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  • Hand-Foot-And-Mouth Disease (HFMD)

    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 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 (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:

    • 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

    Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

    Author and Senior Reviewer: Barton D. Schmitt, M.D.
    Copyright 1994-2013 Barton D. Schmitt, M.D.

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