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pediatric-skin

Hand, Foot, and Mouth Disease in Children

Hand, foot, and mouth disease causes mouth sores and a rash on the hands and feet. It's common in young children, spreads easily, and usually clears in 7–10 days.

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Dr. Lena Park — Pediatric NP

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What HFMD looks and feels like

The illness often starts with a fever and a day or two of feeling unwell — fussiness, reduced appetite, sore throat. The distinctive features appear within one to two days of the fever 2:

  • Mouth sores: small ulcers or red spots on the tongue, inside the cheeks, gums, or throat. These are often the most uncomfortable part, making eating and drinking painful
  • Skin rash or blisters: flat or slightly raised spots that can blister, typically on the palms of the hands, soles of the feet, and sometimes the buttocks and legs. They are usually not itchy

The rash tends to be more of a nuisance than painful on the skin, but mouth sores can significantly reduce a child's willingness to eat and drink. Symptoms are generally worst in the first few days and typically resolve completely within a week 2.

How it spreads

HFMD is caused by enteroviruses — most commonly Coxsackievirus A16 and Coxsackievirus A6 in the United States 1. It spreads through:

  • Direct contact with nasal or throat secretions (sneezing, coughing)
  • Contact with fluid from the blisters
  • Stool — the virus can be shed in stool for weeks after symptoms resolve 2
  • Touching contaminated surfaces and then touching the mouth, eyes, or nose

Children are most contagious during the first week of illness 2. Frequent handwashing, especially after diaper changes and before meals, is the most effective way to limit spread. Children may return to school or daycare once they are fever-free, feel well enough to participate, and do not have uncontrolled drooling from mouth sores 1.

Keeping a child comfortable at home

There is no specific antiviral treatment for HFMD — care focuses on managing discomfort and keeping children hydrated 12.

  • Fluids: staying hydrated is the main concern. Cold fluids, popsicles, and cool soft foods may be more tolerable when mouth sores are present. Avoid salty, spicy, or acidic foods that irritate sores
  • Fever and pain: a provider may suggest age-appropriate over-the-counter acetaminophen or ibuprofen to ease discomfort. Never give aspirin to children 2
  • Mouth sores: a provider can suggest safe options for soothing mouth pain in young children; some home remedies marketed for this aren't appropriate for infants
  • Rest: most children recover within seven to ten days with rest

Dehydration is the main risk with HFMD, because mouth pain makes drinking difficult. Watch for signs that fluid intake is dropping significantly.

What parents often ask about nails and skin after HFMD

A small number of children experience nail loss (onychomadesis) in the weeks following HFMD — nails on the fingers or toes can peel, loosen, or fall off. This looks alarming but is generally harmless; the nails typically grow back without any treatment. It is thought to be a temporary disruption in nail growth caused by the viral illness 2.

If this happens, there is usually no need for urgent evaluation, but a provider can confirm the likely cause and advise on care.

Can adults get HFMD?

Adults can contract HFMD, though they often have milder symptoms or none at all 1. Parents and caregivers should wash hands thoroughly after contact with blister fluid, saliva, or stool, and avoid sharing cups, utensils, or towels.

There is no vaccine for HFMD in the United States 1. Pregnant caregivers who develop symptoms or are concerned about exposure should contact their obstetric provider, as some enteroviruses can rarely be transmitted to a newborn around the time of delivery.

Common questions

When can my child go back to daycare or school?

The CDC and AAP recommend children may return once they are fever-free, feel well enough to participate, and do not have uncontrolled drooling from open mouth sores. Policies vary by program — checking with the specific program is the most accurate guidance.

My child won't drink anything because of the mouth sores — when do I worry?

Reduced drinking with HFMD is very common and expected. Watch for signs of dehydration: no wet diapers or very infrequent urination, no tears when crying, a dry mouth, or a child who is much more lethargic than usual. If any of those appear, contact a provider the same day.

Is hand, foot, and mouth disease the same as foot-and-mouth disease in animals?

No — they are completely different viruses. HFMD is a human enterovirus and cannot be spread to or from animals.

Can my child get HFMD more than once?

Yes. Several different strains of enterovirus can cause HFMD, so immunity from one episode doesn't protect against all strains. It is possible — though not very common — for a child to have more than one episode.

Talk to a clinician

Dr. Lena Park — Pediatric NP

kids & families. Gale can match you with a licensed clinician for a visit.

Find care →

When to get care right away

  • —Signs of dehydration: no wet diapers for 8 hours or more, no tears when crying, dry mouth, marked lethargy
  • —Infant under 3 months with any fever of 100.4°F (38°C) or higher — call a provider immediately
  • —Fever that is very high, lasts more than five days, or returns after going away
  • —Child is difficult to wake, very lethargic, or not responding normally
  • —Stiff neck or sensitivity to light alongside fever
  • —Breathing that seems fast, labored, or unusual
  • —Seizure at any point

If a child has a seizure, cannot be woken, has a stiff neck with fever, or is having trouble breathing, call 911 or go to an emergency room immediately.

This article is general health information for parents and caregivers — not a diagnosis or treatment plan for any individual child. A pediatric provider is the right resource for any questions about a specific child's illness.

References

  1. 1.Centers for Disease Control and Prevention (2024). About Hand, Foot, and Mouth Disease. CDC — National Center for Immunization and Respiratory Diseases. link ✓HFMD common in children under 5; no US vaccine available; coxsackievirus A6 and A16 as leading US causes; return-to-school guidance; handwashing for prevention
  2. 2.American Academy of Pediatrics (2024). Hand, Foot & Mouth Disease: Symptoms, Treatment & Prevention. HealthyChildren.org. link ✓Symptom progression and timeline (worst in first days, resolves within a week); virus shed in stool for weeks; acetaminophen or ibuprofen for pain; never give aspirin to children; nail loss as post-HFMD sequela

2 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.