Hand, Foot and Mouth Disease (HFMD) in Kids

A mes­sage from day­care says some­thing is going around. By din­ner­time, your tod­dler feels warm and push­es away the cup they usu­al­ly drain in sec­onds. The next morn­ing, you see tiny spots on their palms.

That’s often how hand, foot, and mouth dis­ease, or HFMD, presents. It’s a com­mon viral ill­ness in young chil­dren that caus­es fever, mouth sores, and a rash. The spots can look alarm­ing. Typ­i­cal­ly, most chil­dren recov­er with­in sev­en to 10 days with sup­port­ive care and com­fort. The real chal­lenge is keep­ing your child drink­ing, because sore mouths and sip­py cups aren’t the best of friends.

What Caus­es HFMD and How It Spreads

HFMD is caused by a group of virus­es called enterovirus­es and affects main­ly kids under 5 years of age, though it can affect old­er chil­dren and adults too. Though out­breaks are known to occur year-round, it typ­i­cal­ly occurs in late sum­mer and ear­ly fall, around the time schools reopen. The virus pass­es through sali­va, stool, blis­ter flu­id, and shared cups and toys. Chil­dren are most con­ta­gious dur­ing the first week of the ill­ness. Still, the virus can linger in their stool for sev­er­al weeks after they recov­er, and it can be spread even by those who are infect­ed but asymp­to­matic. That makes hand­wash­ing and dis­in­fect­ing sur­faces like toys and dia­per chang­ing tables key.

What Symp­toms Should You Expect?

There can be dif­fer­ent ver­sions of this. Watch for these HFMD symptoms:

• Fever (often the first sign)
• Sore throat and reduced inter­est in food
• Tired­ness, fussi­ness, or clinginess
• Painful sores on the tongue, gums, inner cheeks, or roof of the mouth
• A red­dish rash or small blis­ters on hands, feet, and mouth

In young chil­dren, the clues are behav­ioral: extra drool­ing, turn­ing away from favorite foods, cry­ing part­way through a bottle.

The rash is typ­i­cal­ly non-itchy and can be found on any or all of the below areas:

• More com­mon­ly on the palms, fin­gers, soles, toes, and around the mouth
• Less com­mon­ly on the legs, arms, but­tocks, and genitals
• Rarely even on the chest, back, or abdomen

On dark­er skin tones, feel­ing for raised bumps, rough patch­es, or tex­ture changes rather than look­ing for a red rash is often more helpful.

Con­cerned about your child’s fever, mouth sores, or rash? Sched­ule an appoint­ment with a Duly pediatrician. >

How Do You Help Your Child Feel Better?

Because a virus caus­es it, antibi­otics play no role, as they do not work against viruses.

The virus runs its course, and symp­toms usu­al­ly last any­where between two and five days, except for the rash, which can linger up to 10 days.

Treat­ment cen­ters around con­trol­ling the fever, ensur­ing hydra­tion, and pro­vid­ing comfort:

• Aceta­minophen or ibupro­fen as need­ed to help with fever and mouth pain
• A soft diet, espe­cial­ly cold options like pop­si­cles and ice cream
• Water
• Milk
• Oral rehy­dra­tion solu­tion like Pedi­alyte, or a sports drink like Gatorade
• Ice pops
• Smooth­ies
• Yogurt

Skip any­thing acidic, spicy, or hot for a few days. And if your child isn’t eat­ing much? That’s okay for now. Flu­ids mat­ter far more than solids, and a few sips every 15 to 20 min­utes is more real­is­tic than fin­ish­ing a whole cup in one go.

Leave blis­ters alone and con­tin­ue reg­u­lar baths. Keep up good hand­wash­ing with soap and water.

There’s one more thing worth know­ing before it catch­es you off guard, well after your child seems better.

“I like to edu­cate par­ents about the pos­si­bil­i­ty of mild skin peel­ing or nail changes, even shed­ding, that can some­times occur a few weeks to a few months after the ini­tial HFMD ill­ness. It is uncom­mon and recov­ers ful­ly, but it is nonethe­less dis­turb­ing for par­ents, and they always appre­ci­ate a heads-up.”
— Dr. Tejasi Gho­lap, Pedi­a­tri­cian with Duly Health and Care

If you do notice peel­ing skin or a nail that ridges, loosens, or falls off, it usu­al­ly does­n’t require treat­ment. The nail grows back on its own.

When Should You Call a Doctor?

When swal­low­ing hurts, kids stop drink­ing, so dehy­dra­tion can set in. Call your pedi­a­tri­cian if you notice few­er wet dia­pers, dark urine, a dry mouth, or no tears when crying.

Reach out too if the fever is high and not com­ing down despite fever med­ica­tion, or if symp­toms aren’t improv­ing after five days. The same goes if your baby is very young, or you aren’t sure it’s HFMD.

Seek emer­gency care for dif­fi­cul­ty breath­ing, seizures, con­fu­sion, exces­sive sleepi­ness, trou­ble wak­ing, or a stiff neck with headache. Seri­ous com­pli­ca­tions are rare, but they war­rant imme­di­ate med­ical attention.

If your pedi­atric office has no avail­abil­i­ty or if symp­toms seem more seri­ous, find a Duly Imme­di­ate Care Center. >

Fre­quent­ly Asked Questions

When can my child go back to day­care or school? Most chil­dren can return once they’re fever-free with­out med­ica­tion, feel well enough for nor­mal activ­i­ties, and aren’t drool­ing uncon­trol­lably from mouth sores or deal­ing with mul­ti­ple open blis­ters. The rash does­n’t have to be com­plete­ly gone, though your school or child­care cen­ter may have its own pol­i­cy, so it’s worth a quick phone call to check ahead of their return. If you need a doc­tor’s note, sched­ule an appoint­ment with your Duly pediatrician. >

Do antibi­otics treat hand, foot and mouth dis­ease? No. A virus caus­es HFMD, so that antibi­otics won’t help. They only come into play if your child devel­ops a sec­ondary bac­te­r­i­al infec­tion on top of the HFMD, which does hap­pen, though rarely. See your pedi­a­tri­cian if symp­toms do not start to improve in about five days.

Can adults catch HFMD from their kids? Yes. Par­ents, teach­ers, and child­care work­ers can all pick it up, though adults often have mild symp­toms or even no symp­toms at all.

Can chil­dren get HFMD more than once? Yes. Sev­er­al dif­fer­ent strains of enterovirus­es can cause it, so one round does­n’t pro­tect your child from all the dif­fer­ent strains. Most kids recov­er with rest, flu­ids, sup­port­ive care, and com­fort. If your child won’t drink or some­thing does­n’t seem right, find a Duly pedi­atric provider near you. >