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Hand, Foot, and Mouth Disease in Children

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Jacqui is an RCompN in NZ, with 16+ years of experience. She writes on a number of health topics that she has experience in.

What Is Hand, Foot, and Mouth Disease?

Hand, foot, and mouth disease (HFMD) is a contagious viral infection. It is an illness characterized by sores on or in the mouth and on the hands and feet.

It is more common in children, with pre-schoolers (under five years old) often being at a higher risk than those who are older. Adults and those who are immunosuppressed may also catch HFMD—it is often milder in adults but can be extremely itchy. Once you have had HFMD, you are then immune to the virus and cannot get this disease again.

These lesions are caused by hand, foot, and mouth disease in an 11-month-old male.

These lesions are caused by hand, foot, and mouth disease in an 11-month-old male.

What Are the Causes of HFMD and How Is It Spread?

HFMD is caused by a group of viruses called enteroviruses. The most common virus that causes HFMD is called Coxsackie A16. It is highly infectious and is spread easily through contact with bodily fluids that contain the virus or poor hygiene. This includes:

  • Saliva—coughing, sneezing, and dribbling
  • Fluid from the blisters
  • Contact with feces/poo—changing diapers causes a high risk of contracting it
  • Poor hand-washing technique

Anyone with HFMD is most infectious in the first week after symptoms appear and while the blisters are filled with fluid.

What Are the Symptoms of Hand, Foot, and Mouth Disease?

It usually takes 3-5 days for symptoms to appear once a child has been exposed to the virus that causes HFMD.

Here the symptoms to watch out for:

  • A mild fever usually develops first.
  • Red spots that develop into fluid-filled blisters (these usually start in the mouth before progressing to the hands and feet)
  • Loss of appetite
  • A sore throat
  • Malaise—general weakness or tiredness
  • Occasionally spots may also be present on the bottom and legs (but not all over).

It is usually mild and should only last 3-7 days and while most of the symptoms will subside earlier, the spots take a little longer to disappear. They usually do not leave a scar. It is occasionally mistaken for chickenpox, cold sores, or in our case, dribble/teething rash! However, remember that chickenpox is usually a full body rash.

How the symptoms progressed in our child:

Our nine-month-old was complaning, wasn't eating, and had a slight temperature. We thought she was "teething", so we gave her some pain relief, and she settled to sleep. The following morning, there was a spot on her chin and one near her lip that looked like dribble/a teething rash. She was still not eating and seemed a little 'off' but wasn't sick. Her daycare called a few hours later and said she was unsettled (not like her). She had more spots on her chin and on one on hand. We found out there were other cases of HFMD reported at daycare.

What Are Treatment Options for HFMD?

HFMD does not have a vaccine, unlike the virus that causes chickenpox. Treatment for the disease mostly involves treating the symptoms and 'riding it out'.

Treatments include:

  • Paracetamol or Ibuprofen for the fever—NEVER give Aspirin to a child.
  • Plenty of fluids
  • Rest
  • Salt water rinses for the blisters in the mouth (not suitable for babies)

Infants may be very clingy, generally listless, and weak.

How we treated our daughter's HFMD:

After being picked up from daycare (30 minutes after they called) and brought home, our 9-month-old was very clingy, off her food, and complaning. She alternated between a 'whinge' that was almost constant to a wail—she was completely miserable and generally tired. Crawling seemed to be a strain on her—she was commando crawling at speed just days prior. We spent the day on the couch having lots of cuddles, giving her paracetamol every 4-6 hours, and encouraging fluids and fruity purees.

HFMD is usually a mild illness and is unpleasant for a few days, but people recover from it quickly. However, for some people, HFMD can be dangerous or cause other illnesses that are serious and even life-threatening, so it's important to be aware of these.

A small number of people in an epidemic outbreak of HFMD may develop encephalitis (inflammation of the brain) or pneumonitis (inflammation of the lung tissue). Here are the signs to watch out for in each of these illnesses (in addition to symptoms of HFMD).

Encephalitis Symptoms

  • vomiting
  • light sensitivity
  • stiff neck
  • difficulty waking up
  • problems with walking

Pneumonitis Symptoms

  • Trouble breathing
  • High fever

If you or your child have any of these symptoms, please seek urgent medical attention.

