OHSU

Hand-Foot-And-Mouth Disease

DEFINITION

  • A viral infection that causes mouth ulcers and tiny blisters on the hands and feet

Symptoms

  • Small painful ulcers in the mouth, especially on tongue and sides of mouth (in all children)
  • Small, thick-walled water blisters (like chickenpox) or red spots located on the palms, soles, and webs between the fingers and toes (70%)
  • 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

Return to School

  • Can return to daycare or school after the fever is gone (usually 2 to 3 days). The rash is not contagious.

See More Appropriate Topic (instead of this one) If

WHEN TO CALL YOUR DOCTOR

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Signs of dehydration (e.g., very dry mouth, no tears, no urine in more than 8 hours)
  • Stiff neck, severe headache or acting confused (delirious)
  • 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
  • Fever present for more than 3 days

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns

Parent Care at Home If

  • Probable hand-foot-mouth disease and you don't think your child needs to be seen

HOME CARE ADVICE FOR HAND-FOOT-AND-MOUTH DISEASE

Reassurance: Hand-foot-and-mouth disease is a harmless viral rash.

Liquid Antacid for Mouth Pain:  

  • Use a liquid antacid 4 times per day.
  • For younger children, put ½ teaspoon in the front of the mouth 4 times per day after meals.
  • Children over age 4 can use 1 teaspoon as a mouthwash after meals.

Soft Diet:

  • Encourage favorite fluids to prevent dehydration.
  • Cold drinks, milkshakes, popsicles, slushes, and sherbet are good choices.
  • Avoid citrus, salty, or spicy foods.
  • For infants, give fluids by cup, spoon or syringe rather than a bottle. (Reason: The nipple can cause pain.)
  • Solid food intake is not important.

Fever Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen for fever above 102° F (39° C) or severe mouth pain.

Contagiousness:  

  • Quite contagious but a mild and harmless disease.
  • Incubation period is 3-6 days.  
  • Can return to daycare or school after the fever is gone (usually 2 to 3 days).
  • The rash is not contagious.

Expected Course:  

  • Fever lasts 2 or 3 days.
  • Mouth ulcers resolve by 7 days.
  • Rash on the hands and feet lasts 10 days.The rash on the hands and feet may then peel.

Call Your Doctor If:

  • Signs of dehydration develop
  • Fever present over 3 days
  • Your child becomes worse

 

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.

 

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Author and Senior Reviewer: Barton D. Schmitt, M.D.
Last Reviewed: 9/15/2011
Last Revised: 8/1/2011
Content Set: Pediatric HouseCalls Symptom Checker
Copyright 1994-2012 Barton D. Schmitt, M.D.

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