Hand-foot-mouth disease (HFM) sounds pretty gross (and kind of scary), but know that it’s actually a fairly common viral infection that’s not super serious. In fact, most kiddos get better within 10 days with little to no medical treatment. But it’s still not a pleasant ordeal for a child to go through! And because it’s contagious, it tends to spread quickly in daycares and schools, so being on top of the situation is a must. 

What is hand-foot-mouth disease? 

The quick and dirty is this: Hand-foot-mouth is caused by a group of viruses called enteroviruses. Coxsackievirus A16 is the most common virus that causes HFM in the United States. Kids under 5 years old are the most susceptible, but it can affect older children and adults as well. There are typically more outbreaks in the summer and fall.  

What are the symptoms of hand-foot-mouth disease?

It takes three to six days for a child with hand-foot-mouth disease to show symptoms after exposure.  

Symptoms of hand foot mouth disease in children:

  • First signs often mimic the common cold, with a fever, runny nose, or sore throat. 

  • Soon after, a blistery rash appears on the hands (and fingers), feet, and/or mouth (and sometimes in the diaper area), including the gums and tongue. 

  • All blisters are about the same size (not much bigger than a pencil eraser). Blisters can make the hands and feet sore, but the mouth sores are often pretty miserable (kids drool and refuse food/drink).

Symptoms last about a week. FYI: After a week or two, the skin on your child's hand and feet might peel. This is totally normal and nothing to be concerned about.

How does hand-foot-mouth disease spread? 

Hand-foot-mouth disease is easily spread through direct contact from other infected folks, whether a grownup or a child. That means an infected person can spread the virus via respiratory droplets when they cough, sneeze, or even just talk. It also means that you or your child could become infected by touching toys or other objects that are contaminated with the virus. For instance, if your kiddo plays with a truck where the virus sits, then puts his hands in his mouth or rubs his eyes, he’ll introduce the virus into his body. 

The virus can also be transmitted by fecal contact. (Yes, it’s icky, but it’s a common thing with kids, especially those who are toilet training or are still newbies to the potty.) If a sick child has unwashed hands and plays with toys, other children could get sick by playing with those toys and putting those objects or their hands in their mouths. Adults aren’t immune, either: Changing diapers without washing your hands is another way to contract the virus.  

Finally, the fluid from HFM blisters and scabs can cause transmission, too. Say, your child gives a big ol’ hug to her preschool buddy who’s infected. She may touch a sore and get sick. All of the above is why daycares, pediatrician offices, and schools can be sources of such rapid infection—and why it's so important to practice good handwashing and disinfecting methods. 

While kids are more contagious in the first week they're sick, their saliva can continue to infect (you know, drooling, talking, coughing) for a few weeks. And their stool can be contagious for up to a few months. Having said that, most doctors recommend letting these kids go back to school as soon as the fever is gone and they are back to their normal energy. 

How is hand-foot-mouth treated in children?

Usually, hand-foot-mouth disease goes away on its own in seven to 10 days. Good thing, because there isn't any medicine for it! The best you can do is help make your child more comfortable. 

Your health care provider may advise:

  • Over-the-counter ibuprofen or acetaminophen to lessen fever and pain

  • Soft, easy-to-eat foods like applesauce—cold food feels better in the mouth and older kids like homemade popsicles and frozen yogurt (to numb mouth sores and prevent dehydration)

  • Prescription mouthwash help relieve mouth sore discomfort 

  • Using straws—they help direct fluids away from mouth sores

  • Keeping the skin as clean as possible

When should you see a doctor about hand-foot-mouth disease?

First you want to make sure you’re dealing with hand-foot-mouth disease and not a more serious cause of blistering. For example: 

  • Impetigo is pretty common in young kids. It causes blisters that vary in size, from pinpoint to half an inch (1 cm) and can occur on the body’s soft skin (armpit, diaper area, face, body…but rarely on the palms or soles). The blisters often quickly break, leaving a red round raw area. 

  • Herpes is uncommon, but it causes blisters that mostly occur in the mouth or groin.

  • Steven Johnson Syndrome is quite rare—usually a reaction to a medication—with bigger blisters (1-2” or more), which can also affect the eyes.

Dehydration is the most common complication of HFM (thanks to painful mouth sores that make swallowing difficult). Signs of dehydration include:

  • Less pee (it’s dark yellow and/or has a strong odor)

  • Less drool (the tongue is slightly wet or even dry, but not slobbery)

  • Crying without tears

If you suspect dehydration, immediately speak with your doctor or go to the hospital to be checked.

Always call your doctor if you have ANY concerns about your child’s health. In addition here are a few other reasons to reach out for your provider’s advice:

  • Fever lasting more than three days

  • Stiff neck

  • Irritability or lethargy without any happy, playful period 

  • Symptoms that don't get better in 10 days or seem severe

  • Baby is under 6 months old

  • Child has weakness of the immune system

  • Any of the sores appear infected (for example, are painful, swollen, have pus, or spreading redness)

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