When should I consider referring a patient with HFMD for further evaluation or management?

Consider referring a patient with hand, foot, and mouth disease (HFMD) for further evaluation or management in the following situations:

• If there are symptoms or signs of central nervous system involvement such as persistent or severe headache or fever, myoclonus with sleep disturbances, confusion, weakness, lethargy, drowsiness, irritability, generalized seizures, or coma, which may suggest encephalitis. In such cases, arrange urgent hospital admission ¹.
• If the patient shows signs of significant dehydration, consider hospital admission and referral ¹.
• If oral ulcers persist for more than 3 weeks, use clinical judgement to determine whether to refer via the 2-week wait referral pathway, especially to exclude serious causes such as cancer ¹.
• For pregnant women who are immunocompromised or within 3 weeks of delivery with suspected HFMD, seek specialist advice and consider referral, as neonatal observation may be indicated ¹.

Routine follow-up or referral is not usually required for uncomplicated HFMD, but advise patients or carers to seek medical advice if the condition worsens or complications develop ¹.