Hand-Foot-Mouth Disease

Hand, foot, and mouth disease (HFMD) is a common illness caused by a virus. It’s more common in children under the age of 5, but teens and adults can also get the virus. Most outbreaks happen in the summer and fall.

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HFMD is contagious and spreads easily from person to person. It can spread if you:

• Breathe in virus droplets from an infected person when talking less than 3 feet.
• Touch something that has been sneezed, coughed, or drooled on.
• Kiss, hug, or share cups or eating utensils with an infected person.
• Touch the poop (stool) of an infected person. This can happen by changing a diaper and then touching your eyes, mouth, or nose.
• Touch body fluid from blisters.

Signs and Symptoms

• Symptoms of HFMD usually go away in 5 to 7 days without treatment.
• Early symptoms are a lot like a common cold:
  • Fever
  • Headace
  • Sore throat
  • Runny nose
• 1 or 2 days after a fever, you might see:
  • Small sores (ulcers) on the throat and tonsils.
  • A rash of very small blisters or red spots on the palms of the hands, soles of the feet, and diaper area. They’re usually not itchy.
  • Tenderness or pain when touching the palms of the hands and soles of the feet.
  • Poor appetite due to painful swallowing.
• After the rash has healed, the skin may peel, but this is harmless.

Treatment

Since HFMD is a virus, antibiotics will not help. The following may help your child feel better:

• Offer soft foods that are easy to swallow, like applesauce, mashed potatoes, oatmeal, or eggs.
• Do not give aspirin or products that contain aspirin.
• When giving an over-the-counter (OTC) medicine, read the label to know the right dose for the age of your child.

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Medicines Under 6 months old

• Give acetaminophen (Tylenol®) to help with fever and a sore throat. Do not give ibuprofen to children younger than 6 months.

Over 6 months old

• Give acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) to help with headache, fever, and a sore throat.
• Do not give cold medicines without asking your child’s doctor or health care provider.

Drinks Under 1 year old

• Keep giving them your milk, formula, or both.
• You can also give Pedialyte®.

Over 1 year old

• Give lots of liquids, like water, milk, apple juice, and popsicles.
• Avoid fruit juices that are high in acid, like cranberry juice, orange juice, or lemonade. They may irritate mouth sores.

Soothing a sore throat Over 4 years old

• Use throat lozenges or sprays. They should not contain lidocaine.
• Avoid putting creams or gels on the skin that have benzocaine (Oragel®, Anbesol®) or diphenhydramine (Benadryl®), which can be harmful to children.

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Over 6 years old

• If your child can gargle without swallowing, mix ¼ to ½ teaspoon of salt with one 8-ounce glass of warm water. Have them swish and gargle the salt water 2 to 3 times a day, as needed. Do not let them swallow it. Have them spit it out.

When to Call the Doctor

Call your child’s doctor or health care provider if they have:

• Neck or chest pain.
• Trouble swallowing.
• Pus, drainage, swelling, or a large area of redness around any sores.
• Signs of dehydration:
  • Dry or sticky mouth
  • No tears, sunken eyes
  • very dark urine
  • Baby’s soft spot on their head looks sunken in
  • No wet diaper for 4 to 6 hours
  • Has not peed in 6 to 8 hours
• Younger than 3 months – Rectal temperature of 100.4° Fahrenheit (F) or 38° Celsius (C) or higher.
• Older than 3 months – Rectal armpit (axillary) temperature more than 102°F (38.9°C) that is not coming down with medicine.
• Older than 4 years – Oral temperature of 102°F (38.9°C) for more than 3 days that is not coming down with medicine.
• Seizures, very tired, not able to focus, or has a hard time answering or waking up.
• Does not get better in a few days.

Prevention

There is no vaccine to prevent HFMD. It spreads easiest during the first week the person is sick. It can stay in the body for weeks after your child feels better and still spread to others. To prevent spreading HFMD:

• Teach your child to:
  • Not touch the rash or rub their eyes.
  • Avoid putting fingers or toys in their mouth.
  • Sneeze or cough into a tissue or the bend of their elbow.
  • Wash their hands often with soap and warm water. Wash after touching the rash, going to the bathroom, before touching food, before eating, and after touching animals.
• Wash your own hands with soap and warm water often.
• Disinfect bathrooms, toys, and other objects that your child touches with soap and water or other disinfectants like Lysol® or Clorox®. The virus can live on these things for days.
• Do not share things like: drinking cups, eating utensils, brushes, napkins, combs, or towels.
• Avoid hugging, kissing, or being in close contact with a child who is infected.

Returning to School or Child Care

• Tell your child’s care center or school that they have HFMD. It’s important for school staff and other parents to know so they can watch for symptoms.
• Keep your child home from school or childcare until they have gone 24 hours without a fever and the mouth sores and open blisters have healed.

Hand-Foot-Mouth Disease (PDF)

HH-I-211 • ©2012, revised 2023 • Nationwide Children’s Hospital

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