Hand-Foot-and-Mouth Disease

Symptoms

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 child care 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

• Only has mouth ulcers, see MOUTH ULCERS. (Exception: exposed to HFM)
• Only has a rash, see RASH - WIDESPREAD AND CAUSE UNKNOWN.

Should I Call?

WHEN TO CALL YOUR DOCTOR

Care at Home

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

1. Reassurance: Hand-foot-mouth disease is a harmless viral rash.
2. Liquid Antacid for Mouth Pain:  
   • Use a liquid antacid 4 times per day.
   • For younger children, put ½ teaspoon (2 ml) in the front of the mouth 4 times per day after meals.
   • Children over age 4 can use 1 teaspoon (5 ml) as a mouthwash after meals.
3. 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.
4. Fever Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen for fever above 102° F (39° C) or severe mouth pain.
5. Contagiousness:
   • Quite contagious but a mild and harmless disease.
   • Incubation period is 3-6 days.  
   • Can return to child care or school after the fever is gone (usually 2 to 3 days).
   • The rash is not contagious.
6. 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.
7. Call Your Doctor If:
   • Signs of dehydration develop
   • Fever present over 3 days
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.