What is hand, foot and mouth disease, the infection that empties nurseries every autumn?

We are barely a month into the school year and most of the nursery children, as well as many pupils in primary and secondary schools have already had to stay at home for a day or two due to feeling unwell. Getting sick in autumn is a classic and if it's not a cough, it's a runny nose, a fever or a sore throat. Few children are spared from viruses at this time of year and outpatient clinics have already started to fill up with children and their parents waiting outside doctors' consultations to be checked for colds, asthma attacks, covid and, of course, hand, foot and mouth disease - a very contagious infection that empties nurseries every autumn and scares first-time parents.

This viral disease (from the enterovirus family) with a generally mild prognosis mainly affects children under the age of three. As its name suggests, the most common symptoms are "small ulcers on the tongue, palate, and lips; lesions around the mouth; blisters on the palms of the hands and the soles of the feet; sometimes also in the genital area. These spots are accompanied by fever, lasting no more than three days, and a certain general discomfort. In fact, it is common for children to refuse to eat, to cry or drool", says pediatrician Dr Lucía Galán.

Like the vast majority of nursery diseases, hand, foot and mouth disease spreads through contact with the saliva or nose secretions of a sick child - by talking, coughing, kissing or shaking hands. Simply touching a toy that an already infected child has played with puts another child at risk. Moreover, "this type of virus can survive for a long time on handkerchiefs, towels, sheets, toys", as the Spanish paediatric association (AEP) warns. Once the disease is inside the classroom, it is very difficult for children not to catch it, although some pupils pass it asymptomatically.

Once the initial fear among parents relaxes its grip, the main question is when can children go back to the nursery if they have had hand, foot and mouth disease. Some nurseries don't allow them to return until all the lesions have completely disappeared. However, the AEP assures parents and teachers that children can return "as soon as their fever is down, they are in good spirits and the sores in their mouths allow them to eat. There is no need to wait any longer". "As asymptomatic infection is common and transmission of the virus occurs both before and after symptoms, exclusion from school is ineffective in reducing the transmission of this virus," the association states. In any case, the symptoms of this disease do not usually last more than a week.

The most common treatments target the discomfort that children feel. Medicines relieve the pain in the mouth, as this symptom makes eating uncomfortable for a few days. As with other diseases, paracetamol is used to decrease the fever, while oral gels can soothe the discomfort related to the ulcers. Creams can accelerate the healing of the lesions around the mouth. "It is also important to avoid hot and acidic foods," says Dr Galán, who helps parents through her social media account 'Lucía, mi pediatra'.

What many parents don't know is that a common symptom of the disease may develop five or six weeks after the infection has passed. What Dr Galán refer to is onychomadesis, which concerns the peeling off until complete detachment of the fingernails and, less frequently, the toenails. Fortunately, this happens without pain and complications for the child. "If this happens, maintain good hygiene and moisturise the fingers and toes well until the new nail comes off. You can use Vaseline, for example," Dr Galán recommends.