Hand, foot and mouth disease is a common viral illness in children under five, caused most often by a coxsackievirus. It looks alarming and the name sounds serious, but it is usually mild and runs its course in about a week to ten days. It is unrelated to foot-and-mouth disease in animals.
What it looks like
It usually begins with fever, a sore throat and a child who goes off their food — often a day or two before any rash appears, which is why the first day looks like an ordinary virus.
- Painful mouth sores — small ulcers on the tongue, gums and inside the cheeks. These are the part that actually bothers children.
- A rash on the hands and soles of the feet — flat red spots, sometimes blistering
- Spots on the buttocks, legs or around the mouth
- Drooling and refusing to eat or drink, because swallowing hurts
The one thing that actually matters: fluids
There is no antiviral and no antibiotic for this — antibiotics do nothing. The whole of treatment is comfort, and the real risk is dehydration, because mouth ulcers make drinking painful.
- Offer cold things — ice lollies, chilled milk, yoghurt, smoothies. Cold numbs; hot stings.
- Avoid acidic and salty foods — orange juice, tomato, crisps. They sting badly on ulcers.
- Small amounts, very often, rather than asking for a full cup
- Acetaminophen or ibuprofen for pain as needed — see our dosing guidance. Pain relief is what gets fluids in, so give it before offering a drink rather than after.
- Do not use adult mouthwashes or numbing gels unless we have advised it
How contagious is it?
Very, especially in the first week. It spreads through saliva, fluid from the blisters, and stool — and children can continue to shed the virus in stool for several weeks after they appear completely well, which is why outbreaks in nurseries are so hard to stop. Thorough handwashing, particularly after nappy changes, matters more than anything else.
Most nurseries ask that children stay home while they have fever or open blisters and are drooling, then return once they are well. Check your nursery’s policy, as they differ.
Peeling fingers and lost nails, weeks later
Some children’s fingertips and toes peel a week or two afterwards, and occasionally a fingernail or toenail loosens and falls off a month or two later. This is harmless, it is not a sign anything went wrong, and the nails grow back normally. It is worth knowing in advance, because it is very unsettling if nobody warned you.
When to call us
- Signs of dehydration — no wet nappy or urine for 8 hours, no tears, a dry mouth, unusual drowsiness
- Your child is refusing all fluids
- Fever lasting more than about 3 days, or a very high fever
- Your child is under 6 months old
- Mouth sores so painful they cannot swallow their own saliva
- Blisters that look infected — spreading redness, warmth, pus
- Your child seems much more unwell than the illness explains
Go to the emergency room for difficulty breathing, a stiff neck, a seizure, or a child who is very difficult to rouse.
Same-day visits in MetroWest, Orlando
If your child is not drinking, call us rather than waiting it out — (407) 445-9224. We keep time for same-day sick visits. Primary Care Pediatrics, 1507 S Hiawassee Rd, Suite 105, Orlando, FL 32835, Monday to Friday, 9:00 AM – 5:00 PM.
