Hand-Foot-and-Mouth Disease

What is hand-foot-and-mouth disease?

Hand-foot-and-mouth disease is a common, contagious viral infection that causes fever, painful sores in the mouth, and a rash or blisters on the hands and feet. Despite its name, it has nothing to do with foot-and-mouth disease in farm animals, which is caused by a different virus and does not spread to people in the same way. In medical coding systems, hand-foot-and-mouth disease is listed under ICD-10 code B08.4, which describes viral infections with mouth sores and skin eruptions.

The illness mostly affects infants and children younger than five years, although older children and adults can also catch it. It spreads easily in places where young children gather closely, such as daycare centers, nurseries, kindergartens, and playgroups. Outbreaks are more common in summer and early autumn in many parts of the world, though the infection can occur at any time of year.

For most people, hand-foot-and-mouth disease is a mild illness that clears up on its own within about seven to ten days. Serious complications are uncommon. Understanding what is hand foot and mouth disease, how it spreads, and how to keep a child comfortable while the body fights the virus can make the experience much less stressful for families.

Symptoms of hand-foot-and-mouth disease

Hand foot and mouth disease symptoms usually appear three to six days after a person is exposed to the virus. This waiting period is called the incubation period. The illness often unfolds in stages, and not every child develops every symptom.

Common symptoms

• Fever — often the first sign, usually mild to moderate, sometimes with chills.
• Sore throat — a scratchy or painful throat, especially when swallowing.
• Mouth sores — small red spots that turn into painful blisters or ulcers on the tongue, gums, inside of the cheeks, and back of the mouth. Doctors sometimes call these lesions, meaning areas of damaged tissue.
• Skin rash — flat red spots or small blisters, most often on the palms of the hands and soles of the feet. The rash may also appear on the buttocks, legs, elbows, or around the mouth. It is usually not itchy in children, although adults sometimes describe itching.
• Reduced appetite — eating and drinking can be painful because of the mouth sores.
• General tiredness and irritability — young children may be fussier than usual, drool more, or refuse food and drinks.

How symptoms typically progress

In many cases, the illness begins with one to two days of fever, sore throat, and a general feeling of being unwell. Mouth sores often appear next, followed within a day or two by the rash on the hands and feet. The blisters and ulcers usually heal without scarring within about a week to ten days.

The severity of symptoms can vary depending on which virus is responsible. Infections caused by certain strains, particularly a virus called enterovirus 71, are more likely — though still rarely — to cause more serious illness involving the nervous system. Some strains of coxsackievirus have been linked to more widespread rashes. In some children, the fingernails or toenails may peel or shed painlessly a few weeks after the illness; the nails typically grow back normally.

It is also possible to carry and spread the virus with very mild symptoms or no symptoms at all, which is one reason outbreaks can be hard to prevent.

Causes and risk factors

Hand foot and mouth disease causes are viral. The infection is caused by a group of viruses called enteroviruses. The most common culprits are:

• Coxsackievirus A16 — the most frequent cause in many countries, usually associated with mild illness.
• Enterovirus 71 (EV71) — a less common cause that has been associated with larger outbreaks in some regions and, rarely, with more serious complications such as inflammation of the brain or the membranes around it.
• Other coxsackieviruses — including strains such as coxsackievirus A6, which has been linked to more extensive rashes in some outbreaks.

How the virus spreads

The viruses that cause hand-foot-and-mouth disease spread easily from person to person through:

• Respiratory droplets — released when an infected person coughs, sneezes, or talks.
• Saliva and nasal secretions — for example, through shared cups, utensils, or close contact such as kissing.
• Fluid from blisters — touching the sores of an infected person.
• Stool (feces) — the virus is shed in stool, so it can spread during diaper changes or when hands are not washed well after using the toilet.
• Contaminated surfaces and objects — toys, doorknobs, and other shared items can carry the virus.

People are usually most contagious during the first week of illness, but the virus can remain in the stool for several weeks after symptoms have gone away. This means a child can still pass the infection to others even after appearing fully recovered.

Who is at higher risk?

• Children under five years old — young children have not yet built immunity to these viruses and often have close physical contact with each other.
• Children in group childcare settings — daycare centers and preschools are common places for outbreaks.
• Household contacts — parents, siblings, and caregivers of an infected child can catch the virus, though adults often have milder or no symptoms.

