Hand-Foot-and-Mouth Disease

• Hand-foot-and-mouth disease is a common childhood illness. It starts with a fever and then causes sores in the mouth and on the hands and feet. It usually goes away by itself in a week or so.
• You can treat symptoms at home by giving your child pain relievers and plenty of fluids.
• Wash your hands often when you care for a child with this illness. It spreads easily through coughing and sneezing. You can also get it from changing your child’s diaper. If your child goes to day care or school, talk to the staff about when your child can return.

What is hand-foot-and-mouth disease?

Hand-foot-and-mouth disease is a common childhood illness. It causes sores in the mouth and on the hands, feet, and sometimes the buttocks and legs. Mouth sores can be painful and may make it hard for your child to eat. The disease is not serious, and it usually goes away in a week or so.

It can occur at any time of year, but hand-foot-and-mouth disease is most common in the summer and fall.

Hand-foot-and-mouth disease is not the same as other diseases that have similar names: foot-and-mouth disease (sometimes called hoof-and-mouth disease) or mad cow disease. These diseases almost always occur in animals.

What causes hand-foot-and-mouth disease?

Hand-foot-and-mouth disease is caused by a virus called an enterovirus.

The virus spreads easily through coughing and sneezing. You can also get it by coming in contact with infected stool, such as when you change a diaper. Often the disease breaks out within a community. Children are most likely to spread the disease during the first week of the illness. But the virus stays in the stool and can sometimes spread to others for several months after the blisters and sores have healed.

It usually takes 3 to 6 days for a person to get symptoms of hand-foot-and-mouth disease after being exposed to the virus. This is called the incubation period.

What are the symptoms?

At first your child may feel tired, get a sore throat, or have a fever of around 101°F (38°C) to 103°F (39°C). Then in a day or two, your child may get sores or blisters on the hands, feet, mouth, and sometimes the buttocks. In some cases a child will get a skin rash before the blisters appear. The blisters may break open and crust over. The sores and blisters usually go away in a week or so.

How is hand-foot-and-mouth disease diagnosed?

A doctor can tell if your child has hand-foot-and-mouth disease by the symptoms you describe and by looking at the sores and blisters.

How is it treated?

Hand-foot-and-mouth disease does not usually need treatment. Most cases go away in 7 to 10 days. You can use home care to help relieve your child’s symptoms.

• Offer your child plenty of cool fluids. Your child may also have Popsicles and ice cream.
• Do not give your child acidic or spicy foods and drinks, such as salsa or orange juice. These foods can make mouth sores more painful.
• For pain and fever, give your child acetaminophen (such as Tylenol) or ibuprofen (such as Advil). Do not give your child aspirin. It has been linked Reye's syndrome, a serious illness.

To help prevent the disease from spreading:

• Teach all family members to wash their hands often. It is especially important to wash your hands after you change the diaper of an infected child. This is because the virus may stay in the stool for several months after the blisters heal.
• Do not let your child share toys or give kisses while he or she is infected.
• If your child goes to day care or school, talk to the staff about when your child can return.
• Wear latex or rubber gloves when you apply any lotion, cream, or ointment to your child's blisters.

Frequently Asked Questions

Symptoms of hand-foot-and-mouth disease begin with a sudden onset of sore throat and a fever of around 101°F (38.3°C) to 103°F (39.4°C). A child usually feels tired, not hungry, and generally unwell. About 1 or 2 days later, the child starts developing other symptoms that include:

• About 5 to 10 small sores or blisters on the inside and outside of the mouth. Mouth sores are often painful and may make it hard for your child to eat.
• Small red spots or blisters on the hands, feet, and sometimes the buttocks. Your child may have a skin rash before these blisters form. The blisters may break open and crust over. They usually last a total of about 7 to 10 days.
  • The hands usually have the most blisters. They typically form on the back of the hand and between the fingers. Blisters may form on the palm and finger pads also.
  • On the feet, blisters form mostly on the top, sides, and between the toes. Blisters may form on the bottom (soles) of the feet also.

Most children fully recover after the blisters have healed. In rare cases, skin sores come back and medical treatment is needed.

Adults who are infected with hand-foot-and-mouth disease may not be aware of it because they usually do not have symptoms. If symptoms develop, they are usually milder than those seen in children.

Your child's doctor can usually diagnose hand-foot-and-mouth disease by the distinctive sores and blisters. Your description of any other symptoms your child has is also helpful.

Tests are not usually needed. Sometimes a doctor may want to confirm the type of virus present by examining a sample of blister tissue or fluid.

Treatment for hand-foot-and-mouth disease is not usually needed. Symptoms of the disease generally go away within 7 to 10 days without treatment.

You may choose to treat your child's symptoms to soothe discomfort and pain caused by sore throat, fever, or pain from blisters. Appropriate medication choices include:

• Acetaminophen, such as Tylenol.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.

Do not give aspirin to anyone younger than 20 unless directed to do so by your doctor. Aspirin use is linked to a rare but serious disease, Reye's syndrome, that most often occurs in children and adolescents.

People who have certain problems with their immune system (antibody deficiencies) and get hand-foot-and-mouth disease may be treated with intravenous immunoglobulin (IVIG).

If symptoms do not improve in about a week, see your doctor.

Hand-foot-and-mouth disease goes away on its own without any treatment in about 7 to 10 days. You can help your child feel better during the course of the illness with some basic home treatment measures.

• Have your child drink plenty of cool fluids. This can include Popsicles and ice cream, which can offer some variety.
• Treat fever and pain with acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs). Do not give aspirin to anyone younger than 20 unless directed to do so by your doctor because of the risk of Reye's syndrome.
• Give your child any medication prescribed by a doctor. This may include pills to take by mouth or lotions, creams, or ointment to put on the blisters.
• Do not give your child acidic or spicy foods and drinks, such as salsa or orange juice, which may make mouth sores more painful.

Your child will be contagious during the course of the illness, which lasts 7 to 10 days. However, the virus remains in the feces (stools) and can spread to others for up to 2 months after the blisters and sores have healed. Be especially careful to use good hygiene for several months after your child is better.

To help prevent the disease from spreading:

• Tell child care providers and school staff about your child's infection. Ask about their policies regarding when your child with hand-foot-and-mouth disease can return to daycare or school.
• Have all family members be aware of using good hygiene, such as washing their hands frequently. It is especially important to wash your hands after changing the diapers of a young child who is infected. The virus can be in the stools of a child for up to 2 months after the rash has healed.
• Do not let your child share toys or give kisses while he or she is infected.
• Wear latex or rubber gloves when you apply any prescribed ointment to your child's blisters.

Talk to your doctor about whether to report the infection to a local health agency. Sometimes your doctor will report it. Other times, it is up to you. The health agency helps monitor your community for disease outbreaks.

Online Resource

Other Works Consulted

• Dolin R (2003). Hand-foot-and-mouth disease. In IM Freedberg et al., eds., Fitzpatrick's Dermatology in General Medicine, 6th ed., vol. 2, chap. 211, pp. 2049–2052. New York: McGraw-Hill.

• Khetsuriani N, Parashar UD (2006). Enteric viral infections. In DC Dale, DD Federman, eds., ACP Medicine, section 7, chap. 28. New York: WebMD.

• Rotbart HA (2003). Enteroviruses. In CD Rudolph et al., eds., Rudolph's Pediatrics, 21st ed., pp. 1020–1023. New York: McGraw-Hill.