Hand, Foot and Mouth Disease: What Parents Need to Know

What Are the Symptoms of Hand, Foot and Mouth Disease?

Quick Answer: HFMD typically begins with fever and sore throat for 1-2 days, followed by painful mouth sores and a characteristic rash with small red spots or blisters on the hands and feet. The mouth sores can make eating and drinking difficult.

Hand, foot and mouth disease follows a predictable progression of symptoms that parents can watch for. Understanding these stages helps you identify the illness early and provide appropriate care for your child.

Early Symptoms (Days 1-2)

The illness typically begins with general symptoms that may seem like any common childhood infection:

Mouth Sores (Days 2-3)

After the initial symptoms, painful sores develop in the mouth:

• Small red spots that develop into ulcers or blisters
• Most commonly found on the tongue, gums, and inside of the cheeks
• May also appear on the roof of the mouth and throat
• Often very painful, making eating and drinking difficult
• Usually 2-4 mm in size with a red border

Skin Rash (Days 2-4)

The characteristic rash typically appears on specific body areas:

• Hands: Palms, fingers, and backs of hands
• Feet: Soles, toes, and tops of feet
• Buttocks: Common in infants and young children
• Legs and arms: May occasionally spread to these areas

The rash appears as small, flat red spots that may develop into tiny blisters. The spots typically range from 2-10 mm in diameter. On darker skin tones, the rash may appear darker than the surrounding skin rather than red. The rash usually isn't itchy but may cause some discomfort.

How Is HFMD Different from Chickenpox?

Parents sometimes confuse HFMD with chickenpox (varicella) because both cause blisters. Here are the key differences:

• Location: HFMD blisters concentrate on hands, feet, and mouth, while chickenpox spreads over the entire body
• Number: HFMD typically causes fewer lesions than chickenpox
• Itching: Chickenpox blisters are intensely itchy; HFMD rash usually isn't
• Progression: Chickenpox blisters appear in waves and crust over; HFMD blisters remain relatively unchanged

What Causes Hand, Foot and Mouth Disease and How Does It Spread?

Quick Answer: HFMD is caused by enteroviruses, most commonly Coxsackievirus A16 and Enterovirus 71. It spreads through direct contact with an infected person's saliva, respiratory droplets, blister fluid, or stool. The virus is most contagious during the first week of illness.

The Viruses Behind HFMD

Hand, foot and mouth disease is caused by a group of viruses called enteroviruses. The most common culprits include:

• Coxsackievirus A16: The most frequent cause, usually causing milder illness
• Enterovirus 71 (EV71): Less common but can cause more severe disease and complications
• Other Coxsackieviruses: A6, A10, and others can also cause HFMD

Because multiple virus strains can cause HFMD, a person can get the disease more than once. Each infection provides immunity only against that specific strain.

How HFMD Spreads

The virus spreads through several routes, making it highly contagious in settings where children gather:

Contagious Period

HFMD is most contagious during the first week of illness when symptoms are present. However, the virus can continue to be shed in stool for weeks after symptoms resolve, which is why good hand hygiene remains important even after your child feels better.

The incubation period (time from exposure to first symptoms) is typically 3-7 days. During the later part of this period, a person may already be contagious before showing any symptoms.

Seasonal Patterns

HFMD outbreaks are more common during late summer and early fall in temperate climates. However, in tropical regions, the disease can occur year-round. Outbreaks frequently occur in childcare centers and schools where children are in close contact.

How Can I Care for My Child with HFMD at Home?

Quick Answer: Focus on relieving symptoms: give age-appropriate pain relievers for fever and mouth pain, offer cold foods and drinks to soothe mouth sores, ensure adequate hydration, and keep your child comfortable. Most cases resolve within 7-10 days with supportive care alone.

Since there is no specific antiviral treatment for HFMD, home care focuses on keeping your child comfortable and preventing dehydration while the illness runs its course.

Managing Pain and Fever

• Acetaminophen (paracetamol): Helps reduce fever and relieve pain. Follow age-appropriate dosing on the package or as directed by your healthcare provider.
• Ibuprofen: An alternative for children over 6 months old. Also reduces fever and provides pain relief.
• Avoid aspirin: Never give aspirin to children or teenagers due to the risk of Reye's syndrome.
• Consult your doctor: Before giving any medication to infants under 6 months old.

Soothing Mouth Sores

Mouth sores can make eating and drinking painful. Try these strategies:

• Cold foods: Ice pops, frozen fruit, chilled yogurt, and ice cream can numb the pain temporarily
• Cold drinks: Chilled water, milk, or diluted fruit juice (avoid citrus)
• Soft foods: Mashed potatoes, smooth soups, pudding, and smoothies
• Avoid irritating foods: Acidic foods (citrus, tomatoes), salty or spicy foods, and crunchy textures
• Topical relief: Your doctor may recommend an oral numbing gel or mouth rinse for older children

Preventing Dehydration

Dehydration is the most common complication of HFMD because mouth sores can make drinking painful. Watch for these signs:

• Fewer wet diapers or urinating less frequently
• Dry mouth and lips
• No tears when crying
• Sunken eyes or fontanelle (soft spot on baby's head)
• Unusual drowsiness or irritability

Encourage small, frequent sips of fluids throughout the day. Using a straw or sippy cup may help if drinking from a regular cup is painful. For infants, continue breastfeeding or formula feeding as usual.

Caring for the Skin Rash

• Keep the affected areas clean and dry
• If the rash itches, apply a cooling balm or cold compress
• Avoid popping or breaking blisters, as this increases infection risk
• Dress your child in loose, comfortable clothing
• Keep fingernails short to prevent scratching

General Comfort Measures

• Ensure plenty of rest
• Keep your child in a comfortable, cool environment
• Offer comfort and reassurance, as the illness can be distressing
• Maintain normal routines as much as possible while allowing for extra rest

When Should I Take My Child to the Doctor?

