Hand, foot and mouth disease

Hand, foot and mouth disease (HFMD) is a viral infection that can affect young children.

Information written and reviewed by Certified Doctors.

Contents

Key Information

What should I do?

If you think you or your child have this condition you may not need to see a doctor.

How is it diagnosed?

Hand foot and mouth disease can be diagnosed based on your or your child’s symptoms and the appearance of the rash.

What is the treatment?

You or your child may not need any treatment for hand, foot and mouth disease. It is caused by a viral infection which clears itself within 7–10 days. During this time, you or your child should:

  • drink plenty of fluids
  • minimise contact with others.

It can be helpful to take non-prescription treatments such as non-steroidal anti-inflammatory (NSAID) medication if you develop a fever.

When to worry?

If you or your child have the following symptoms then you should see a doctor immediately:

  • unable to drink fluids
  • passing small amounts of urine
  • passing no urine
  • seizure or fit
  • confusion or abnormal drowsiness
  • loss of consciousness
  • painful, swollen, red, swollen skin
  • discharge or pus from the skin.

If you think you or your child have hand, foot and mouth disease and any of the following applies to you or your child then you should see a doctor immediately:

  • you are pregnant
  • your child is under 3 months old and has a temperature of 38°C or above
  • your child is between 3 and 6 months old and has a temperature of 39°C or above
  • the symptoms are getting worse
  • the symptoms have not improved after 7–10 days.

Introduction

Hand, foot and mouth disease (HFMD) is a viral infection that can affect young children.

It doesn't usually pose a serious threat to a child's health, but it can be be an unpleasant condition, particularly if it affects younger children.

Typical symptoms of hand foot and mouth disease include:

  • cold-like symptoms, such as loss of appetite, cough and a moderately high temperature of around 38-39°C (100.4- 102.2°F)
  • a non-itchy red rash that develops on the hand and the feet; sometimes the rash can develop into painful blisters
  • painful mouth ulcers

Read more about the symptoms of hand, foot and mouth disease.

When to see your doctor

Hand, foot and mouth disease is a self-limiting condition, which means that it will get better on its own without treatment. The symptoms will usually pass within seven days.

However, speak to your doctor if you're unsure whether your child has hand, foot and mouth disease.

You should also contact your doctor if your child isn’t drinking any fluid or their symptoms last longer than seven days.

Treating hand, foot and mouth disease

There is currently no cure for hand, foot and mouth disease, so treatment involves making your child feel as comfortable as possible while waiting for the infection to take its course.

Possible treatment options include:

  • using paracetamol, ibuprofen and mouth gels to relieve the pain of mouth ulcers
  • drinking plenty of fluids to help relieve a high temperature

Read more about treating hand, foot and mouth disease.

What causes HFMD?

Hand, foot and mouth disease is caused by a group of viruses known as enteroviruses. The two most common types of viruses that can cause the condition are the:

  • coxsackievirus A16
  • enterovirus 71

Enterovirus 71 carries a higher risk of causing serious complications (see below).

Read more about the causes of hand, foot and mouth disease.

How the infection spreads

A person with hand, foot and mouth disease is highly contagious until about a week after the symptoms begin. The infection can be spread if:

  • an infected person coughs or sneezes; contaminated droplets can either be inhaled by another person or can contaminate surfaces, leading to the spread of infection when someone touches the surface before touching their mouth or nose
  • an infected person doesn't wash their hands properly after going to the toilet and then contaminates surfaces or food (the viruses can live for up to four weeks in a person’s stools)
  • you come into contact with the fluids of an infected person’s blisters or saliva

Due to the way the infection is spread, outbreaks of HFMD can occur in places where there are groups of small children who need to have their nappies changed or use a potty, such as a nurseries or childcare centres.

You should keep your child away from school or nursery while they are unwell. However, there's no need to wait until the last blister has gone before your child can return to school or nursery, provided they are otherwise well. The same advice applies to adults and the workplace.

However, some schools and nurseries may reserve the right to refuse admission to your child until the condition has cleared up completely.

It is possible to get HFMD more than once, although not during the same outbreak. As they get older, most children will develop immunity to the viruses that cause the condition.

Complications

It’s important to make sure that anyone with hand, foot and mouth disease keeps drinking fluids to avoid becoming dehydrated.

Dehydration can often occur because the mouth ulcers can make drinking fluids painful.

Life-threatening complications, such as brain infections (encephalitis), have been reported during epidemics of HFMD that are known to be caused by the enterovirus 71. However, the rate of these types of complications is very low.

Read more about the complications of hand foot and mouth disease.

Causes

Hand, foot and mouth disease (HFMD) is usually caused by the coxsackie A virus, but it can also be caused by the enterovirus 71 or other types of coxsackie viruses.

