Hand, Foot and Mouth Disease (HFMD): Symptoms, Causes, and Treatment

Hand, foot and mouth disease (HFMD) is a mild but contagious viral infection mostly affecting children under 5. It causes fever, painful mouth sores, and a rash on hands and feet. Caused by enteroviruses, it spreads through close contact. While uncomfortable, HFMD usually resolves in 7-10 days with home care. Good hygiene helps prevent spread.

In plain words

Hand, foot, and mouth disease (HFMD) is a common illness in young kids. It causes fever, mouth sores, and a rash on hands and feet. Most children get better in 7-10 days. It spreads easily in daycares and schools. The virus passes through coughs, sneezes, poop, and blister fluid. There's no special medicine for it, but you can help ease symptoms at home. Washing hands often helps stop the spread.

What is Hand, Foot and Mouth Disease (HFMD): Symptoms, Causes, and Treatment?

Hand, foot and mouth disease (HFMD) is a mild but contagious viral infection mostly affecting children under 5. It causes fever, painful mouth sores, and a rash on hands and feet. Caused by enteroviruses, it spreads through close contact. While uncomfortable, HFMD usually resolves in 7-10 days with home care. Good hygiene helps prevent spread.

Symptoms

Early symptoms

  • Fever: Often the first symptom - a moderate fever (101°-102°F/38.3°-38.9°C) that may last 2-3 days, sometimes with reduced appetite and general discomfort. (2) (5)
  • Sore throat: A painful throat often precedes the mouth sores, making swallowing uncomfortable. Children may refuse food or drink due to the pain. (2) (5)
  • Mouth sores: Small red spots appear in the mouth 1-2 days after fever starts, then develop into painful blisters or ulcers. Typically on tongue, gums, and inside cheeks. (2) (5)
  • Skin rash: Flat red spots develop on palms, soles, and sometimes buttocks or genitals. Spots may turn into small blisters with a grayish center and red border. (2) (5)
  • Loss of appetite: Due to painful mouth sores, children may refuse food and drink, increasing risk of dehydration if not managed carefully. (2)

Serious or emergency symptoms

  • Dehydration signs: Dry mouth, no tears when crying, sunken eyes, decreased urine output (fewer wet diapers in infants) - require prompt medical attention. Contact your healthcare provider immediately if dehydration is suspected. (2)
  • Neurological symptoms: High fever with severe headache, neck stiffness, confusion, or seizures may indicate rare complications like meningitis or encephalitis. Seek emergency care immediately for these symptoms. (2)
  • Persistent high fever: Fever above 101°F/38°C lasting more than 3 days suggests possible complication or alternative diagnosis. Contact your healthcare provider for evaluation. (2)

Causes

Primary causes

  • Coxsackievirus A16: This enterovirus strain causes most HFMD cases in the U.S. It spreads through close personal contact, respiratory droplets, and contaminated surfaces. (1)
  • Other enteroviruses: Sometimes caused by enterovirus 71 and others. Outbreaks from these viruses may have more severe symptoms. (1)

Risk factors

Age under 5

Young children are most susceptible because they haven't developed immunity to the common viruses causing HFMD. (8)

Childcare attendance

Daycare and preschool settings encourage close contact and sharing of toys/surfaces where viruses spread easily. (8)

Seasonal exposure

In temperate climates, most cases occur in summer and fall, though tropical areas see cases year-round. (8)

Diagnosis

Doctors typically diagnose HFMD by examining the characteristic rash and mouth sores along with reported symptoms. Lab tests are rarely needed except in severe cases or outbreaks where identifying the specific virus is important. The provider will distinguish HFMD from other rash illnesses like chickenpox or allergic reactions based on the sores' location and appearance.

Clinical examination

Visual inspection of mouth sores and skin rash location/pattern confirms typical HFMD cases. (7)

Throat swab or stool sample

In unusual cases, testing for enterovirus RNA may be done to confirm diagnosis. (7)

Treatment

Medication options

Pain and fever relievers

Reduces fever and relieves pain from mouth sores to improve comfort and fluid intake. (3) (6)

Topical oral anesthetics

Numbing gels can temporarily relieve painful mouth sores to allow eating and drinking. (3)

Lifestyle and self-care

  • Hydration management: Offer cool liquids frequently - ice pops, chilled applesauce, or yogurt can be soothing. Avoid acidic drinks like orange juice that may sting. (3) (6)
  • Soft, bland foods: Choose foods requiring little chewing like mashed potatoes, scrambled eggs, or oatmeal. Avoid spicy, salty, or crunchy foods. (3) (6)
  • Hand hygiene: Frequent handwashing with soap and water helps prevent spread, especially after diaper changes or contact with blisters. (4) (6)
  • Surface disinfection: Clean and disinfect frequently touched surfaces and shared toys daily during illness to limit transmission. (4)

Always discuss dosing and treatment changes with your own prescriber.

Possible complications

  • Dehydration: Most common complication when mouth pain prevents adequate fluid intake, sometimes requiring IV fluids in severe cases. (3)
  • Fingernail/toenail loss: Temporary nail shedding may occur weeks after illness in some cases, with normal regrowth in months. (3)
  • Viral meningitis: Rare but serious inflammation of membranes covering brain/spinal cord, requiring hospitalization. (3)

When to see a doctor

Routine follow-up

  • If mouth sores make drinking difficult causing signs of dehydration (dry mouth, no tears when crying, decreased urine output). (5)
  • If fever persists beyond 3 days or symptoms worsen after initial improvement. (5)

Seek emergency care

  • Seek emergency care for severe headache with neck stiffness, confusion, difficulty breathing, or seizures - may indicate neurological involvement. (5)

Frequently asked questions

How long is hand, foot and mouth disease contagious?

People are most contagious during the first week of illness, but the virus can remain in stool for weeks after symptoms resolve. Stay home from school/work until fever is gone and mouth sores have healed enough to eat/drink normally. (1)

Can adults get hand, foot and mouth disease?

Yes, though it's much less common in adults. Symptoms are usually milder, though pregnant women and immunocompromised individuals should take precautions if exposed. (5) (7)

Is there a vaccine for hand, foot and mouth disease?

No vaccine exists in the U.S. for the common strains causing HFMD. Prevention focuses on thorough handwashing and avoiding close contact with infected individuals. (1)

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

Yes, because multiple virus strains can cause it. Immunity develops only against the specific virus causing each infection. (1) (7)

References

  1. CDC — About Hand, Foot and Mouth Disease source 1
  2. CDC — Symptoms of Hand, Foot and Mouth Disease source 2
  3. CDC — Treatment of Hand, Foot and Mouth Disease source 3
  4. CDC — Prevention of Hand, Foot and Mouth Disease source 4
  5. NHS — Hand, foot and mouth disease source 5
  6. NHS — How to treat hand, foot and mouth disease yourself source 6
  7. MedlinePlus — Hand-foot-mouth disease source 7
  8. WHO — Hand, Foot and Mouth Disease source 8