In our information-rich age, it is a commonplace that "more information is better than less information". This is particularly so in medicine. The more that is known about diseases like diabetes, cancers, and hardening of the arteries, the better. But what about common illnesses caused by the viruses our children catch? When I discuss viruses with parents, most want to know how long the illness can be expected to last, and how long a child will remain contagious. And of course, parents want to know if there any treatments that would make the child better.

But when the parents ask me "What virus does my child have, doctor?" I hesitate.

I’ve just told the parents that their child is going to recover fully, that he or she will have a fever for a couple of days. I’ve told them the child won’t be contagious in a couple days more, and I’ve given advice as to how to make the child feel better. Must I speculate as to the name of the virus? This I don’t want to do.

The reason for my hesitation is that viruses with names are scarier than viruses without names. Why would I want to frighten parents unnecessarily? I almost never receive calls from parents informing that "Johnny was exposed to some kind of virus: do I need to be concerned?" On the other hand, I’m much more likely to receive a call that begins: "Johnny was exposed to ‘Hand, Foot, and Mouth’…"

Hand, Foot, and Mouth Disease

The worst thing about "Hand, Foot, and Mouth Disease" is its name. It’s hard not to worry about a condition whose name includes the word ‘disease’! In fact, "Hand, Foot, and Mouth" is fairly benign, self-limited and resolves without leaving a trace, most unlike diseases as we commonly think of them. To make matters worse, the expression "Hand, Foot, and Mouth" resonates with another scary-sounding disease, "Hoof and Mouth Disease", which afflicts only cattle.

It gets worse. This virus has two common names. In addition to "Hand, Foot, and Mouth", it’s also commonly known as "Coxsackie Virus", after Coxsackie, New York, where the virus was first isolated. I mean no disrespect to the fine citizens of Coxsackie, but their town might have been invented by Stephen King.

That is why I prefer to respond to the question "What does my child have, doctor?" with a simple reply: "Some kind of virus".

Almost half of the children infected with Coxsackie virus do not get sick at all. The rest develop fevers, headaches, and muscle aches. Some also develop a mild sore throat, belly pain, or nausea. A child with Coxsackie virus may simply feel hot but have no other symptoms. In most children, the fever lasts about 3 days, and then disappears; in others, the fever goes away for a day only to return for 2 to 4 more days. The illness is called "Hand, Foot, and Mouth" when the child gets painful red blisters in the throat, tongue and gums. There are also red dots that appear on the palms of the hands and the soles of the feet.

If the worst things about Coxsackie virus are its names, the next worse things are the sores in the throat. Oftentimes the child will not feel like eating or drinking very much. To soothe the pain of mouth sores, I recommend a gargle or mouth rinse of equal parts Maalox and Benadryl Children’s Allergy (diphenhydramine). For children too young to gargle or swish and spit, I recommend giving one teaspoon by mouth of this mixture three times per day. Maalox/Benadryl helps dull the pain of the mouth sores so that the child drinks well and stays well-hydrated.

Fifth Disease

Often mistakenly called "Fifth’s Disease", Fifth Disease is another benign viral illness with a perfectly terrible name. Its name derives from an old naming convention for childhood illnesses that gave fever and rash. These illnesses were named "First Disease", "Second Disease", etc. Eventually, all these illnesses were associated with particular viruses or bacteria, with the exception of "Fourth Disease", which is probably caused by the same agent as "Third Disease" (Rubella). Although the virus that causes Fifth Disease has also been isolated and named (Parvovirus B19), the older name stuck.

The symptoms of Fifth Disease are very similar to those of a common cold: fever, runny nose and cough. The difference is that the fever goes away and the child gets a rash on the cheeks that looks as though he or she has been slapped.

Despite its benign nature in children, it is nevertheless important to know whether a child has Fifth Disease. This is because Fifth Disease is not a good illness to have if you are pregnant and in your first trimester. Parvovirus B19 infections have been associated with early pregnancy loss. It turns out that many children get Fifth Disease when they are in child care or school, where they are cared or taught, very often, by young women in their childbearing years. If you suspect your child has Fifth Disease, it’s important to know if he or she has had any contact with a woman who is pregnant or trying to get pregnant.

Sometimes less information is better than more information. The most important thing that parents need to know about their kids is that they are essentially healthy human beings who recover completely from virtually every acute illness that nature and daycare centers can throw at them. Parents struggling to keep straight names and numbers of particular viruses are less likely to remember this simple, reassuring fact.

For more information about Natick Pediatrics, or to talk to the doctor, please call the office at (508) 655-9699.