ConditionInfections
Hand, Foot and Mouth Disease
Hand, foot and mouth disease (HFMD) is a common, contagious viral illness, mainly in children under 5, caused by enteroviruses such as coxsackievirus A16 and A6 and enterovirus 71. It starts with fever and sore throat, followed by painful sores in the mouth and a rash of flat spots or small blisters on the palms, soles and often the buttocks. It usually clears in 7 to 10 days without treatment. The main risk is dehydration because swallowing hurts. It is not related to foot-and-mouth disease in animals.
Also called: HFMD, coxsackievirus infection, enterovirus infection
At a glance
- Cause
- Enteroviruses, most often coxsackievirus A16 and A6, and enterovirus 71.
- Who gets it
- Mostly children under 5; older children and adults can catch it too.
- Symptoms
- Fever, sore throat, painful mouth sores, rash or blisters on hands, feet and buttocks.
- Duration
- 7 to 10 days.
- Treatment
- Fluids, pain relief and soft cold foods; no antibiotics or antivirals needed.
When to get help
Call 911 or go to the ER
- Signs of dehydration: no urine for 8 hours or more, no tears, very dry mouth, sunken eyes, or a sunken soft spot in a baby
- Stiff neck, severe headache, confusion, unusual sleepiness, jerking movements or weakness
- Difficulty breathing, or a racing heart in a child who seems very unwell
See a doctor within a day or two
- A baby under 6 months with HFMD, or a fever of 38 °C (100.4 °F) or higher in a baby under 3 months
- Fever lasting more than 3 days, or fever over 39 °C (102.2 °F) that does not come down with medicine
- Refusing to drink because of mouth pain
- Symptoms not improving after 10 days, or a weakened immune system
Book a routine appointment
- Peeling skin or nails falling off a few weeks after the illness (usually harmless)
Usually safe to manage at home
- A child with mild fever, mouth sores and a rash who is drinking enough and alert
Symptoms
Symptoms begin 3 to 6 days after exposure:
- Day 1 to 2: fever, sore throat, poor appetite and feeling unwell.
- Day 1 to 3: painful red spots in the mouth that turn into small ulcers, often on the tongue, gums and inside the cheeks.
- Day 1 to 3: a rash of flat or raised red spots, sometimes with small blisters, on the palms of the hands and soles of the feet. It may also appear on the buttocks, legs, arms and around the mouth. It is usually not itchy.
Not everyone gets all the symptoms. Some adults have no symptoms but can still spread the virus.
Atypical HFMD
Coxsackievirus A6 can cause a more widespread rash with larger blisters, including in older children and adults, and can affect areas of eczema (eczema coxsackium).
Peeling and nail loss
Weeks after the illness, skin on the hands and feet may peel, and some children lose fingernails or toenails (onychomadesis). Nails grow back normally without treatment.
How it spreads
HFMD spreads through:
- saliva, nose secretions and sputum from coughs and sneezes
- fluid from blisters
- stool, especially when changing diapers
- contaminated surfaces and toys
People are most contagious during the first week. The virus can stay in stool for weeks after symptoms go, so handwashing remains important.
HFMD vs similar illnesses
| Illness | Key differences |
|---|---|
| Herpangina | Also coxsackievirus; ulcers at the back of the throat, no hand or foot rash |
| Primary herpes (gingivostomatitis) | Swollen, bleeding gums, sores on lips and front of the mouth |
| Chickenpox | Very itchy blisters starting on the trunk, in different stages |
| Impetigo | Honey-colored crusts, often around the nose and mouth |
Diagnosis
Diagnosis is usually made by examining the mouth and rash. Swabs for lab testing are rarely needed, except for severe cases or outbreak investigation.
Treatment
There is no specific treatment. Care focuses on comfort and preventing dehydration:
- fluids: offer small amounts often. Cold water or milk, ice pops and smoothies are soothing. Avoid acidic juices and salty or spicy foods.
- soft, cool foods such as yogurt, applesauce and mashed foods
- pain and fever relief: acetaminophen (paracetamol) or ibuprofen, following the label dose for the child's weight and age. Do not give aspirin to children or teenagers.
- mouth rinses with salt water for older children who can rinse and spit
- avoid popping blisters
Antibiotics do not help because it is a viral infection.
Complications
Complications are uncommon but include:
- dehydration
- viral (aseptic) meningitis
- encephalitis and polio-like paralysis, mostly with enterovirus 71 in Asia-Pacific outbreaks
- heart inflammation (myocarditis), rare
- nail loss
Prevention and returning to school
- wash hands with soap and water after diaper changes and using the toilet
- clean and disinfect toys and surfaces
- avoid kissing, hugging and sharing cups with infected people
- children can usually return to childcare or school once they are fever-free and feeling well, even if the rash remains; follow local guidance
- vaccines against enterovirus 71 are used in some Asian countries but are not available in the US
Frequently asked questions
What are the first signs of hand, foot and mouth disease?
The first signs are usually fever, sore throat, tiredness and poor appetite. Within a day or two, painful sores appear in the mouth, followed by a rash of red spots or small blisters on the palms, soles and often the buttocks.
How long is hand, foot and mouth disease contagious?
People are most contagious during the first week of illness. However, the virus can remain in the stool for several weeks and in saliva for a shorter time, so good handwashing should continue after symptoms resolve.
Can adults get hand, foot and mouth disease?
Yes. Adults can catch it, usually from children. Many adults have mild or no symptoms, but some develop painful mouth sores, fever and a rash. Adults can spread it even without symptoms.
Can you get hand, foot and mouth disease more than once?
Yes. Several different viruses cause HFMD. Infection with one gives immunity to that virus, but you can still catch the disease again from a different one.
Sources
This guide was written from current patient and clinical guidance, including:
- CDC: Hand, foot, and mouth disease
- American Academy of Pediatrics (HealthyChildren.org): Hand, foot, and mouth disease
- MedlinePlus: Hand-foot-mouth disease
- NHS: Hand, foot and mouth disease
- World Health Organization: A guide to clinical management and public health response for HFMD