Having hand-foot-and-mouth disease once does not guarantee lifelong protection. A person develops immunity to the specific virus that caused their illness, but because several different viruses can cause the disease, it is possible to get it more than once.

Diagnosis

Hand foot and mouth disease diagnosis is usually made clinically, which means the doctor identifies the illness based on the symptoms and a physical examination rather than laboratory tests. During the visit, the doctor will typically:

• Ask about the child’s age, symptoms, and how long they have been present.
• Ask about recent contact with other sick children, such as at daycare or school.
• Examine the mouth for ulcers and blisters.
• Look at the rash on the hands, feet, buttocks, and other areas.

The combination of the child’s age, the pattern of fever followed by mouth sores and a rash on the palms and soles, and knowledge of local outbreaks is usually enough to confirm the diagnosis. Imaging tests such as X-rays or scans are not needed for this condition.

When are laboratory tests used?

Testing is not routine, but a doctor may order tests in certain situations — for example, if the illness is unusually severe, the diagnosis is unclear, or public health authorities are tracking an outbreak. Possible tests include:

• Throat swab or stool sample — a sample can be sent to a laboratory to identify the specific virus, often using a technique called PCR (polymerase chain reaction), which detects the virus’s genetic material.
• Swab of blister fluid — occasionally used to confirm the virus when the rash looks unusual.

Doctors may also consider other conditions that can look similar, such as chickenpox, herpes infections of the mouth, or other viral rashes, and the examination helps distinguish among them.

Treatment options

There is no specific antiviral medicine that cures hand-foot-and-mouth disease. Hand foot and mouth disease treatment focuses on relieving symptoms and keeping the child comfortable and hydrated while the immune system clears the virus, which usually takes about a week to ten days.

Watchful waiting and home care

For most children, supportive care at home is all that is needed. Helpful measures often include:

• Plenty of fluids — dehydration (losing more fluid than the body takes in) is the most common complication, because painful mouth sores make children reluctant to drink. Offer small, frequent sips of water or milk. Cold fluids, ice pops, and cool soft foods such as yogurt may be soothing. Avoid acidic drinks like orange juice and salty or spicy foods, which can sting the sores.
• Rest — allow the child to rest as much as they need.
• Soft foods — foods that require little chewing are easier to manage while the mouth heals.
• Gentle skin care — keep blisters clean and avoid deliberately breaking them, as the fluid inside is contagious.

Medications for symptom relief

• Pain and fever relievers — over-the-counter medicines such as acetaminophen (paracetamol) or ibuprofen, given in doses appropriate for the child’s age and weight, can ease fever and mouth pain. Aspirin should not be given to children or teenagers with a viral illness because of the risk of a rare but serious condition called Reye’s syndrome, which affects the liver and brain.
• Mouth rinses or topical gels — for older children who can rinse and spit, a doctor or pharmacist may suggest a soothing mouth rinse. Always ask a healthcare professional before using numbing gels in young children, as some products are not safe for them.

Antibiotics do not work against hand-foot-and-mouth disease because it is caused by a virus, not bacteria. Antibiotics would only be considered if a separate bacterial infection developed, for example in broken skin.

Hospital care in rare cases

A small number of children — usually those who cannot drink enough fluids or who develop rare complications — may need care in a hospital, where fluids can be given through a vein if necessary. Surgery and other procedures play no role in treating this condition. Childhood infections such as hand-foot-and-mouth disease are generally managed by pediatricians; at Acibadem, this condition falls under the Pediatrics department.

Living with hand-foot-and-mouth disease and outlook

The outlook for hand-foot-and-mouth disease is generally very good. In most cases, the fever settles within a few days and the mouth sores and rash heal within about seven to ten days without leaving scars. Most children recover fully with home care alone.

Complications are uncommon but can include:

• Dehydration — the most frequent problem, caused by painful swallowing.
• Nail changes — temporary peeling or loss of fingernails or toenails a few weeks after the illness; the nails usually regrow normally.
• Rare nervous system complications — very occasionally, particularly with enterovirus 71, the infection can lead to viral meningitis (inflammation of the membranes around the brain and spinal cord) or, even more rarely, encephalitis (inflammation of the brain). These situations are serious and need urgent medical care, but they are rare.

