Study: Gender Differences in the Presentation of Hand-Foot-and-Mouth Disease

Gender differences in the presentation of hand-foot-mouth disease (HFMD) in children.  Journal of Mothers at Home with Ill Children (End My Misery). 2017 Mar. (Original).


Gender differences in illness presentation are well-known (for instance the man-flu experienced by males vs. the suck-it-up-and-get-on-with-life-flu experienced by females).  With this study the author explored whether this gender difference extends to other illness presentations.

To evaluate the gender differences in hand-foot-mouth-and-mouth disease.

A single-centered observational study. The mother doubled as observer, and was a largely non-consenting volunteer.*
* Due to a lack of funding and staffing.

A single centre in Melbourne, Australia.

Two children: female aged 20 months, male aged 43 months. Both blinded to the study design and indeed to any sensible suggestions from the observer.

General parenting care, with bodily emissions disposal in line with currently accepted guidelines.

Gender differences in speech and behavioural indices of illness-related parameters (primary outcomes: pain perception, anxiety).

A clear inverse gender-based relationship between both apparent pain perception and anxiety was observed in the study population.

In the female child (20 months, more severe presentation of HFMD with multiple deep aphthous ulcers), a relative lack of pain perception & lower anxiety was evidenced by gentle, delicate whisperings of ‘ouchie’ associated with progressive, sustained food intake despite actually dripping copious amounts of fresh blood into her food.

Clinical Photo 1: (right) female child subject (despite being pre-verbal, could be heard muttering “Just a flesh wound”)

In the male child (43 months, relatively mild HFMD, presenting only with several cutaneous lesions), a clearly demonstrable pain perception and anxiety level seemingly out of proportion with physical findings, as shown by pointing at a solitary facial lesion screaming ‘OUCHIEEEEEE!!!’, followed by statements such as “I think I need to go to hospital”, “I need a bandaid – the blue Peppa Pig one”, and “I can’t walk Mummy, my feets is broken”. These statements were uttered repeatedly and seemingly without control, and were interspersed with whiny crying noises akin to a baby harp seal being slaughtered.

Clinical Photo 2: (absent) the subject’s level of pain exceeded the maximum level on the Ouchie Pain Scale, and clinical documentation at this stage would have been in breach of the Declaration of Helsinki.

Levels of pain perception and anxiety in relation to HFMD were significantly lower in female, compared with male, children.  Parents and carers should be aware of this gender difference and should enlist adequate preparation should they anticipate being home-bound with sick children (the author recommends self-priming with an alcoholic beverage of choice, taking careful note to maintain the fine balance between (1) Aural nerve numbing, and (2) Potential third-party calls to child services).

Going forward, the author recommends administration of the below tonic in an attempt to strengthen the constitution of male children.*

*  It should be noted however that empirical evidence has shown this medication to be largely (and sadly) useless in the male population, based on countless adult male cohort studies.

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