Your toddler won't eat breakfast. By lunchtime, they're running a fever. Then you spot it: tiny red blisters dotting their palms and the soles of their feet.
It could be hand, foot and mouth disease, the viral illness that sweeps through daycares every year. Shalini Sethi, M.D., a pediatrician at Henry Ford Health, explains what to do if your child might have this illness, and how to (hopefully) prevent it from striking again.
What Is Hand, Foot and Mouth Disease?
Hand, foot and mouth disease is an illness caused by a group of viruses called enteroviruses. The most common culprits are Coxsackievirus A16 and Enterovirus A71, though several different viral strains can cause the infection.
These viruses are common in places where young kids congregate, such as daycares and elementary schools. “During the summer and early fall, we see so many children coming into the clinic with hand, foot and mouth disease,” says Dr. Sethi. “It spreads around the same time every year, when children go back to school and the weather is still warm.”
While the disease primarily affects young children, anyone can get it, including teenagers and adults. And sadly, you and your child are not immune if you’ve had this illness before. “Like colds, you can get hand, foot and mouth multiple times because there are so many different viruses that cause it,” says Dr. Sethi.
Though it sounds scary, hand, foot and mouth disease is usually not life-threatening. “Most cases are mild and resolve within 10 days,” says Dr. Sethi. “In rare cases, however, children can develop serious complications, so closely monitor your child as they recover.”
Symptoms of Hand, Foot and Mouth Disease
The name gives away the most obvious symptoms, but the illness actually starts in the mouth before spreading elsewhere. “The first sign is often that a young child will refuse to eat because mouth sores are causing them pain,” Dr. Sethi explains. “These sores can form on the gums, inner cheeks and tongue. Then comes the fever—usually around 101 degrees Fahrenheit—followed by the visible rash.”
The hand, foot and mouth rash appears as small red spots or blisters that can show up on:
- Arms and legs
- Buttocks
- Palms of the hands
- Soles of the feet
“The mouth lesions typically hurt, but the skin lesions aren't usually painful or itchy,” says Dr. Sethi. “That's one way we can distinguish it from other rash illnesses like chickenpox.”
How Does Hand, Foot and Mouth Spread?
Hand, foot and mouth disease is highly contagious, and spreads through:
- Direct contact with an infected person's saliva, fluid from blisters, or stool (like when changing a child's diaper)
- Fecal-oral transmission, which means touching a surface contaminated with fecal germs and then eating or touching your mouth
- Respiratory droplets when an infected person coughs or sneezes
Young children are the main spreaders of hand, foot and mouth because, well, they’re kids. They drool, put their hands and other things in their mouths, and may not yet know how to wash their hands properly. The virus can live in stool for up to four weeks after infection, so that’s a long time to be potentially spreading the virus.
The incubation period (the time between exposure and the first symptoms) is typically three to five days, though it can range from two to seven days. “If your child was exposed at a party and seven days have passed without symptoms, they probably won't get it,” says Dr. Sethi. “But if it's only been two or three days, watch for signs.”
What’s the Best Treatment for Hand, Foot and Mouth Disease?
There's no specific medication to treat hand, foot and mouth disease. Because it’s a virus, antibiotics won’t help—and giving them when not needed could contribute to antibiotic resistance.
But there are ways you can help your child heal and avoid serious complications, including:
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Focus on fluids
“The most important thing is keeping your child hydrated,” Dr. Sethi emphasizes. “A child in pain may refuse to drink, which is a common complication. Some children have to go to the hospital for IV fluids because they have become severely dehydrated.”
Of course, you can’t force a child to drink, but you may have success with:
- Offering popsicles, especially frozen electrolyte drinks for kids
- Giving small, frequent sips of water or milk
- Serving soft, soothing foods that contain water, like yogurt or applesauce
- Avoiding acidic or spicy foods that may irritate mouth sores
Control pain with medications
If your pediatrician gives the go-ahead, your child can take acetaminophen (Tylenol) or ibuprofen (Motrin). These medicines can help sore mouths feel better so they can eat and drink.
However, steer clear of numbing gels or other topical medicines. “Children can have allergic reactions or absorb too much medication through the sores, and that can be dangerous,” says Dr. Sethi.
Should I Call the Doctor?
If your child seems very ill or you’re unsure whether they need to be seen, don’t hesitate to contact your pediatrician. “We’re here to help, and we can provide guidance on home care,” says Dr. Sethi.
Luckily, most cases of hand, foot and mouth disease go away on their own. Children can return to school or daycare once they've been fever-free for 24 hours without medication and their blisters have dried.
However, contact your child’s pediatrician if you see red flags such as:
- Fever that persists beyond a few days
- Rash that becomes more widespread or severe
- Signs of dehydration, such as dry mouth, no tears or decreased urination
- Symptoms that get worse or don't improve after 10 days
While rare, hand, foot and mouth disease can occasionally lead to serious complications, including viral meningitis or encephalitis. Seek immediate medical attention if your child experiences:
- Severe headache or stiff neck
- Difficulty breathing or chest pain
- Extreme drowsiness or confusion
- Seizures
Preventing Hand, Foot and Mouth Disease
Good hand hygiene is the best way to keep this nasty bug away from you and your kids. But even if you’re a diligent handwasher, there’s no guarantee that you’ll never get it. You can reduce your risk if you:
- Avoid close contact with infected individuals.
- Disinfect toys and surfaces regularly.
- Wash hands thoroughly after diaper changes.
Hand, foot and mouth disease may be common, but that doesn't make it any less miserable. “Unfortunately, it takes over a week to go away, so it’s not a quick, 24-hour virus,” Dr. Sethi says. “But with some time and proper home care, you’ll get through it.”
Reviewed by Shalini Sethi, M.D., a pediatrician at Henry Ford Medical Center — Beck Road in Plymouth.
