Herpangina in Children: Causes, Symptoms, and Treatment
Key takeaways:
Herpangina is a common childhood viral illness. It usually causes fever and ulcers in the throat.
Your child will usually recover from herpangina on their own in about a week’s time.
If your child isn’t drinking well or has changes in their behavior, it’s important to get checked by a healthcare provider because it could be a sign that they’re dehydrated or have a more serious illness.
Herpangina is a viral infection that’s usually seen in children less than 10 years old. Most often, it affects toddlers. Teens and adults can get it too, but this is much more rare. It’s characterized by fever and sores in the mouth and back of the throat. For this reason, one of the biggest problems with this infection is that eating and drinking can be painful. We’ll provide some tips for how to care for your child if this happens to them, so that they can recover as quickly as possible.
What causes herpangina?
Herpangina is caused by a family of viruses called enteroviruses. While it can be caused by many different strains of enteroviruses, the most common ones are Coxsackie and E71. These viruses tend to be seasonal, meaning kids are more likely to get herpangina in the summer months. And because a number of different viruses cause herpangina, your child can get similar infections more than once.
Herpangina is sometimes confused with hand, foot, and mouth disease. There are some similarities between the two infections because they’re caused by viruses in the same family. But the two illnesses look different. Hand, foot, and mouth disease involves a skin rash as well, most often seen on the palms and soles (hence the name). Herpangina only affects the mouth.
How do you get herpangina?
Herpangina is fairly contagious. It spreads easily among preschool and school-age children, especially around 1 to 3 years of age. They spread it to each other by “fecal-oral transmission,” when microscopic feces particles make their way into someone‘s mouth. For children, this often means they aren’t washing their hands after using the bathroom, and then they touch a common surface (like counters or door knobs). And younger children often explore the world around them by mouthing toys, which can also bring them into contact with the virus.
The best way to keep from spreading herpangina is by washing your hands well and often. The CDC recommends washing with soap and water for at least 20 seconds. This is especially important after changing diapers and before eating or drinking foods.
To minimize your chance of getting sick, it’s also important to avoid sharing food and drinks with your child when they’re sick.
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Symptoms of herpangina
How do you know if your child has herpangina? Here are the symptoms to look for:
Fever: Commonly this will be the first symptom you notice.
Sore throat: Children will then complain of sore throat. Early on, you might not be able to see anything in their throat. Over the next day or two, you can begin to see red spots. These spots tend to be in the back of the throat rather than in the front of the mouth or tongue. The red spots will then slowly change into blisters — and then ulcers.
Fussy: For children who are too young to talk, you may notice them to be fussier than normal. Or they may be less interested in eating or drinking.
Headache: For older children, they may also tell you their head hurts. The headaches tend to be worse when they have a fever.
Usually kids start to feel better in about a week. By then, fevers should have resolved, and the ulcers will start healing. If your child has a more severe case, the ulcers may not heal completely for up to 2 weeks. As the mouth and throat get better, kids will start eating more.
Treatment of herpangina
Unfortunately, there isn’t a magic medicine that makes herpangina go away. And antibiotics don't help because it’s caused by a virus. Treatment is aimed at helping your child feel better:
Pain and fever relievers: Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) can help with both fever and pain.
Antacids: Aluminum hydroxide/magnesium hydroxide (Maalox or Mylanta) are antacids that can sometimes help with painful ulcers. These medications coat the sores, making it less painful to swallow.
Fluids: It’s important to keep your child drinking well so they can stay hydrated. When their throat hurts, it can be hard to get them to drink. Any fluid is better than no fluid. So if they prefer milk or juice, it’s fine to let them have it. Popsicles also work well. The cold can be soothing to their painful throat. Each standard-size popsicle is about 1 ounce of fluid.
Diet: It’s OK if they don’t eat well for a few days. Most kids will catch up on calories when they feel better. Avoid spicy foods, citrusy foods, and carbonated drinks because these tend to make their throats hurt more. Try soft foods like scrambled eggs, mashed potatoes, soft pastas, and bananas.
When to see your provider
While most kids recover well at home, there’s a small percentage of children who might need more medical attention.
One initial concern might be that your child is becoming dehydrated. You might notice they are:
Not drinking well
Not making as many wet diapers, or not urinating as much or as often
Not making tears when they cry
If your child has these symptoms, you should have a healthcare provider see them as soon as possible. A provider can check for signs of dehydration and help get them rehydrated.
Another concern, although rare, is the possibility of meningitis. The same viruses that cause herpangina can (in a very small number of children) cause meningitis. This is an infection of the lining of the brain and spinal cord. And in severe cases, it can be fatal. You should go to your nearest emergency room to get checked if your child develops the following symptoms:
Headache or neck pain that doesn’t get better with ibuprofen or acetaminophen
Hard to awake or very sleepy
The bottom line
Herpangina is a common childhood illness, most often seen in toddlers. Because of the mouth and throat ulcers, it can be challenging to get your child to drink well. But most kids do recover well at home. There’s a small chance that your child can become dehydrated or have a worsening illness, so it’s important to keep an eye out for concerning symptoms. If you’re worried that your child is drinking poorly or is behaving differently (very fussy, difficulty staying awake), get them checked at the nearest emergency room.
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References
Centers for Disease Control and Prevention. (2021). Hand, foot, and mouth disease (HFMD).
Centers for Disease Control and Prevention. (2021). When and how to wash your hands.
Corsino, C. B., et al. (2021). Herpangina. StatPearls.
Lee, T. A., et al. (2009). Diseases caused by enterovirus 71 infection. Journal of Infectious Disease.
