Hand-Foot-Mouth Disease

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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 daycare 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.

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WHEN TO CALL YOUR DOCTOR

Call Your Doctor Now (night or day) If

• Your child looks or acts very sick.
• Signs of dehydration (e.g., very dry mouth, no tears, no urine in more than 8 hours).
• Stiff neck, severe headache or acting confused. (delirious)

Call Your Doctor Within 24 Hours (between 9am and 4pm) If

• You think your child needs to be seen.
• Red, swollen and tender gums.  
• Fever present for more than 3 days.  

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns.

Parent Care at Home If

• Probable hand-foot-mouth disease and you don't think your child needs to be seen.

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HOME CARE ADVICE FOR HAND-FOOT-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 in the front of the mouth 4 times per day after meals.
   • Children over age 4 can use 1 teaspoon 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 daycare or school after the fever is gone (usually 2 to 3 days). The rash is not contagious.
6. Expected Course:  The fever lasts 2 or 3 days.  The mouth ulcers resolve by 7 days.  The rash on the hands and feet lasts 10 days.
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.

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