Hand, Foot, and Mouth Disease: What Parents Should Know

What causes it and how does it spread?

HFMD is caused by viruses that can spread through:

• Close contact, such as hugging or kissing
• Sharing cups, utensils, or other objects that have contacted saliva
• Coughing and sneezing
• Contact with fluid from blisters
• Contact with stool, such as during diaper changes, followed by touching the mouth
• Touching contaminated toys, surfaces, and other objects

A child is usually most contagious during the first week of illness.

However, the virus can remain in respiratory secretions for several weeks and in stool for even longer after symptoms improve.

Because of this prolonged viral shedding, it is impossible to prevent every exposure simply by keeping children home until all signs of illness disappear.

Common symptoms

Symptoms usually begin about 3 to 6 days after exposure.

They often start with:

• Fever
• Sore throat
• Reduced appetite
• Feeling generally unwell

Within a day or two, the more characteristic symptoms may appear.

Mouth sores

Painful small blisters or ulcers can develop inside the mouth, including on:

• The tongue
• Gums
• Inner cheeks
• Other areas inside the mouth

These sores can make eating and drinking uncomfortable.

Skin rash

Small red spots or blisters often appear on the:

• Palms of the hands
• Soles of the feet
• Fingers and toes

The rash may also appear on:

• Buttocks
• Legs
• Arms
• Around the mouth

The rash is usually not very itchy in children, although some children may experience itching or discomfort.

Not every child develops every symptom.

Most children have a mild illness that improves on its own within about 7 to 10 days.

How is HFMD diagnosed?

Doctors can usually diagnose hand, foot, and mouth disease by examining the rash and mouth sores and hearing about your child's symptoms.

Laboratory testing is rarely needed.

Testing may occasionally be considered when symptoms are unusual, severe, or the diagnosis is uncertain.

Caring for your child at home

There is no specific antiviral medicine that cures HFMD, and antibiotics do not help because the illness is caused by viruses.

Treatment focuses on keeping your child comfortable and preventing dehydration.

Fever and pain

Acetaminophen (Tylenol) or ibuprofen (Motrin/Advil) can be used when appropriate for your child's age and weight.

Use medication primarily to improve comfort rather than simply to lower a number on the thermometer.

Do not give aspirin to children or teenagers with a viral illness.

Prevent dehydration

This is one of the most important parts of home care.

Painful mouth sores may make children reluctant to drink.

Offer cool fluids frequently.

Options may include:

• Water for age-appropriate children
• Milk
• Breast milk or formula for infants
• Oral rehydration solution when needed
• Popsicles
• Ice chips for children old enough to safely use them
• Smoothies
• Yogurt

Cold foods and drinks can be soothing.

Avoid foods and drinks that may sting mouth sores, including:

• Citrus
• Acidic juices
• Spicy foods
• Very salty foods

Be careful with numbing mouth medicines

Avoid numbing mouth products containing lidocaine or benzocaine in young children unless your child's clinician specifically recommends a particular product.

These medicines can cause serious side effects if too much is swallowed or absorbed.

Do not use an over-the-counter numbing medicine simply because mouth sores are painful.

Your child's pediatrician can help you decide on safer ways to control significant mouth pain.

Rest

Let your child rest as needed.

There is no need to force bed rest if your child feels well enough to quietly play or participate in normal activities at home.

What about peeling skin or nails afterward?

Some parents become worried when the skin begins peeling after the child otherwise seems better.

Peeling of the fingers or toes can occur about 1 to 2 weeks after HFMD.

It can look dramatic, but it is usually harmless and the skin heals normally.

Rarely, a fingernail or toenail may loosen or even fall off several weeks after the illness.

This can also look alarming, but the nail usually grows back normally over time.

If the area becomes painful, swollen, red, or appears infected—or if you are unsure whether what you are seeing is related to HFMD—contact your child's pediatrician.

When should I call the doctor?

Contact your child's pediatrician or seek medical care if your child:

• Is not drinking enough
• Has very few wet diapers or is urinating much less than usual
• Has no tears when crying together with a dry mouth or other signs of dehydration
• Is unusually sleepy or weak
• Has a fever lasting more than 3 days
• Is younger than 6 months
• Has a weakened immune system
• Has symptoms that are getting worse rather than improving
• Has very painful mouth sores that make drinking difficult
• Has a rash that is unusually severe or widespread
• Simply seems significantly more ill than expected

When you are worried about how your child looks or behaves, contacting your pediatrician is always reasonable.

When should I seek urgent or emergency care?

Seek urgent medical evaluation if your child develops:

• Trouble breathing
• Extreme sleepiness, confusion, or difficulty waking normally
• Persistent vomiting together with inability to stay hydrated
• A stiff neck
• A seizure
• New weakness
• Difficulty walking or an unsteady walk
• Signs of severe dehydration

Serious complications from HFMD are rare.

Very rarely, the viruses that cause HFMD can affect the nervous system and cause conditions such as viral meningitis or encephalitis.

For a possible life-threatening emergency, call 911.

Preventing the spread

Good hygiene is the best way to reduce transmission.

Wash hands frequently

Wash hands thoroughly with soap and water:

• After using the bathroom
• After diaper changes
• Before preparing food
• Before eating
• After helping a child with saliva, mucus, or other secretions

Teach children to wash their hands well when they are old enough.

Clean shared surfaces

Regularly clean and disinfect:

• Toys
• Doorknobs
• Changing areas
• Frequently touched household surfaces
• Shared classroom or daycare objects

Avoid sharing personal items

Avoid sharing:

• Cups
• Eating utensils
• Towels
• Other objects that contact the mouth or saliva

Cover coughs and sneezes

Teach children to cough or sneeze into a tissue or their elbow and then wash their hands.

When can my child return to daycare or school?

Children with HFMD do not usually need to remain home until every blister disappears.

They can often return to daycare or school when they:

• Have no fever
• Feel well enough to participate in normal activities
• Have no uncontrolled drooling from painful mouth sores

Because the virus can continue to be shed for weeks after symptoms improve, keeping children home until all viral shedding stops is not practical.

Always follow your daycare, school, or local health department's specific policies.

During an outbreak, a school or childcare program may have additional requirements.

Key takeaways

• HFMD is common, contagious, and usually mild.
• Most children recover within about 7 to 10 days.
• Treatment focuses on comfort and preventing dehydration.
• Painful mouth sores can make drinking difficult, so fluids are especially important.
• Acetaminophen or ibuprofen may help discomfort when appropriate for your child's age and weight.
• Avoid lidocaine or benzocaine mouth-numbing products in young children unless specifically recommended by a clinician.
• Peeling fingers or toes—and occasionally temporary nail shedding—can happen after the illness and usually resolve normally.
• Handwashing and cleaning shared surfaces help reduce spread.
• Children generally do not need to stay home until every blister is gone.
• Serious complications are rare, but concerning neurologic symptoms need urgent evaluation.