Hand, foot and mouth disease Causes, Symptoms, Treatment and FAQs

Hand, foot and mouth disease

Hand, foot, and mouth disease (HFMD) is a common infection caused by a group of viruses. It typically begins with a fever and feeling generally unwell. This is followed a day or two later by flat discolored spots or bumps that may blister, on the hands, feet, and mouth and occasionally buttocks and groin.

Signs and symptoms normally appear 3–6 days after exposure to the virus. The rash generally resolves on its own in about a week. Fingernail and toenail loss may occur a few weeks later, but they will regrow with time. The viruses that cause HFMD are spread through close personal contact, through the air from coughing and the feces of an infected person.

Contaminated objects can also spread the disease. Coxsackievirus A16 is the most common cause, and enterovirus 71 is the second-most common cause. Other strains of coxsackievirus and enterovirus can also be responsible. Some people may carry and pass on the virus despite having no symptoms of the disease. Other animals are not involved. Diagnosis can often be made based on symptoms. Occasionally, a throat or stool sample may be tested for the virus.

Symptoms of Hand, foot and mouth disease

• Fever
• Sore throat
• The feeling of being unwell (malaise)
• Painful, red, blister-like lesions on the tongue, gums, and inside of the cheeks
• A red rash, without itching but sometimes with blistering, on the palms, soles and sometimes the buttocks
• Irritability in infants and toddlers
• Loss of appetite

The usual period from initial infection to the onset of signs and symptoms (incubation period) is three to six days. A fever is often the first sign of hand-foot-and-mouth disease, followed by a sore throat and sometimes a poor appetite and malaise.

One or two days after the fever begins, painful sores may develop in the front of the mouth or throat. A rash on the hands and feet and possibly on the buttocks can follow within one or two days.

Sores that develop in the back of the mouth and throat may suggest that your child is infected with a related viral illness called herpangina. Other distinguishing features of herpangina include sudden high fever and in some instances, seizure. Sores that develop on the hands, feet or other parts of the body are very rare.

Causes of Hand, foot and mouth disease

The most common cause of hand-foot-and-mouth disease is infection with the coxsackievirus A16. The coxsackievirus belongs to a group of viruses called nonpolio enteroviruses. Other types of enteroviruses sometimes cause hand-foot-and-mouth disease.

Oral ingestion is the main source of coxsackievirus infection and hand-foot-and-mouth disease. The illness spreads by person-to-person contact with an infected person’s:

• Nasal secretions or throat discharge
• Saliva
• Fluid from blisters
• Stool
• Respiratory droplets sprayed into the air after a cough or sneeze

Common in the childcare setting

Hand-foot-and-mouth disease is most common in children in childcare settings because of frequent diaper changes and potty training, and because little children often put their hands in their mouths.

Although your child is most contagious with hand-foot-and-mouth disease during the first week of the illness, the virus can remain in his or her body for weeks after the signs and symptoms are gone. That means your child still can infect others.

Some people, particularly adults, can pass the virus without showing any signs or symptoms of the disease.

Outbreaks of the disease are more common in summer and autumn in the United States and other temperate climates. In tropical climates, outbreaks occur year-round.

Different from foot-and-mouth disease

Hand-foot-and-mouth disease isn’t related to foot-and-mouth disease (sometimes called hoof-and-mouth disease), which is an infectious viral disease found in farm animals. You can’t contract hand-foot-and-mouth disease from pets or other animals, and you can’t transmit it to them.

Risk factors of Hand, foot and mouth disease

Hand-foot-and-mouth disease primarily affects children younger than age 10, often those under 5 years. Children in childcare centers are especially susceptible to outbreaks of hand-foot-and-mouth disease because the infection spreads by person-to-person contact, and young children are the most susceptible.

Children usually develop immunity to hand-foot-and-mouth disease as they get older by building antibodies after exposure to the virus that causes the disease. However, it’s possible for adolescents and adults to get the disease.