While the child is ill, it helps to reduce the chance of spreading the virus to others:

• Wash hands thoroughly and often with soap and water, especially after diaper changes and before preparing food. Alcohol-based sanitizers are less effective against these viruses than proper handwashing.
• Clean and disinfect frequently touched surfaces and shared toys.
• Avoid sharing cups, utensils, towels, and personal items.
• Keep the child home from daycare or school while they have a fever or open, weeping blisters, and follow local guidance on when they can return. Many facilities allow children back once the fever has resolved and they feel well enough, but rules vary, so check with your childcare provider and doctor.

Pregnant women who are exposed to hand-foot-and-mouth disease should mention it to their doctor or midwife. Serious problems are uncommon, but it is sensible to seek advice, particularly close to the due date.

There is currently no widely available vaccine against hand-foot-and-mouth disease in most countries, although a vaccine against enterovirus 71 has been used in some regions. Good hygiene remains the main way to reduce the spread.

Frequently asked questions

What is hand foot and mouth disease in simple terms?

It is a common viral infection, most often seen in young children, that causes fever, painful sores in the mouth, and a rash or blisters on the hands and feet. It is caused by a group of viruses called enteroviruses and usually clears up on its own within about a week to ten days. It is not related to foot-and-mouth disease in animals.

How serious is hand-foot-and-mouth disease?

For the vast majority of children, it is a mild illness that resolves without lasting effects. The main risk is dehydration, because mouth sores can make drinking painful. Serious complications, such as inflammation of the brain or its surrounding membranes, are rare and are more often linked to a particular virus strain called enterovirus 71. If a child seems very unwell, unusually drowsy, or is not drinking, they should be assessed by a doctor.

Can hand-foot-and-mouth disease heal on its own?

Yes, in most cases the body clears the virus without specific treatment. There is no medicine that kills the virus directly, so care focuses on relieving fever and pain and keeping the child well hydrated while the immune system does its work. Most children feel noticeably better within a few days, and the rash and sores usually heal within seven to ten days.

How long is a child contagious with hand foot and mouth disease?

Children are usually most contagious during the first week of illness, while they have fever and fresh blisters. However, the virus can continue to be shed in the stool for several weeks after recovery, so careful handwashing — especially after diaper changes and toilet use — remains important even after the child appears well.

Can adults get hand-foot-and-mouth disease?

Yes. Adults can catch the virus, often from an infected child in the household. Many adults have mild symptoms or none at all, but some develop the typical fever, sore throat, mouth ulcers, and rash. Adults with symptoms should follow the same supportive care and hygiene measures and consult a doctor if symptoms are severe or unusual.

Can you get hand-foot-and-mouth disease more than once?

It is possible. After an infection, a person usually becomes immune to the specific virus that caused it, but several different viruses can cause hand-foot-and-mouth disease. Catching a different strain later can lead to another episode, although repeat infections are often milder.

How long does recovery from hand foot and mouth disease take?

Most children recover fully within about seven to ten days. The fever usually settles first, followed by healing of the mouth sores and rash. In some children, the fingernails or toenails peel or shed painlessly a few weeks later; this is temporary, and the nails typically grow back normally. If symptoms last much longer than ten days or seem to worsen, it is worth checking with a doctor.

When to see a doctor

Most cases of hand-foot-and-mouth disease can be managed safely at home. However, some warning signs mean a child should be seen by a doctor promptly. Seek medical care if the child has:

• Signs of dehydration — very little or no urine (dry diapers for many hours), no tears when crying, a dry mouth and lips, sunken eyes, or unusual sleepiness.
• Refusal to drink — the child will not take fluids despite pain relief and soothing measures.
• High or persistent fever — fever lasting more than three days, or any fever in an infant younger than three months.
• Worsening or unusual symptoms — a stiff neck, severe headache, repeated vomiting, sensitivity to light, unusual drowsiness or confusion, unsteady walking, weakness of a limb, twitching, or seizures.
• Breathing difficulties — fast, labored, or noisy breathing.
• Signs of skin infection — blisters that become increasingly red, swollen, warm, or filled with pus.
• No improvement after ten days — or symptoms that keep getting worse instead of better.

Children with weakened immune systems, and pregnant women who have been exposed to the infection, should also seek medical advice. When in doubt, it is always reasonable to have a child assessed — a doctor, often a pediatrician, can confirm the diagnosis, rule out other conditions, and advise on safe symptom relief.