It is thought that the virus first spreads to tissue inside the mouth near to the tonsils and also down to the digestive system.

The virus can then spread into nearby lymph nodes (glands) and then throughout the body via the blood. The immune system (the body’s defence against infection) controls the virus before the virus can spread into vital organs such as the brain.

How HFMD spreads

The viruses that cause HFMD can be spread in much the same way as the common cold.

They are contained in the millions of tiny droplets that come out of the nose and mouth when someone with the disease coughs or sneezes. These droplets hang suspended in the air for a while, then land on surfaces. Anyone who touches these surfaces can spread the virus by touching something else.

People usually become infected by picking up the virus on their hands from contaminated objects and then placing their hands near their mouth or nose. It is also possible to breathe in the virus if it is suspended in the air.

The viruses are unable to spread in this way once a person’s symptoms have passed.

However, the viruses can remain in the stools of an infected person for up to four weeks after the symptoms pass. This means a person can still pass the hand foot and mouth disease on to others if they do not wash their hands properly after going to the toilet and they then touch objects that are handled by others.

You can also become infected with hand foot and mouth disease if you have contact with fluid from the blisters or saliva of someone who is infected.

Diagnosis

There are a number of viruses that can cause sores and ulcers to develop in the mouth, as well as those that are responsible for hand, foot and mouth disease (HFMD).

However, your doctor will usually be able to distinguish HFMD from other viral infections by:

  • the age of the affected person - hand, foot and mouth disease is most common in children under the age of 10
  • the pattern of symptoms - symptoms begin with a high temperature and a sore throat; ulcers then develop in your child’s mouth and a spotty skin rash on their hands and feet
  • the appearance of sores - the sores are smaller than chickenpox sores and usually have a distinctive colour, size and shape

If there is any doubt, hand foot and mouth disease can be confirmed (or ruled out) by taking a small sample from the skin or inside the mouth, or alternatively a stool sample, and checking it for infection.

Treatment

There is no specific treatment for hand, foot and mouth disease (HFMD). The condition usually clears up by itself after 7-10 days.

As HFMD is caused by a viral infection, it cannot be treated with antibiotics. Antiviral medications are also ineffective in treating hand foot and mouth disease.

You can help ease your child’s symptoms by:

  • encouraging them to rest and to drink plenty of fluids (water or milk are ideal while you should avoid anything acidic like cola or orange juice)
  • offering them soft foods, such as mashed potatoes and soup that are easier to chew, making eating and swallowing less uncomfortable
  • using medication to relieve symptoms

Medication

Over-the-counter painkillers, such as paracetamol and ibuprofen, can often help ease a sore throat and a high temperature. For pregnant women, paracetamol is preferred to ibuprofen. Aspirin should not be given to children under 16 years of age.

There are a number of gels, sprays and mouthwashes available for the treatment of mouth ulcers, although it is unclear how effective they actually are.

These include:

  • lidocaine gel - which can be used in children of all ages
  • benzydamine mouth spray - which can be used in children aged five and over
  • benzydamine mouth rinse - which can be used in children aged 12 and over
  • choline salicylate gel - which is only suitable for adults aged 16 and above and should not be used if you are pregnant or breastfeeding

Make sure you read the instructions that come with these types of medication as you can only use them a certain number of times over a course of a day.

An alternative method is to gargle with warm salty water - mix half a teaspoon of salt (2.5g) with a quarter of a litre (eight ounces) of water. It is important never to swallow the water so it’s not recommended for younger children.

If your child develops blisters you should avoid piercing them as the fluid inside is infectious. The blisters should dry over and then disappear within seven days.

Preventing the spread of infection

HFMD is very contagious. The best way to avoid catching and spreading it is to avoid close contact with people who have the disease and to practise good hygiene.

  • Always wash your hands after going to the toilet and handling nappies, and before preparing food.
  • Encourage them to wash their hands regularly.
  • Avoid sharing utensils with people who are infected.
  • Make sure work surfaces are clean.
  • Clean any bedding, clothing or similar that could have been contaminated with droplets of saliva, blister fluid or stools in a hot wash before allowing them to be used by others.

Work, school and nursery

If your child has hand, foot and mouth disease, you should keep them away from school, nursery or playschool while they are feeling unwell.

They can usually return as soon as they feel better. There is no need to keep your child away from school or nursery until the last blister has healed, providing they are otherwise well.

However, this advice is only a recommendation. Individual nurseries and schools may reserve the right to refuse admission to your child until the condition has completely cleared up.

The above advice also applies to adults with HFMD in terms of returning to work.

Symptoms

The symptoms of hand, foot and mouth disease (HFMD) usually develop 3-5 days after initial exposure to the infection. This time is known as the incubation period.