Complications of Hand, foot and mouth disease

The most common complication of hand-foot-and-mouth disease is dehydration. The illness can cause sores in the mouth and throat, making swallowing painful and difficult.

Watch closely to make sure your child frequently sips fluid during the course of the illness. If dehydration is severe, intravenous (IV) fluids may be necessary.

Hand-foot-and-mouth disease is usually a minor illness causing only a few days of fever and relatively mild signs and symptoms. A rare and sometimes serious form of the coxsackievirus can involve the brain and cause other complications:

• Viral meningitis. This is a rare infection and inflammation of the membranes (meninges) and cerebrospinal fluid surrounding the brain and spinal cord.
• Encephalitis. This severe and potentially life-threatening disease involves brain inflammation caused by a virus. Encephalitis is rare.

Prevention of Hand, foot and mouth disease

Certain precautions can help to reduce the risk of infection with hand-foot-and-mouth disease:

• Wash hands carefully. Be sure to wash your hands frequently and thoroughly, especially after using the toilet or changing a diaper and before preparing food and eating. When soap and water aren’t available, use hand wipes or gels treated with germ-killing alcohol.
• Disinfect common areas. Get in the habit of cleaning high-traffic areas and surfaces first with soap and water, then with a diluted solution of chlorine bleach and water. Childcare centers should follow a strict schedule of cleaning and disinfecting all common areas, including shared items such as toys, as the virus can live on these objects for days. Clean your baby’s pacifiers often.
• Teach good hygiene. Show your children how to practice good hygiene and how to keep themselves clean. Explain to them why it’s best not to put their fingers, hands or any other objects in their mouths.
• Isolate contagious people. Because hand-foot-and-mouth disease is highly contagious, people with the illness should limit their exposure to others while they have active signs and symptoms. Keep children with hand-foot-and-mouth disease out of childcare or school until fever is gone and mouth sores have healed. If you have the illness, stay home from work.

What is the outcome for someone who has hand-foot-and-mouth disease?

For most people, the disease goes away in 7 to 10 days without leaving a trace.

In the United States, it’s rare for a virus that causes HFMD to lead to a more serious disease. A few people have developed viral meningitis, which causes inflammation in the brain and spinal cord. Symptoms of viral meningitis include an excruciatingly painful headache and neck stiffness.

There have also been a few reports of people getting encephalitis (swelling in the brain). This can cause an excruciatingly painful headache and confusion.

Other problems have been reported. In a few cases, people lose one or more fingernails or toenails. Their nails usually regrow normally.

While HFMD tends to go away on its own in 7 to 10 days, it may be possible to prevent it. Find out what you can do at Hand-foot-and-mouth disease: Tips for preventing

Frequently Asked Questions About Hand, foot and mouth disease

What are hand, foot, and mouth disease?

Despite its scary name, hand, foot, and mouth disease is a common, contagious illness caused by different viruses. It typically affects infants and children under age 5, but older kids and adults can catch it as well.

What are the signs and symptoms?

From the time the child is exposed to hand, foot, and mouth disease, it takes 3 to 6 days for the first symptoms to show up. This is called the incubation period. It usually starts with a fever, sore throat, and runny nose—much like the common cold—but then a rash with tiny blisters may start to show up on the following body sites:​

• In the mouth
  • On the inner cheeks
  • Gums
  • Sides of the tongue
  • Top of the mouth
• Fingers
• Palms of hands
• Soles of feet
• Buttocks

Note: One, few, or all of these body sites may have blisters.

Symptoms are the worst in the first few days but are usually completely gone within a week. Peeling of the fingers and toes after 1 to 2 weeks can happen, but it is harmless.

How are hand, foot, and mouth disease diagnosed?

Your pediatrician can tell if your child has a hand, foot, and mouth disease based on the symptoms you describe and by looking at your child’s mouth sores and rash. Depending on how severe your child’s symptoms are, your pediatrician may collect samples from your child’s throat send them to a lab for testing.

If your child is diagnosed with hand, foot, and mouth disease, make sure to inform your child’s childcare provider or school. They may need to inform other parents and staff members about watching for symptoms.

