Enteroviruses in Children
What is an enterovirus infection in children?
An enterovirus is a very common type of virus. There are many types of enteroviruses. Most of them cause only mild illness. Infections most often occur in the summer and fall. The viruses mostly cause illness in babies, children, and teens. This is because most adults have already had enteroviruses and have built up immunity.
The viruses usually don’t cause symptoms, or cause only mild symptoms. Enteroviruses often cause what is known as the “summer flu.” They can also cause a rash known as hand-foot-and-mouth disease. This is caused by coxsackievirus, a type of enterovirus.
But in some cases, an enterovirus can be more severe and cause complications. Some of the viruses, such as polio, can cause serious illness. Polio can be prevented with a vaccine. A type of enterovirus called echovirus can cause inflammation of the tissue that covers the brain and spinal cord (meningitis). Enterovirus 68 can cause severe symptoms in some children, such as trouble breathing.
What causes an enterovirus infection in a child?Enteroviruses can be spread when an infected person sneezes or coughs droplets into the air or on surfaces. A child may then breathe in droplets, or touch a contaminated surface and touch his or her eyes, mouth, or nose. Some of the viruses can spread through contact with infected feces (stool). This can happen when children don't wash their hands or don't wash them properly. It can also happen from eating or drinking food or water that contains the virus.
What are the symptoms of an enterovirus infection in a child?
In most cases, enteroviruses don’t cause symptoms. If they do, the symptoms are mild. Most symptoms usually go away in a few days and can include:
- Muscle aches
- Sore throat
- Runny nose
- Trouble breathing
- Nausea and vomiting
- Red sores in the mouth, and on the palms of the hands and soles of the feet (hand-foot-and-mouth disease)
- Red rash over large areas of the body
The symptoms of an enterovirus can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.
How is an enterovirus infection diagnosed in a child?
A healthcare provider will ask about your child’s symptoms and health history. The provider will do a physical exam. This may include an exam of the mouth, eyes, and skin. The healthcare provider will listen to your child’s chest as he or she breathes.
In the case of severe symptoms, your child may need certain tests. These are done to see if your child has an enterovirus, or has a different kind of illness. The tests can look for problems in the heart, lungs, and brain. The tests may include:
- Virus culture. The healthcare provider takes a small sample of saliva, blood, urine, or stool. It is then tested for a virus.
- Polymerase chain reaction (PCR). The healthcare provider takes a small sample of blood, urine, or saliva. The sample is tested for a virus.
- Spinal fluid test. The healthcare provider takes a small sample of spinal fluid. This is done by putting a small needle into your child's back. The fluid is tested for levels of certain chemicals and cells.
- Blood test. The healthcare provider takes blood from a vein. It is then tested for chemicals that may show the cause of your child's illness, or show organ problems.
- X-rays. This test is done to look at the lungs and heart.
- Electrocardiogram (ECG). This test is done to look at the electrical action of the heart.
- Echocardiogram. This test uses sound waves and a computer to look at the structure and movements of the heart.
How is an enterovirus infection treated in a child?
Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.
Antibiotics don't work on viral illnesses like enterovirus. And no antiviral medicines are available to help cure an enterovirus infection. Instead, treatment is done to help your child feel better while his or her body fights the illness. This includes:
- Pain medicine. These include acetaminophen and ibuprofen. They are used to help ease pain and reduce fever. Don't give aspirin to your child if he or she has a fever.
- Oral pain reliever (anesthetic). This is a gel used to help ease the pain of sores in the mouth.
- Bed rest. This helps your child’s body fight the illness.
- Change in diet. If your child has painful mouth sores, give only bland, soft foods. Don't give your child salty or crunchy foods.
In severe cases, treatment may include:
- Opioid medicines for severe pain
- Medicine for heart problems
- IV (intravenous) fluids for dehydration
- Medicine called immunoglobulin given through an IV
Symptoms such as muscle aches, fever, and sore throat usually go away in a few days. The red sores known as hand-foot-and-mouth disease usually go away in 7 to 10 days.
Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all medicines.
What are possible complications of an enterovirus infection in a child?
Complications from enteroviruses are not common. But they can cause severe problems such as:
- Inflammation of the brain (encephalitis)
- Inflammation of the tissues around the brain and spinal cord (meningitis)
- Inflammation of the heart (myocarditis)
- Inflammation of the liver (hepatitis)
- Eye infection (conjunctivitis)
- Severe illness in the lungs
- Paralysis of muscles
How can I help prevent an enterovirus infection in my child?
Children are vaccinated against poliovirus. But there is no vaccine for other enteroviruses. Enteroviruses can spread easily from person to person. They are spread through stool and mucus from coughing or sneezing. They can live on surfaces that sick people have touched, coughed, or sneezed near. To help prevent illness:
- Teach children to wash their hands after using the toilet, before eating, and before touching their eyes, mouth, or nose.
- Wash your hands often, especially if caring for someone who is sick. Use a hand sanitizer if you don't have soap and water handy.
- Try to have less contact with people who are sick.
- Clean surfaces at home regularly with disinfectant.
When should I call my child’s healthcare provider?
Call a healthcare provider right away if your child has:
- Fever (see Fever and children, below)
- Severe headache that doesn't get better after taking a pain reliever
- Trouble breathing
- Chest pain when breathing
- Pain, swelling, and redness of the eyes
- Stiffness and trouble moving
- Yellow tint to the skin and eyes (jaundice)
Fever and children
Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.
For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.
Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.
Infant under 3 months old:
- Ask your child’s healthcare provider how you should take the temperature.
- Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider
- Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider
Child age 3 to 36 months:
- Rectal, forehead (temporal artery), or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider
- Armpit temperature of 101°F (38.3°C) or higher, or as directed by the provider
Child of any age:
- Repeated temperature of 104°F (40°C) or higher, or as directed by the provider
- Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.
Key points about enteroviruses in children
- Enteroviruses are very common. The viruses mostly cause illness in babies, children, and teens. This is because most adults have already had enteroviruses and have built up immunity.
- The viruses usually don’t cause symptoms, or cause only mild symptoms.
- Enteroviruses can be spread when an infected person sneezes or coughs droplets into the air or on surfaces. A child may then breathe in droplets, or touch a contaminated surface and touch his or her eyes, mouth, or nose.
- The viruses are treated with supportive care such as pain medicine.
- In some rare cases, the viruses may cause inflammation of the brain, heart, or other parts of the body.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
May 28, 2017
Freeborn, Donna, PhD, CNM, FNP,Lentnek, Arnold, MD,Walton-Ziegler, Olivia, MS, PA-C