Hand, Foot, & Mouth Disease: Symptoms & Treatment

What Is Hand, Foot, and Mouth Disease?

Hand, foot, and mouth disease is a common viral infection that causes mild fever, mouth sores, and rashes on the palms of the hands and soles of the feet. Infants and children under five years old are at the highest risk of contracting HFMD, but older children and adults can also contract HFMD. While there is no medication to treat HFMD, you can treat the symptoms or strengthen and support your immune system to fight the virus.

Signs and Symptoms

Symptoms usually appear three to six days after exposure to the virus. When children and adults develop symptoms of HFMD, they often experience:

• Mild fever
• Sore throat
• Stomach ache
• Feeling generally unwell and fussy

About a day or two after the fever begins, the above symptoms fade, and the following symptoms may appear:

• Sores: Red, painful sores may appear on the tongue, roof of the mouth, gums, and inside of the cheeks. These sores can start as small red spots but can blister and grow more painful with time.

• Rash: A red rash may develop on the hands and feet, or on the knees, elbows, buttocks, or genital area. The rash can start as flat red spots, like in the mouth, and then develop into blisters and scabs that may be itchy.

• Loss of appetite: Infants and toddlers can become irritable and lose their appetite.

• Swollen glands: The glands in the neck may swell as the virus develops.

Many adults develop the virus without experiencing any notable symptoms. For those who do experience symptoms, most clear within seven to ten days, though for children under two years old, it may take longer for their developing immune systems to fight the virus.

Causes of Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease is caused by viruses in the enterovirus family. In the United States, the coxsackievirus A16 and coxsackievirus A6 virus are most commonly responsible for HFMD. HFMD occurs most frequently in the summer and fall. Children can easily be exposed to the virus that causes HFMD at daycare because they often put shared toys in their mouths, touch other children and put their hands in their mouths, and get saliva and mucus on each other by coughing, sneezing, or being in close proximity.

Spreading the virus is most common during the first week of symptoms, but the person with HFMD can be contagious for weeks after the symptoms dissipate.

HFMD is spread by:

• Breathing in virus droplets after an infected person sneezes or coughs.

• Coming into physical contact with an infected person, like hugging or kissing.

• Sharing food, utensils, or cups with an infected person.

• Not washing your hands after changing the diapers of a child with HFMD, then rubbing your eyes, nose, or touching your mouth.

• Touching surfaces that have the virus on them, like toys and doorknobs.

• Touching fluid from a HFMD-caused blister or rash.

HFMD cannot be contracted from a pet or animal. Animals get foot-and-mouth disease, also known as hoof-and-mouth disease, which is a separate illness that develops only in animals with hooves, like horses, sheep, and cows.

Diagnosing Hand, Foot, and Mouth Disease

Diagnosing HFMD is often straight-forward and quite simple to health care providers. HFMD is diagnosed by:

• Examination of the rash, mouth, and sores

• Taking into consideration age and possible exposures to HFMD (like a young child being in a daycare setting)

• Mouth swab

• Stool sample (rarely)

Treatment Options

Because HFMD is viral, it can’t be cured with medicine. HFMD generally resolves on its own within seven to ten days, though babies and children under two years old may take longer to clear the virus. To help treat the symptoms, there are several options you can consider, including:

• Topical oral anesthetics: Gels, mouthwashes, sprays, and patches can temporarily numb the tongue and mouth and help relieve pain caused by mouth lesions.

• Over-the-counter medications: Acetaminophen or ibuprofen can reduce fever and relieve general pain and discomfort. Avoid giving aspirin to babies, children, or teenagers as it can cause Reye's syndrome, which can damage the brain and liver of a young person fighting a virus.

Home Remedies

To ease the discomfort of HFMD for you or your children, the following home remedies may provide some relief:

• Get plenty of rest to support your immune system.

• Drink cold liquids both to stay hydrated and soothe mouth ulcers. Dehydration is one of the most common complications of HFMD.

• Suck on ice cubes, ice chips, or popsicles.

• Eat frozen foods like ice cream or sherbet—dairy and the cold temperatures can have a soothing effect on mouth sores.

• Eat soft foods like porridges, avocado, yogurt, and creamy soups to avoid irritation of the tongue and mouth.

• Swish lukewarm water or lukewarm salt water in your mouth after meals to reduce inflammation.

• Avoid eating salty, spicy or acidic foods, drinking warm or hot beverages and consuming acidic drinks like fruit juices. These can all irritate mouth sores and make them more painful.

Prevention Tips

Unfortunately, there is no vaccine against hand, foot, and mouth disease. However, there are some simple actions you can take to reduce your likelihood of contracting it, including:

• Avoiding close contact with those infected with HFMD: Because HFMD is so contagious, it’s a good idea to avoid playdates and get-togethers with anyone who has it. If the infected person lives in your home, avoid sharing food and excessive contact, making sure to wash your hands thoroughly after feeding, diaper changes, and potty training.

• Frequent hand washing: It’s especially important to wash your hands and your child’s hands—particularly before handling food, after changing a diaper, potty training, and touching high-traffic public items like doorknobs and subway handholds.

• Disinfect common surfaces: Frequently disinfecting surfaces that many people touch, like toys, doorknobs, counters, and tabletops can reduce the likelihood of contracting HFMD.

Risk Factors for Hand, Foot, and Mouth Disease

The overwhelming majority of HFMD cases affect children under five years old. Babies and children in childcare centers are the most susceptible to catching the virus because of close proximity with other children, shared toys and play surfaces, and frequent diaper changes in common spaces. Once someone in your house gets HFMD, it’s easy for others, like siblings and parents, to become infected as well. In the United States, HFMD occurs most frequently in the summer and fall. However, it is possible to catch the virus at any time of year. \

Complications From Hand, Foot, and Mouth Disease

In the United States, complications from HFMD are rare. The majority of cases resolve naturally without complication. However, complications can occur, and may include:

• Dehydration: Dehydration is the most common complication of HFMD, especially in young children. Because mouth sores can cause pain when eating, drinking, and swallowing, some children and babies may refuse food and liquids. Cold foods and beverages may make the pain more tolerable.

• Viral meningitis: This rare complication of HFMD can cause fever, stiff neck, headache, or back pain. If viral meningitis is suspected, make an appointment with a health care professional right away, as treatment can require hospitalization.

• Encephalitis: Even more rarely, a very small percentage of HFMD cases can lead to encephalitis (swelling of the brain). Encephalitis is a medical emergency requiring immediate attention that can cause irritability, nausea, vomiting, lethargy and balance issues. Infants might also develop a bulge in the soft spots of their skull.

• Loss of fingernails and toenails: In rare instances, people, mostly children, can lose a fingernail or toenail within a few weeks of having HFMD. While this can be alarming, and necessitates a check up with a health care provider, the nails usually grow back normally without treatment.

When to See a Doctor

Hand, foot, and mouth disease is a common childhood illness that health care providers can diagnose easily. Most cases are relatively mild and doctors will encourage you to monitor signs and symptoms at home. However, it’s a good idea to call your health care provider if your or your child's symptoms worsen after a few days. You should also see a healthcare provider if:

• Your symptoms or your child’s symptoms are still present after ten days, or worsen after a few days

• Your child refuses to eat or drink enough and is showing signs of dehydration

• Your child has particularly severe symptoms, or has a compromised immune system

• Your child is younger than six months of age

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