Hand-Foot-And-Mouth Disease (HFMD)  

This Care Guide Covers:

  • A viral infection that causes mouth ulcers (sores)
  • Most child also get tiny blisters on the hands and feet

If not, see these topics
When to Call Your Doctor

Call Your Doctor Now (night or day) If
  • Your child looks or acts very sick
  • Dehydration suspected. (No urine in over 8 hours, dark urine, very dry mouth and no tears)
  • Stiff neck, severe headache or acts confused
  • You think your child needs to be seen urgently
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen, but not urgently
  • Red, swollen and tender gums
  • Ulcers and sores also on the outer lip
  • Rash spreads to the arms and legs
  • Fever lasts more than 3 days
Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
  • Fingernails or toenails fall off
Parent Care at Home If
  • Hand-foot-mouth disease and no complications
Causes & Health Information

Symptoms

  • Small painful ulcers in the mouth. Look for them on the tongue and sides of mouth. 100% of children with HFMD have these.
  • Small, thick-walled water blisters OR red spots on the hands and feet. Occurs on palms, soles, and webs of the fingers and toes. This happens in 70% of children.
  • 1 to 5 water blisters per hand or foot
  • Small blisters or red spots on the buttocks (30%)
  • Low-grade fever less than 102° F (39° C)
  • Mainly occurs in children age 6 months to 4 years

Cause

  • Coxsackie A-16 virus
  • Not related to animal disease

Severe Form of Hand Foot and Mouth Disease (HFMD)

  • In 2012, a severe form of HFMD occurred in much of the world. It’s caused by a new Coxsackie A6 virus.
  • The rash spreads to the arms, legs and face (but not the trunk). The rash is made up of many small blisters.
  • Children with such a severe rash usually need to be seen. Reason: To confirm the diagnosis. Exception: They were exposed to HFMD within the last 7 days.
  • Treatment is the same. Drink enough fluids to prevent dehydration.
  • Peeling of the fingers and toes is common. It looks bad but is harmless. It happens at 1 to 2 weeks. Use a moisturizing cream on the raw skin.
  • Some fingernails and toenails may fall off. It occurs in 4% of severe cases. It happens at 3 to 6 weeks out. Trim them if they catch on things.
  • Fingernails grow back by 3 to 6 months and toenails by 9 to 12 months. They will look normal.

Return to School

  • Can return to child care or school after the fever is gone. Most often, this takes 2 to 3 days.
CARE ADVICE FOR HAND-FOOT-AND-MOUTH DISEASE

  1. What You Should Know:
    • Most often, hand-foot-and-mouth disease (HFMD) is a harmless rash.
    • It is caused by a virus called Coxsackie.
    • Here is some care advice that should help.
  2. Liquid Antacid for Mouth Pain:  
    • For mouth pain, use a liquid antacid such as Mylanta or the store brand. Give 4 times per day as needed. After meals often is a good time. Age: For children over 1 year old.
    • For children over age 6, can use 1 teaspoon (5 ml) as a mouth wash. Keep it on the ulcers as long as possible. Then can spit it out or swallow it.
    • For younger children age 1 to 6, put a few drops in the mouth. Can also put it on with a cotton swab.
    • Caution: Do not use regular mouth washes, because they sting.
  3. Soft Diet:
    • Try to get your child to drink adequate fluids.
    • Goal: Keep your child well hydrated.
    • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
    • Solids. Offer a soft diet. Also avoid foods that need much chewing. Do not give citrus, salty, or spicy foods. Note: Fluid intake is more important than eating any solids.
    • For babies, you may need to stop the bottle. Give fluids by cup, spoon or syringe instead. Reason: The nipple can increase the pain.
  4. Pain Medicine:
    • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed. See Dose Table.
  5. Fever:
    • For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. See Dose Table. Note: Lower fevers are important for fighting infections.
    • For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.
    • For babies, dress lightly. Don't wrap in too many blankets. Reason: Can make the fever higher.
  6. Return to School:  
    • HFMD is easily spread to others.
    • However, it's a mild and harmless illness.
    • After contact with HFMD, children come down with symptoms in 3-6 days.  
    • Can return to child care or school after the fever is gone. Most often, this takes 2 to 3 days.
  7. What to Expect:  
    • Fever lasts 2 or 3 days.
    • Mouth ulcers should go away by 7 days.
    • Rash on the hands and feet lasts 10 days. The rash on the hands and feet may then peel.
  8. Call Your Doctor If:
    • Signs of dehydration occur
    • Fever lasts more than 3 days
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.
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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 9/1/2012

Last Revised: 1/13/2013

Content Set: Child Symptom Checker

Copyright 1994-2012 Barton D. Schmitt, M.D.