Hand, Foot, and Mouth Disease (HFMD) is a common viral illness in toddlers that is characterized by a fever and a distinctive rash. The most challenging symptom for parents to manage is the presence of painful, blister-like sores that develop inside the mouth, on the tongue, gums, and throat. These mouth lesions make swallowing and eating extremely uncomfortable, often leading to feeding refusal and a reduced appetite. Successfully managing a toddler’s nutrition during this acute phase requires focusing on soothing their mouth pain and preventing fluid loss.
Prioritizing Hydration
Maintaining proper hydration is the most important goal for a toddler with HFMD, surpassing the need for solid food intake during the peak symptomatic days. The pain from the mouth sores can make drinking liquids difficult, which increases the risk of dehydration. Encourage your child to take small, frequent sips of fluid rather than attempting to drink a large amount all at once.
Offer bland, non-acidic liquids that are gentle on the sores, such as cold water, milk, or diluted, non-acidic fruit juices like pear or apple. Oral rehydration solutions (like Pedialyte) are an excellent choice because they replenish water and electrolytes lost due to fever or reduced intake. If the toddler is refusing a bottle or sippy cup, try offering fluids with a spoon, a syringe, or a novelty cup, as the sucking motion can increase mouth pain. Cold temperatures can provide a temporary numbing effect on the irritated tissues.
Comforting and Easy-to-Swallow Foods
When a toddler is ready to attempt eating, the focus should shift to foods that require minimal chewing and are smooth in texture. Cold foods are particularly helpful because the low temperature helps to soothe and temporarily numb the sensitive mouth sores, providing nourishment while reducing pain.
Specific dairy products like plain yogurt, cottage cheese, or milkshakes are good options, as they offer protein and a comforting texture. Frozen treats are highly recommended; popsicles, ice cream, or sorbet can be appealing to a reluctant eater and provide needed calories and fluids. Do not worry about the sugar content of these treats for a few days, as the priority is preventing dehydration and calorie loss.
Beyond cold items, soft, room-temperature, or slightly cool cooked foods can be introduced. Mashed potatoes, oatmeal, or pasta prepared without acidic sauce, like buttered noodles, are easy to swallow. Bland purees, such as applesauce, mashed bananas, or vegetable purees, slide down easily without irritating the sores. The goal is to maximize calorie and nutrient intake with the least amount of oral discomfort, so offer small portions frequently throughout the day.
Foods and Drinks That Irritate Mouth Sores
Certain foods and beverages must be avoided as they will sting and irritate the mouth sores, causing pain that leads to further feeding refusal. This category includes anything highly acidic, such as citrus fruits like oranges and lemons, as well as tomato-based products like pasta sauce or ketchup. The acidity can cause a burning sensation on the open ulcers.
Salty, spicy, or hot items should be kept away from the toddler. This means avoiding salted crackers, chips, pretzels, and overly hot soups or liquids. Foods with a rough or crunchy texture, like toast, crackers, or dry cereal, can scrape against the sores, increasing discomfort. Carbonated drinks should be avoided because the bubbles can create an irritating, stinging feeling on the sensitive tissues.
When to Contact a Healthcare Provider
While most cases of HFMD are mild and resolve on their own, parents must monitor for signs that the lack of fluid intake is becoming dangerous. Contact a healthcare provider immediately if your toddler shows signs of dehydration, including not producing a wet diaper for six to eight hours, having fewer wet diapers than normal, or a lack of tears when crying.
Other concerning symptoms are a dry or sticky mouth and tongue, sunken eyes, or the soft spot on an infant’s head appearing sunken. Seek medical attention if the toddler is unusually lethargic, difficult to wake, or has a high fever that persists for more than three days. Refusal to drink any liquid for more than a few hours warrants consultation to prevent complications.