Definition
- A viral infection that causes mouth ulcers (sores)
- Most children also get tiny blisters on the hands and feet
Symptoms
- Small painful ulcers in the mouth. Look for them on the tongue and sides of mouth. 100% of children with HFMD have these.
- Small, thick-walled water blisters OR red spots on the hands and feet. Occurs on palms, soles, and webs of the fingers and toes. This happens in 70% of children.
- 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
Severe Form of Hand Foot and Mouth Disease (HFMD)
- In 2012, a severe form of HFMD occurred in much of the world. It’s caused by a new Coxsackie A6 virus.
- The rash spreads to the arms, legs and face (but not the trunk). The rash is made up of many small blisters.
- Children with such a severe rash usually need to be seen. Reason: To confirm the diagnosis. Exception: They were exposed to HFMD within the last 7 days.
- Treatment is the same. Drink enough fluids to prevent dehydration.
- Peeling of the fingers and toes is common. It looks bad but is harmless. It happens at 1 to 2 weeks. Use a moisturizing cream on the raw skin.
- Some fingernails and toenails may fall off. It occurs in 4% of severe cases. It happens at 3 to 6 weeks out. Trim them if they catch on things.
- Fingernails grow back by 3 to 6 months and toenails by 9 to 12 months. They will look normal.
Return to School
- Can return to child care or school after the fever is gone. Most often, this takes 2 to 3 days.
When to Call Us for Hand-Foot-And-Mouth Disease (HFMD)
Call Us Immediately If: Click to View
Call Us Now (night or day) If:
- Your child looks or acts very sick
- Dehydration suspected. (No urine in over 8 hours, dark urine, very dry mouth and no tears)
- Stiff neck, severe headache or acts confused
- You think your child needs to be seen urgently
Call Us Within 24 Hours If: Click to View
Call Us Within 24 Hours (between 9 am and 4 pm) If:
- You think your child needs to be seen, but not urgently
- Red, swollen and tender gums
- Ulcers and sores also on the outer lip
- Rash spreads to the arms and legs
- Fever lasts more than 3 days
Call Us During Weekday Office Hours If:
- You have other questions or concerns
- Fingernails or toenails fall off
Parent Care at Home If: Click to View
Parent Care at Home If:
- Hand-foot-mouth disease and no complications
Care Advice for Hand-Foot-And-Mouth Disease
What You Should Know:
- Most often, hand-foot-and-mouth disease (HFMD) is a harmless rash.
- It is caused by a virus called Coxsackie.
- Here is some care advice that should help.
Liquid Antacid for Mouth Pain:
- For mouth pain, use a liquid antacid such as Mylanta or the store brand. Give 4 times per day as needed. After meals often is a good time. Age: For children over 1 year old.
- For children over age 6, can use 1 teaspoon (5 ml) as a mouth wash. Keep it on the ulcers as long as possible. Then can spit it out or swallow it.
- For younger children age 1 to 6, put a few drops in the mouth. Can also put it on with a cotton swab.
- Caution: Do not use regular mouth washes, because they sting.
Soft Diet:
- Try to get your child to drink adequate fluids.
- Goal: Keep your child well hydrated.
- Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
- Solids. Offer a soft diet. Also avoid foods that need much chewing. Do not give citrus, salty, or spicy foods. Note: Fluid intake is more important than eating any solids.
- For babies, you may need to stop the bottle. Give fluids by cup, spoon or syringe instead. Reason: The nipple can increase the pain.
Pain Medicine:
- To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed. See Dose Table.
Fever:
- For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. See Dose Table. Note: Lower fevers are important for fighting infections.
- For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.
- For babies, dress lightly. Don’t wrap in too many blankets. Reason: Can make the fever higher.
Return to School:
- HFMD is easily spread to others.
- However, it’s a mild and harmless illness.
- After contact with HFMD, children come down with symptoms in 3-6 days.
- Can return to child care or school after the fever is gone. Most often, this takes 2 to 3 days.
What to Expect:
- Fever lasts 2 or 3 days.
- Mouth ulcers should go away by 7 days.
- Rash on the hands and feet lasts 10 days. The rash on the hands and feet may then peel.
Call Your Doctor If:
- Signs of dehydration occur
- Fever lasts more than 3 days
- Your child becomes worse