HFMD in pregnant women can be dangerous to the unborn child. Whilst even rarer than encephalitis and pneumonitis, if HFMD is contracted in the third trimester of pregnancy, it can cause the baby to become very unwell once delivered, with illnesses including inflammation of the liver, thrombocytopenia (low platelets in the blood— causes bleeding), inflammation of the brain and membranes, and disease of the heart muscle.

If you have contracted HFMD whilst pregnant, please alert your doctor so that you can be monitored appropriately.

How Can I Prevent Hand, Foot, and Mouth Disease?

HFMD is highly contagious/infectious, but there are a few simple ways that you can slow or prevent the spread of this common childhood illness.

  • Proper hand hygiene: Regularly washing your hands, particularly after changing nappies, dealing with sick children, before food preparation, or after using the toilet, can prevent the spread of many illnesses including HFMD. Childcare workers are recommended to wear gloves if caring for a sick child (while waiting for the parent to collect), as well as proper hand washing.
  • Avoid sharing food or drinks both with a sick person and in general everyday life. There are many illnesses spread through saliva and sharing food or drinks promotes the spread of both HFMD and other diseases.
  • Avoid sharing toys, particularly if the children are young enough to consider toys a 'chew thing'. Recommend this to older children as well since faecal matter on children's hands can cause the spread of HFMD.
  • Encourage good cough etiquette: Putting a hand or tissue over your mouth when you cough or sneeze, properly disposing of used tissues, and properly washing your hands will also help to contain the spread of the disease—as well as the common cold!
  • Keeping sick children home from school or childcare: Children are generally contagious for 7-10 days, so keeping them home from school or daycare can prevent the illness from spreading further. Children who do not have mouth sores and whose hands and feet only have a few sores that can be covered may attend school/daycare.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Questions & Answers

Question: What can be done at home while recovering from HFM?

Answer: Rest, fluids, Paracetamol/Tylenol are a few things to do or take.

Once they've had HFM once, they shouldn't get it again, but some do.

Question: My granddaughter has had foot and mouth disease for a week. How much longer until she's better? She still has sores around her mouth, but they are dried up.

Answer: Hopefully, she has recovered. I think it's about a week to 10 days, but they only feel really yucky for a few days. They can usually go back to daycares etc. when the spots are dry.

Question: My baby is nine-months-old, with HFM disease. How do I care for my baby in the time that they are with fever and pain? What should I offer to prevent dehydration when not taking in fluids by mouth?

Answer: We just used water or very diluted juice. Encourage sips, if they aren't taking much. Or use a syringe. If they are having very few wet diapers - please see a dr asap. Or if they are refusing all fluids.

Tylenol or paracetamol can help with fever - check with your doctor before administering.


Jacqui (author) from New Zealand on January 25, 2016:

Good to know! Yes, my daughter has now had it twice!

on immunity on January 25, 2016:

There are actually multiple viruses that cause HFMD. Once you have had one, you are indeed immune to a recurrence of that one for life, but not the others.

James from The Eastern Bypass on October 02, 2015:

Yeah, the disease is highly contagious. The problem is you cannot prevent your kids from interacting with others

peachy from Home Sweet Home on June 01, 2015:

My son had this problem when he was 6 yrs old.It repeated again when he was 7. I think he got it from school

Jacqui (author) from New Zealand on May 27, 2015:

Thanks for your comment, Deborah. I didn't either - poor wee kid.

Deborah Carr from Orange County, California on May 27, 2015:

How scary! I had no idea that children could get this disease!

Jacqui (author) from New Zealand on January 12, 2015:

Thanks MsDora. I smiled too about the rest - but I remember popping her on the floor (as she seemed to want to crawl) and she'd crawl a wee way, then stop and cry so I think she was exhausted by the virus.

Dora Weithers from The Caribbean on January 12, 2015:

Thanks for writing about this. I had never heard of it, before my grandson was diagnosed; his must have been a slight case. (I smile at a prescription of rest for a child.) Good presentation!

Jacqui (author) from New Zealand on January 11, 2015:

Thanks for your comment DJ. She is all back to normal - no evidence of any spots even!

Thanks for the question - I meant to go back and add the answer last night before I publish - HFMD is a once only disease - once you've had it, you become immune to it so cannot get it again.

DJ Anderson on January 11, 2015:

Jacqui, this is most interesting, but thankfully me or mine have never

suffered this malady.

Can children have a re-infestation or is an anti-body built up after having had HFMD. If re-infestation occurs from others children at

a child care facility, this could be an on-going problem.

Hope your wee one is better.