hear that Ethan is doing well. No fevers yet this morning, so we decide against calling his pediatrician’s office for an appointment. Jeff hates the idea of taking the children without me anyway because, “it makes more sense for me to go since I speak the language!” By the time I arrive home I have my answer to what is ailing Ethan. It is evident by the rash he has developed on his legs, and more importantly on his hands, feet and gums. He has a form of Enterovirus, aka “Hand, Foot, and Mouth.”

This virus is more commonly seen in the summer and fall months. I am wondering if this crazy mild winter has something to do with why I am seeing it now. This illness is characterized by fevers, a runny nose for a few days and then a rash that develops. Typically the rash develops one to two days into the illness and starts as red spots or blisters in the mouth. These blisters can occur on the tongue, throat, and gums, and often cause affected children to be fussy or whiny, not really want to eat or drink, and possibly have a slight drool. The rash can then develop on the extremities or other parts of the body and look like a pink to red, bumpy and scabbing rash. Specifically the rash causes blisters to develop on the hands and feet. These blisters erupt over a few days and slowly resolve. They can be painful for some children. Overall the illness lasts one to two weeks and does not require any treatment other then what we call symptomatic care.

Encourage fluids to keep your kids hydrated, treat fevers or pain with ibuprofen (over the age of 6 months) or acetaminophen, and allow your child time to rest and heal. This virus is commonly passed from person to person due to runny nose, sneezing, coughing, fluids from the blisters or even from the stool of an infected person. Good hand washing is a key prevention technique. Keep your children away from other children whenever they have fevers for at least 24 hours after the fevers have resolved without further treatment with fever reducing medication. Discourage children from placing their hands in their mouth or eyes (I am pretty sure this is how Ethan catches colds-- since he puts EVERYTHING in his mouth... I will be telling you about this soon!)

Even though I have given you this description I would expect you to have seen your doctor at one of two points above. If your child has a fever that lasts more than three days or there is a rash that develops in the mouth, hands and/or feet or has blisters. Also in you have an infant under the age of 3 months you should contact your physician at the first sign of a fever.

So, luckily for us Ethan did well. He only ran fevers for three days and then was acting like himself except for the rash. The rash looked a lot worse than I expected but has since healed up nicely. I did put more lotion on him for my peace of mind. No one else was affected or should I say infected!