What is the treatment?

There isn’t any medicine to treat or cure hand, foot, and mouth disease. The only thing parents can do is ease the fever and pain with acetaminophen or ibuprofen. Call your pediatrician if your child’s fever lasts more than 3 days or if he or she is not drinking fluids.

For mouth pain:

In children over age 1 year, parents can consult with their doctor as a variety of liquid mouth-soothing remedies may be useful to alleviate mouth ulcer pain. Do not use regular mouth washes, because they sting.

• Age 1 to 6 years: Put a few drops in your child’s mouth or put it on with a cotton swab.
• Age over 6 years: Use 1 teaspoon (5 mL) as a mouth wash. Keep it on the mouth blisters as long as possible. Then have your child spit it out or swallow it.

Avoid dehydration:

Children with hand, foot, and mouth disease need to drink plenty of fluids. Call your pediatrician now or go to the ER if you suspect your child is dehydrated.

How long is it contagious?

You are generally most contagious during the first week of illness. But, children with hand, foot, and mouth disease may shed the virus from the respiratory tract (nose, mouth, and lungs) for 1-3 weeks and in the stool for weeks to months after the infection starts.

How are hand, foot, and mouth disease spread?

The virus causing hand, foot, and mouth disease is usually spread through person-to-person contact in different ways:

Respiratory route:

• Contact with large droplets that form when a child talks, coughs, or sneezes. These droplets can land on or be rubbed into the eyes, nose, or mouth. Most of these droplets do not stay in the air; usually, they travel no more than 3 feet and fall onto the ground.

• Contact with the respiratory secretions (nasal mucus or saliva) from objects contaminated by children who carry these viruses.

Fecal-oral route:

• Contact with the stool of children who are infected. This generally involves a sick child dirtying his own fingers and then touching an object that another child touches. The child who touched the contaminated surface then puts her fingers into her own mouth.

How can I help prevent and control the spread of hand, foot, and mouth disease?

• Teach your children to cover their mouths and noses when sneezing or coughing with a disposable tissue, if possible, or with an arm sleeve if no tissue is available. Teach everyone to wash their hands right after using tissues or having contact with mucus. Change or cover contaminated clothing.
• Wash your hands after changing diapers. Parents can spread the virus to other surfaces by coming in contact with any feces, blister fluid or saliva.
• Clean, rinse, and sanitize toys that may have come in contact with your child’s saliva.
• Prevent the sharing of food, drinks, and personal items that may touch your child’s mouth, such as eating utensils, toothbrushes, and towels.
• Protect other children in the house. Make sure they do not come in close contact with the child who is infected. Kissing, hugging, and sharing cups and utensils can spread the infection quickly. If your children share a room, separate them while the sick child is contagious.
• Disinfect any surfaces your child touches frequently—this may be helpful to prevent a sibling from getting hand, foot, and mouth disease (and it is doable if you’re are careful about cleaning surfaces).

Can my child go to school or childcare with hand, foot, and mouth disease?

Yes, except for when:

• The child is not feeling well enough to participate in a class or has a fever.
• The teacher or childcare provider feels he or she cannot take care of the child without compromising care for the other children in the class. Excessive drooling from mouth sores might be a problem that people find difficult to manage.
• The child has many open blisters. It usually takes about 7 days for the blisters to dry up.
• The child meets other exclusion criteria.

Note: Exclusion from childcare or school will not reduce the spread of hand, foot, and mouth disease because children can spread the virus even if they have no symptoms and the virus may be present in the stool for weeks after the symptoms are gone

When can my child go back to school or childcare?

A child can return to school or childcare after all of the exclusion criteria (listed above) are resolved and the child feels well enough to participate. Talk with your child’s pediatrician if you are not sure when your child should return to school or childcare.

If my child has already had a hand, foot, and mouth disease can he or she get it again?

Yes. A child can have repeat infections with the same type of virus or different viruses that cause hand, foot, and mouth disease.