Hand, Foot, and Mouth Disease

Overview

Hand, foot, and mouth disease (HFMD) is a contagious viral infection most common in infants and children younger than 5, though older children and adults can also catch it. It is caused by enteroviruses, most often coxsackievirus A16. The illness gets its name from its typical pattern: painful sores inside the mouth and a rash or small blisters on the hands and feet.

HFMD is usually mild and clears up on its own within about a week to ten days. It is not the same as foot-and-mouth disease, an unrelated illness that affects livestock. Outbreaks are most frequent in summer and early fall, and the virus spreads easily in childcare settings, schools, and homes.

Symptoms

Symptoms usually appear three to six days after exposure. The first signs are often fever, reduced appetite, sore throat, and a general feeling of being unwell. A day or two later, other features develop:

• Mouth sores: Painful red spots that blister and ulcerate, typically on the tongue, gums, and inside of the cheeks.
• Skin rash: Flat red spots or small blisters on the palms, soles, and sometimes the buttocks, legs, or genital area. The rash is usually not itchy in children.
• Sore throat and fussiness, especially in babies and toddlers.
• Drooling and refusing food or drink because the mouth sores make swallowing uncomfortable.

Some people, particularly adults, may carry and spread the virus with few or no symptoms. After the illness, fingernails and toenails sometimes peel or shed a few weeks later; this is harmless and temporary.

Causes

HFMD is caused by viruses in the enterovirus family. The most common culprit is coxsackievirus A16. Enterovirus 71 is another cause and is occasionally linked to more serious illness. The virus spreads from an infected person through:

• Respiratory droplets from coughing and sneezing.
• Direct contact with fluid from blisters.
• Contact with saliva or nasal secretions.
• Contact with stool, for example during diaper changes, or with surfaces and objects that have been contaminated.

A person is most contagious during the first week of illness, but the virus can remain in the stool for several weeks after symptoms resolve, allowing continued spread even after the child feels better.

Risk Factors

Anyone can develop HFMD, but several factors increase the likelihood of catching it:

• Young age: Children under 5 are most affected, partly because their immune systems have not yet encountered these viruses.
• Group settings: Childcare centers, preschools, and camps make close contact and sharing of toys common.
• Close household contact with an infected child.
• Warm seasons, as cases peak in summer and early autumn in temperate climates.

Having had HFMD once provides immunity to that specific virus, but because several different viruses can cause it, a person can get the illness more than once.

Diagnosis

A clinician can usually diagnose HFMD by examining the mouth and skin and asking about symptoms and the child's age. The combination of mouth ulcers with a rash on the hands and feet is distinctive. Laboratory testing is rarely needed for routine cases.

If the diagnosis is unclear or symptoms are unusual, a throat swab or stool sample can be tested to identify the specific virus. Testing is more likely during outbreaks or when a more serious complication is suspected. Distinguishing HFMD from other causes of mouth sores or rashes, such as herpangina or chickenpox, is part of the evaluation.

Treatment

There is no specific antiviral medicine for HFMD, and antibiotics do not help because the cause is viral. Treatment focuses on easing symptoms and keeping the child comfortable and hydrated while the body clears the infection:

• Pain and fever relief: Acetaminophen or ibuprofen can ease mouth pain and fever. Aspirin should not be given to children.
• Fluids: Offer cool water, milk, or ice pops. Avoid acidic or salty foods and drinks that sting the mouth sores.
• Soft, bland foods such as yogurt, applesauce, and smoothies are easier to swallow.
• Mouth comfort: For older children and adults, some soothing mouth rinses may help, but young children should not use rinses they could swallow.

The most important goal is preventing dehydration, since painful mouth sores can make a child reluctant to drink.

Prevention

Good hygiene greatly reduces the spread of HFMD:

• Wash hands thoroughly with soap and water, especially after diaper changes, using the toilet, and before eating.
• Clean and disinfect shared surfaces and toys frequently, particularly in childcare settings.
• Avoid close contact such as kissing, hugging, or sharing cups and utensils with someone who is infected.
• Teach children to cover coughs and sneezes.
• Keep sick children home from childcare or school until the fever is gone and they feel well enough to participate.

There is no widely available vaccine for the viruses that cause HFMD in most countries.

When to See a Doctor

Most cases resolve at home, but contact a healthcare provider if:

• Your child cannot drink fluids and shows signs of dehydration, such as little or no urine, no tears when crying, dry mouth, or unusual sleepiness.
• Fever lasts more than three days or is very high.
• Symptoms are severe or worsen instead of improving after a few days.
• The child is very young (under 6 months) or has a weakened immune system.

Seek urgent care if a child has a stiff neck, severe headache, confusion, difficulty breathing, or seizures, as these may signal a rare but serious complication and require prompt medical evaluation.

Related Topics

Frequently Asked Questions

References

1. Centers for Disease Control and Prevention (CDC). Hand, Foot, and Mouth Disease.
2. Mayo Clinic. Hand-foot-and-mouth disease.
3. MedlinePlus, U.S. National Library of Medicine.
4. American Academy of Pediatrics.