Hand, Foot and Mouth Disease: Everything Parents Should Know

Why Hand, Foot & Mouth Doesn't Necessarily Mean a Trip to the Doctor

Hand, foot and mouth disease may cause every parent of an infant or toddler to cringe. It spreads like wildfire through daycares and causes little ones discomfort. Pediatrician Scott Oelberg, DO, UnityPoint Health, explains what causes hand, foot and mouth disease, how long it’s contagious and why your child might have to deal with it more than once.

What is Hand, Foot and Mouth Disease?

Hand, foot and mouth disease is a viral illness typically causing small, painful sores or ulcers.

“Hand, foot and mouth is caused by a group of viruses, referred to as enteroviruses. The most common cause is the Coxsackie A16 virus, but other strains of Coxsackie virus, as well as other enteroviruses, can cause the illness. When there is an outbreak of hand, foot and mouth disease, there may be more than one type of virus circulating. Since there are different strains of the virus, it’s possible to get the virus more than once, even in the same season,” Dr. Oelberg says.

Who Can Get Hand, Foot and Mouth Disease?

Dr. Oelberg says hand, foot and mouth typically impacts children ages 6 months to 4 years.

“While it’s most common in young children, adults and older children can get the virus, too. Most often, hand, foot and mouth symptoms in the older age groups are the same but milder than the symptoms babies and toddlers experience. In some cases, adults can contract the virus without showing any symptoms,” Dr. Oelberg says.

As with any adult, individuals who are pregnant may contract the virus. If you’re expecting, it’s best to contact your doctor if you think you have the virus, or you’ve been exposed. Complications are rare, but possible.

Stages and Symptoms of Hand, Foot and Mouth

Providers look for a few main symptoms when diagnosing hand, foot and mouth. Dr. Oelberg says there is a typical progression the illness follows.

  • Fever. This virus may first show as a temperature (usually 101 or 102°F) for one to two days.
  • Mouth sores. After a day or two of fever, sores usually appear in the back of the mouth, but may also be on the gums, tongue and inner lips. This may cause children to be fussy and refuse to eat or drink because their mouth hurts. Some children may drool more because it hurts to swallow. In some children, the hand, foot and mouth disease symptoms stop here. This is referred to as “herpangina.”
  • Skin Rash. Over the next day or so, spots may appear elsewhere on their hands, feet, elbows, knees and bottoms. The rash may be tiny, flat and barely noticeable, or they may be more raised with opening blisters. nullSome children may have many spots on hands and feet with blisters that are a bit painful, whereas other children will have only tiny red spots that aren’t painful. These spots are usually not itchy.

“If the rash has fluid-filled blisters, beware that the fluid may contain the virus. Make sure to keep the blisters or scabs clean and avoid touching them to reduce the spread of the virus,” Dr. Oelberg says.

How Does Hand, Foot and Mouth Spread?

The virus that causes hand, foot and mouth is found in:

Dr. Oelberg says children can get the virus through personal contract or when they touch something, like a toy, with infected saliva, and then the child puts that object to his/her nose or mouth. That’s why frequent hand washing is important, as is disinfecting surfaces and toys.

“Hand, foot and mouth disease is more common during the spring through fall, however, it can occur any time of the year. I’m not sure why this is, but I can only reason that the virus prefers more moderate temperatures,” Dr. Oelberg says.

One distinction: hand, foot and mouth disease in humans is not related to the hoof and mouth disease that cattle and other livestock can contract.

How Long is Hand, Foot and Mouth Contagious?

Hand, foot and mouth is contagious and spreads easily through families and daycares. It also usually takes three to six days after exposure to the virus before your child starts showing symptoms.

“Children are usually considered contagious two days before the rash appears and until two days after the rash goes away,” Dr. Oelberg says.

How Long Does Hand, Foot and Mouth Last?

Dr. Oelberg says the virus usually runs its course in about a week, with mouth sores usually healing a little earlier than the sores on the hands and feet, which can last around 10 days.

“Since the illness is generally harmless, and because it’s very difficult to prevent the spread of this virus once it has started, it isn’t practical or necessary to isolate children for the duration of the illness.
Children should be able to return to daycare or school once their fever has resolved. I recommend following the guidelines set by your child’s daycare or school for returning after an illness. Those rules are usually to be fever-free for 24 hours,” Dr. Oelberg says.

Hand, Foot and Mouth Disease Testing and Treatments

Usually doctors can diagnose the illness by simply looking at the blisters. Rarely, your care team will perform a test by gathering samples from the throat, blisters or stool to send to the lab. Testing is rare, however, since identification of the virus won’t change treatment plans. Since this is a viral illness, antibiotics won’t help.

“The good thing is your body’s immune system responds to the virus and fights it off without any help. The most common problem children experience is dehydration because it hurts for them to swallow, and they refuse to eat or drink,” Dr. Oelberg says.

There is a sort of hand, foot and mouth disease home remedy you can try to help ease discomfort. Dr. Oelberg calls it a “magic mouthwash.”

  • Liquid Benadryl (or similar antihistamine)
  • Liquid Maalox (or similar antacid)

Instructions: Mix the Benadryl and Maalox in equal parts, and dab on sores in your child’s mouth. You could also have your child swish with the “magic mouthwash” and spit in the sink. It’s OK for them to swallow small amounts, as long as the dose of Benadryl is appropriate for their age/weight.

Can You Lose Fingernails from Hand, Foot and Mouth?

According to the Centers for Disease Control and Prevention (CDC), one rare complication of hand, foot and mouth is the loss of fingernails or toenails a few weeks after recovering from the virus. Most reports of fingernail or toenail loss is in children, but it’s possible in adults, too. The nail usually grows back on its own.

4 Warning Signs for Hand, Foot and Mouth

Although hand, foot and mouth in children is typically a mild illness, there are four warning signs to watch for to know it’s time to call the doctor.

  • Fever lasting longer than three days.
  • Your child complains of a stiff neck.
  • You child is acting very sick or seems extremely sleepy.
  • Your child has not urinated in eight hours.

Dr. Oelberg advises all parents to call their doctor’s office any time they have a question or concern about their child.


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