Hand, Foot & Mouth

What It Is, and How It Spreads

Hand, foot, and mouth disease (HFMD) is a common, usually mild viral infection that mostly affects children under 5, though older kids and adults can get it too. It is caused by enteroviruses, most often coxsackievirus A16, and is best known for the trio of symptoms in its name: painful sores in the mouth and a rash or blisters on the hands and feet. Despite the alarming look, it is rarely serious and almost always clears on its own. It spreads easily through saliva, nose and throat droplets, blister fluid, and stool, which is why it moves quickly through daycares and households, especially in summer and fall. It is generally most contagious during the first week, but the virus can be shed in stool for weeks after a child feels better, so good handwashing matters even during recovery. (This is unrelated to foot-and-mouth disease in farm animals.)

Signs and Symptoms

Symptoms usually appear about 3 to 6 days after exposure. Many children start with a fever, which is often mild but can run higher, along with a sore throat, reduced appetite, and a general feeling of being unwell. A day or two later, small painful sores or blisters tend to show up inside the mouth, on the tongue, gums, and inner cheeks, and a rash of flat red spots or small blisters often appears on the palms, soles, and sometimes the buttocks, knees, elbows, or diaper area. Some children get only mouth sores, some get only the rash, and some have a case so mild there are barely any signs at all. Because the mouth sores hurt, drooling and fussiness around eating and drinking are common. A few weeks after recovery, some children harmlessly peel a little skin on their fingers or toes, and occasionally a fingernail or toenail loosens or comes off and then regrows on its own.

Caring for It at Home

There is no specific cure and antibiotics do not help, because this is a virus, not a bacterial infection. Care is all about comfort and, above all, keeping your child hydrated, since the painful mouth sores are what make many kids stop drinking. Offer plenty of cool fluids in small, frequent sips; cold items like water, ice pops, and smooth chilled foods often go down more easily than warm, salty, spicy, or acidic foods like citrus juice that can sting. For fever and pain, acetaminophen or ibuprofen can help (ibuprofen only for infants 6 months and older), and you should confirm the right product and dose for your child's age and weight with your pediatrician or pharmacist. Do not give aspirin to children. Talk to your provider before using any numbing mouth gels or sprays, as some are not recommended for young children. For the vast majority of children this is a short, self-limited illness that runs its course in about 7 to 10 days with nothing more than rest, comfort, and careful attention to fluids.

When to Call the Doctor (and the Bottom Line)

Most cases never need a visit, but some warning signs do. Call your pediatrician if signs of dehydration appear: no wet diaper or no urination for 8 or more hours, no tears when crying, a dry mouth, unusual sleepiness, or sunken eyes. Also call if your child simply refuses to drink and you cannot keep fluids in them, if the fever lasts more than 3 days or seems unusually high, or if symptoms are getting worse rather than better after about 10 days. Reach out as well for any fever in a baby under 3 months, for a very stiff neck or severe headache, or for signs that a sore is becoming infected (spreading redness, swelling, warmth, or pus). Seek emergency care right away for trouble breathing, a seizure, a child who is hard to wake or extremely lethargic, or signs of significant dehydration. Bottom line: HFMD looks worse than it usually is, and watching for dehydration is your main job at home. Use this as general information, not a diagnosis, and lean on your pediatrician for advice tailored to your child — when in doubt, call, because your provider would rather hear from you than have you wait.