Quick Answer: Most children recover without medical treatment. Seek care if your child cannot drink fluids, shows signs of dehydration, has fever lasting more than 3 days, develops worsening symptoms, or appears very unwell. Emergency care is needed for severe symptoms like difficulty breathing or stiff neck.

While most cases of HFMD are mild and resolve on their own, certain situations require medical attention.

Contact Your Healthcare Provider If:

• Your child cannot drink enough fluids due to mouth pain
• Signs of dehydration develop (decreased urination, dry mouth, no tears)
• Fever lasts more than 3 days
• Symptoms don't improve within 7-10 days
• Your child appears very unwell or is unusually drowsy
• Your child is under 6 months old
• Your child has a weakened immune system
• You're pregnant and have been exposed to HFMD

These symptoms could indicate rare but serious complications like viral meningitis or encephalitis, which require immediate medical evaluation.

How Is Hand, Foot and Mouth Disease Treated?

Quick Answer: There is no specific antiviral treatment for HFMD. Treatment focuses on relieving symptoms with pain relievers, maintaining hydration, and keeping the child comfortable. The infection typically resolves on its own within 7-10 days.

Since HFMD is caused by a virus, antibiotics are not effective and should not be used unless there's a secondary bacterial infection. The body's immune system will fight off the virus naturally.

Medical Treatment Options

Your healthcare provider may recommend:

• Pain relievers: Acetaminophen or ibuprofen for fever and pain
• Topical oral anesthetics: Numbing gels or mouth rinses for older children to help with mouth pain
• Oral rehydration solutions: If there's concern about dehydration

Hospital Care (Rare Cases)

In rare instances, hospitalization may be necessary if:

• Severe dehydration requires intravenous (IV) fluids
• Complications such as viral meningitis or encephalitis develop
• The child is very young (newborn) or has a weakened immune system

Recovery Timeline

How Can I Prevent Hand, Foot and Mouth Disease?

Quick Answer: Prevention relies primarily on good hand hygiene and avoiding close contact with infected individuals. Wash hands frequently with soap and water, especially after diaper changes and before eating. Clean and disinfect frequently touched surfaces. No widely available vaccine exists in most countries.

Hand Hygiene

Good hand hygiene is the most effective way to prevent HFMD spread:

• Wash hands thoroughly with soap and water for at least 20 seconds
• Always wash hands after using the toilet or changing diapers
• Wash hands before preparing or eating food
• Use hand sanitizer with at least 60% alcohol when soap and water aren't available
• Teach children proper handwashing technique

Avoid Close Contact

• Avoid kissing, hugging, or sharing utensils with infected individuals
• Don't share cups, bottles, or food with someone who has HFMD
• Avoid touching your face, especially your mouth and eyes

Environmental Cleaning

• Clean and disinfect frequently touched surfaces (doorknobs, toys, changing tables)
• Use a disinfectant effective against viruses
• Wash soiled clothing, bedding, and towels in hot water
• Ensure proper diaper disposal

Is There a Vaccine?

Currently, there is no widely available vaccine for HFMD in most countries. Vaccines against Enterovirus 71 (EV71), one of the viruses causing HFMD, have been developed and are used in some Asian countries (including China) where severe HFMD outbreaks are more common. Research continues on developing broader vaccines that could protect against multiple strains.

Should My Child Stay Home from School or Daycare?

Quick Answer: Keep your child home during the most contagious period, especially while they have fever. Once fever-free for 24 hours without medication and mouth sores have healed enough to eat and drink normally, most children can return. Check your school or daycare's specific policies.

When to Stay Home

Your child should stay home if they:

• Have a fever
• Have open, draining blisters
• Feel too unwell to participate in normal activities
• Cannot control drooling (young children with mouth sores)

When to Return

Your child may generally return to school or daycare when:

• Fever-free for at least 24 hours without fever-reducing medication
• Mouth sores have healed enough to eat and drink comfortably
• They feel well enough to participate in regular activities
• Open blisters have dried and crusted over

School and Daycare Policies

Policies vary by location and institution. Check with your child's school or daycare about their specific guidelines for HFMD. Some may require a doctor's note before returning, while others follow general guidelines about fever and symptom resolution.

What Are the Potential Complications?

Quick Answer: Most cases of HFMD resolve without complications. The most common complication is dehydration from refusing to drink. Rare but serious complications include viral meningitis, encephalitis, and cardiopulmonary complications, which are more associated with Enterovirus 71 infection.

Common Complications

• Dehydration: The most frequent complication, caused by painful mouth sores making drinking difficult. Monitor fluid intake and watch for signs of dehydration.
• Nail changes: Fingernails or toenails may loosen and shed weeks after infection. This is usually painless and nails grow back normally.

Rare but Serious Complications

Serious complications are uncommon, especially with Coxsackievirus A16 infection. Enterovirus 71 is more likely to cause severe disease:

• Viral meningitis: Inflammation of the membranes surrounding the brain and spinal cord. Symptoms include severe headache, stiff neck, and sensitivity to light.
• Encephalitis: Brain inflammation causing neurological symptoms. Very rare but requires immediate medical attention.
• Acute flaccid paralysis: Rare polio-like syndrome causing limb weakness
• Cardiopulmonary complications: Very rare, more common in severe EV71 outbreaks in some regions

HFMD in Adults and Pregnant Women

Adults can get HFMD, though it's less common. The illness is usually milder in adults but can still cause significant discomfort. Pregnant women who contract HFMD near their due date may, in rare cases, pass the virus to the newborn. Most newborn infections are mild, but monitoring is recommended. If you're pregnant and exposed to HFMD, consult your healthcare provider.