Hand, Foot, and Mouth Disease

Symptoms

If your child has a fever plus a rash on the hands or feet, or a few sores in the mouth, hand, foot, and mouth disease is a likely culprit — especially in summer and fall, when it circulates most. It's very common in group care settings and spreads easily among children under 5.

HFMD is caused by nonpolio enteroviruses — most often coxsackievirus A16, with coxsackievirus A6 and enterovirus A71 also common. Symptoms usually appear three to six days after exposure, starting like a cold with fever and sore throat, then progressing to the mouth sores and rash that make it recognizable a day or two later.

Here are the common signs and symptoms of HFMD in children:

Fever — Often the first sign, usually low-grade to moderate (around 101-103°F), and typically the earliest symptom, appearing before any rash.
Sore throat — Common at the start, sometimes with reduced appetite before the mouth sores appear.
Mouth sores — Small red spots that blister into painful ulcers on the tongue, gums, and inside the cheeks. These are the most uncomfortable parts for most children and the main reason kids stop eating and drinking.
Rash on hands and feet — Flat or raised red spots, sometimes with small blisters, on the palms of the hands and soles of the feet. The rash is usually not itchy and not painful.
Rash in other areas — Can also show up on the buttocks and diaper area, and sometimes the knees, elbows, arms, legs, or face.
Reduced appetite — Painful mouth sores make eating and drinking hurt, so children often refuse food and fluids. This is the biggest thing to watch.
Fussiness and tiredness — Common with the fever, especially in babies and toddlers.

What HFMD looks like by age

Infants and pre-verbal toddlers — They can't tell you their mouth hurts, so watch for fussiness, drooling more than usual, refusing the bottle or breast, and fewer wet diapers. In babies, painful mouth sores can quickly lead to dehydration.
Older children — They can usually point to a sore throat or painful mouth, complain that spots sting, and tell you when swallowing hurts. Fever may be their first clear complaint.

Is it hand, foot, and mouth or something else?

A few childhood illnesses can look similar at first. Knowing the difference helps you describe it when you call:

Condition	What it's like	Key difference
Hand, foot, and mouth	Mouth sores plus rash on palms and soles; fever	Rash concentrated on hands, feet, and mouth
Chickenpox	Itchy blisters spread all over the body	Widespread, very itchy rash; different pattern
Herpangina	Painful blisters only at the back of the mouth/throat	Caused by related viruses, but no hand/foot rash
Teething	Drooling and fussiness in a baby	No fever pattern or blistering rash

Other factors: The biggest risk with HFMD is dehydration, because a painful mouth keeps children from drinking. Watch closely for signs of dehydration (dry mouth or lips, no tears when crying, far fewer wet diapers, unusual sleepiness), as these move you into the urgent tier in When to seek care below.

Treatments

There's no medicine that cures HFMD and no antiviral or vaccine for it in the U.S. It's a virus that runs its course, usually in seven to 10 days. Treatment is about keeping your child comfortable and, above all, well hydrated while their immune system clears it. Because urgent problems come first, here's when to seek care, then the everyday plan.

Seek care now: Call the clinic or go to the emergency room

HFMD should stay mild. Call us right away or seek emergency care if your child:

Shows signs of dehydration — dry mouth, no tears when crying, far fewer wet diapers, sunken eyes, or unusual sleepiness
Won't drink anything at all, or a baby is taking less than half their usual feeds
Has a fever over 102°F lasting more than three days, or any fever in an infant under 3 months
Has a stiff neck, severe headache, persistent vomiting, or seems very lethargic or hard to wake
Has trouble breathing
Has a rash that turns red, warm, swollen, or oozes pus (a possible skin infection)

The everyday plan

For the typical mild case, two things matter most:

1. Keep fluids going. This is the single most important step. Offer small, frequent sips of water, milk, or an oral rehydration drink. Cold fluids, popsicles, and smoothies soothe sore mouths; skip acidic juices and salty or spicy foods that sting.

2. Manage fever and pain. Weight-based acetaminophen or ibuprofen can bring down fever and ease mouth pain so your child will drink more (see the safety box in At-home Care). Controlling mouth pain is how you prevent dehydration — the two go together.

What to expect

Days 1-2 — Fever, sore throat, and reduced appetite, much like a cold.
Days 2-3 — Mouth sores and the hand and foot rash appear. This is usually the most uncomfortable stretch.
Days 4-6 — The fever usually breaks and mouth sores start to heal, so eating and drinking get easier. Blisters may open into shallow sores that heal without scarring. Keep fluids going and keep blisters clean — your child is still contagious this week.
Days 7-10 — The rash fades and your child feels better. Mild peeling of the fingertips or toes — and occasionally a shed fingernail or toenail — can follow a few weeks later and is harmless.

Contagiousness and returning to school

HFMD is highly contagious and spreads through saliva, nasal, and throat secretions; fluid from the blisters; and stool. It's most contagious during the first week, but children can shed the virus from the respiratory tract for one to three weeks and in stool for weeks to months after symptoms start.

Per CDC guidance, children can usually return to childcare or school once they have no fever, feel well enough to take part, and have no uncontrolled drooling with mouth sores. When in doubt, call us and check your childcare provider's policy, which may be stricter during an outbreak.

At-home Care

For a child with mild HFMD who doesn’t need urgent care, these steps keep them comfortable and, most importantly, hydrated:

Offer fluids constantly. Small, frequent sips beat large drinks. Cold water, milk, popsicles, and smoothies are easiest on sore mouths.
Choose soft, soothing foods. Yogurt, applesauce, mashed potato, and lukewarm soups go down easily. Avoid citrus, tomato, salty, and spicy foods that sting the sores.
Treat fever and pain. Weight-based acetaminophen (any age) or ibuprofen (6 months and up) keep kids comfortable enough to keep drinking.
Rest and quiet play. Extra rest helps recovery; keep your child home while feverish or unwell.
Wash hands and disinfect. Wash hands often — especially after diaper changes and bathroom trips — and clean shared toys and surfaces to protect the rest of the household.

Medication Safety

Dose acetaminophen and ibuprofen by your child’s weight, not age, and don’t exceed the labeled frequency. Ibuprofen is not for babies under 6 months.

No over-the-counter cough or cold medicines for children under 4, and for ages 4-6, only if your pediatrician specifically recommends it.

Never give aspirin to a child or teen. It’s linked to Reye’s syndrome, a rare but serious condition.

Keep all medicines locked and up high. For any suspected overdose or accidental ingestion, call Poison Control: (800) 222-1222.

These steps are for comfort only — they never replace the Treatments guidance above. If your child stops drinking or shows any sign of dehydration, call us.

How long is my child contagious?

When can my child go back to daycare or school?

Can my child get hand, foot, and mouth more than once?

Can I catch it from my child?

Do we need antibiotics or an antiviral?

My child won't eat or drink because their mouth hurts. What can I do?

My child's fingernails or toenails look odd weeks later. Is that from the disease?

Is hand, foot, and mouth dangerous?