Early symptoms of HFMD include:

  • a high temperature (fever); usually around 38- 39°C (100.4-102.2°F)
  • loss of appetite
  • cough
  • abdominal pain
  • sore throat

Occasionally, hand, foot and mouth disease can cause vomiting (being sick), particularly if it is caused by the enterovirus 71 strain.

Mouth ulcers

After one or two days, red spots develop inside the mouth, particularly around the tongue, gums and inside of the cheeks.

At first the sores are around the size of a small button. They then rapidly develop into larger yellow-grey mouth ulcers surrounded by a red ring of tissue. You would normally expect to see between 5-10 ulcers in the mouth.

The ulcers can be very painful and can make eating, drinking and swallowing difficult, which may cause a young child to dribble excessively.

The ulcers should pass within 5-7 days.

Skin rash

Soon after the mouth ulcers appear you will probably notice small red spots on your child’s skin.

The most common places for the spots to develop are on the side of the fingers, the back of the hands and the side of the heels. Less commonly the palms of the hands and the soles of the feet can also be affected as can the buttocks and groin areas.

The spots are around 2-5 mm in size with a darkish-grey centre with a ‘rugby-ball’ type of shape.

The spots are usually painless and non-itchy, although occasionally they can progress into small blisters which can be painful and tender. It is important not to burst any blisters as this can spread the infection.

The skin rash and any blisters should pass within 3-7 days.

When to seek medical advice

Most cases of hand foot and mouth disease do not require medical attention as the symptoms will pass within seven days without the need for treatment.

However, if you are uncertain whether your child does have HFMD you could always telephone your doctor for advice.

You should also contact your doctor if:

  • your child is unable or unwilling to drink any fluids
  • your child is showing signs of dehydration, such as not passing urine as much as normal, dry, wrinkled skin and your child seems unusually tired
  • your child’s symptoms show no sign of improvements after seven days, or they worsen during this time
  • your child has additional symptoms, such as a change in mental state, seizures (fits) and changes in personality and behaviour

Complications

Hand, foot and mouth disease (HFMD) is usually a mild condition that clears up on its own without the need for treatmen

Complications of HFMD are rare, but they could include those described below.

Dehydration

The sores that develop in your throat and mouth may make drinking and swallowing difficult which can lead to dehydration. It is important for your child (or yourself) to drink plenty of fluids. Encourage your child to drink water and milk over acidic drinks like fruit juice.

It may be easier if you encourage your child to drink small amounts frequently rather than attempting to drink a large amount.

Contact your doctor for advice if your child is unable or unwilling to drink any fluids or they are showing signs of dehydration, including:

  • dry, wrinkled skin that sags slowly into position when pinched up
  • an inability to urinate, or not passing urine for eight hours
  • irritability
  • sunken eyes
  • your child appears unusually tired and listless
  • in babies - a sunken soft spot (fontanelle) on their head

Mild cases of dehydration can be treated using rehydration solutions which are available from most pharmacists.

More severe cases may require treatment in hospital.

Read more about dehydration.

Secondary infection

There is also a risk that the sores on the skin can become infected, especially if the sores is scratched.

Symptoms of skin infection include:

  • pain, redness, swelling and a feeling of heat at the site of the infection
  • a discharge of pus or liquid from the skin

Contact your doctor if you think your child has a skin infection as they may need to be treated with antibiotic cream or tablets.

Viral meningitis

In rare cases, hand, foot and mouth disease can lead to viral meningitis. Viral meningitis is an infection of the membranes that cover the brain and spinal cord (the meninges)

Viral meningitis is less severe than bacterial meningitis and does not pose a serious threat to health.

Most children will make a full recovery within two weeks.

Symptoms include

  • a high temperature (fever) of or above 38C (100.4F)
  • drowsiness
  • headache
  • neck stiffness
  • dislike of bright lights

There is no specific treatment for viral meningitis other than using painkillers to help relieve symptoms.

Read more about meningitis.

Encephalitis

The most serious but rarest complication of hand foot and mouth disease is encephalitis - an infection that causes the brain tissue to swell and become inflamed.

It can cause brain damage and is potentially life threatening.

Early signs of encephalitis are flu-like symptoms, which can develop in a few hours or over a few days. Other symptoms include:

  • being sick
  • drowsiness or confusion
  • seizures (fits)
  • dislike of bright lights

If you develop encephalitis, you will need to be admitted to hospital.

Most reported cases of encephalitis related to hand foot and mouth disease have occurred during mass outbreaks of cases (epidemics) involving thousands of people that are known to be caused by enterovirus 71.

And at the current time these epidemics have only occurred in Asian countries such as China and Taiwan.

Read more about encephalitis.

Content supplied by NHS Choices