If your toddler suddenly refuses to eat, runs a fever and then breaks out in little spots on the hands and feet, there is a good chance the culprit is hand, foot and mouth disease. This viral illness is extremely common in child care centers and preschools, especially in summer and early fall. It can make children miserable for several days, but most recover completely within about a week to 10 days.
Here is what parents need to know about the symptoms, how the illness spreads, how to ease your child's discomfort and which warning signs mean it's time to call the pediatrician.
What Is Hand, Foot and Mouth Disease?
Hand, foot and mouth disease (often shortened to HFMD) is caused by a group of viruses called enteroviruses, most commonly coxsackieviruses. It mostly affects children younger than 5, but older children and adults can catch it too. Because several different viruses cause it, a child can have hand, foot and mouth disease more than once.
Despite the similar name, it is not related to the foot-and-mouth disease that affects cattle and other farm animals, and you cannot catch it from pets.
Symptoms to Watch For
Symptoms usually start 3 to 6 days after a child is exposed. The illness often follows a typical pattern:
- Early symptoms: fever, sore throat, reduced appetite, fussiness and a general feeling of being unwell.
- Mouth sores: a day or two after the fever starts, painful red spots appear on the tongue, gums and inside of the cheeks. These can turn into blisters or ulcers. Babies and toddlers may drool more or refuse to eat and drink.
- Skin rash: flat or slightly raised red spots, sometimes with small blisters, show up on the palms of the hands and soles of the feet. The rash may also appear on the knees, elbows, buttocks or diaper area.
Not every child develops every symptom. Some only have mouth sores, while others mainly have a rash. The rash usually is not itchy. A few weeks after the illness, some children lose a fingernail or toenail; this is temporary, and the nail grows back normally.
How It Spreads
The viruses that cause hand, foot and mouth disease spread easily through:
- Saliva, nasal mucus and droplets from coughing and sneezing
- Fluid from blisters
- Stool (poop), which is why diaper changes are a common route of spread
- Touching toys, doorknobs and other surfaces that have the virus on them
Children are most contagious during the first week of illness. However, the virus can remain in the stool for several weeks after symptoms go away, so careful handwashing remains important even after your child feels better.
How the Doctor Diagnoses It
Pediatricians usually diagnose hand, foot and mouth disease by looking at the pattern of mouth sores and rash and asking about symptoms. Lab tests are rarely needed. A visit is helpful if you aren't sure what is causing your child's rash or if your child isn't drinking enough.
Caring for Your Child at Home
Because hand, foot and mouth disease is caused by a virus, antibiotics won't help. The goal is to keep your child comfortable and hydrated until the illness runs its course.
Focus on fluids
The biggest concern with hand, foot and mouth disease is dehydration, because mouth sores make swallowing painful. Offer small sips often. Many children prefer cold liquids such as water or milk, and frozen treats like ice pops can soothe the mouth while adding fluid. Babies should continue breastfeeding or taking formula; a cup or spoon may be easier than a bottle if sucking hurts.
Choose soft, cool, bland foods
Yogurt, applesauce, smoothies, mashed potatoes, pudding and cold soups are usually easier to eat. Avoid salty, spicy and acidic foods and drinks, such as citrus juice and tomato sauce, which can sting the sores.
Manage pain and fever
Acetaminophen or ibuprofen (for children 6 months and older) can relieve pain and fever. Give the correct dose for your child's weight, and never give aspirin to children. Don't use numbing mouth gels or sprays containing benzocaine in young children, and ask your pediatrician before using any mouth rinse.
Rest and comfort
Let your child rest as needed. Keep fingernails short and dress your child in light, loose clothing if the rash is in the diaper area.
When to Call the Pediatrician
Most children get better without problems, but call our office if your child:
- Shows signs of dehydration: fewer wet diapers or urinating much less than usual, dry mouth, no tears when crying, or unusual sleepiness
- Refuses to drink anything because of mouth pain
- Has a fever lasting more than 3 days
- Is younger than 6 months, or has a weakened immune system
- Has symptoms that are not improving after 10 days
Seek emergency care if your child has a stiff neck, severe headache, unusual sleepiness or confusion, trouble walking, weakness, seizures, or trouble breathing. These complications are rare, but they need immediate attention.
Preventing the Spread
There is no vaccine in the United States for hand, foot and mouth disease, but good hygiene lowers the risk of spreading it:
- Wash hands with soap and water for at least 20 seconds, especially after diaper changes and using the bathroom and before preparing food.
- Teach children to cover coughs and sneezes with a tissue or their elbow.
- Avoid kissing, hugging and sharing cups or utensils with someone who is sick.
- Clean and disinfect toys, changing tables and frequently touched surfaces.
- Don't pop blisters.
When Can My Child Return to Child Care or School?
Children can generally return when they have been fever-free for 24 hours without fever medicine, feel well enough to participate, and do not have open, oozing blisters. Mouth sores that cause a lot of drooling may also be a reason to stay home. Policies vary, so check with your child care center or school.
Key Takeaways
- Hand, foot and mouth disease is a common viral illness in young children that causes fever, painful mouth sores and a rash on the hands and feet.
- It usually lasts 7 to 10 days and gets better on its own.
- Keeping your child drinking is the most important part of home care.
- Handwashing is the best way to protect the rest of the family.
Rashes can have many causes. If you're unsure, our team is happy to take a look. You may also find our articles on chickenpox, sore throats and preventing dehydration helpful.
This article is general health information for parents and is not a substitute for medical advice. If you are worried about your child, contact your pediatrician; in an emergency, call 911.
Questions about your child's health?
Our Chestertown pediatric team cares for newborns, children and teens. Request an appointment, read our new patient information or browse more articles on the pediatric health blog.