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

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Baby Crying
Hand, foot and mouth disease may cause every parent of an infant or toddler to cringe. It spreads like wild fire through daycares and causes little ones some 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 in a child’s mouth,” Dr. Oelberg says.

Dr. Oelberg says it typically impacts children ages 6 months to 4 years. The virus is found in:
  • Saliva
  • Nasal secretions
  • Feces
  • Fluid in blisters
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 at 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.

Hand, Foot and Mouth Symptoms & Progression

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. In some children, the hand, foot and mouth disease symptoms stop here. This is referred to as “herpangina.”
  • Body spots. Over the next day or so, spots may appear on their hands, feet, elbows, knees and bottoms. The spots on their skin may be tiny, flat and barely noticeable, or they may be more raised with opening blisters. Some 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.
“Children may seem fussy, more tired and refuse to eat or drink because their mouth hurts. Some children may drool more because it hurts to swallow,” Dr. Oelberg says.

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 is very difficult to prevent the spread of this virus once it has started, it is not 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.

Can You Get Hand, Foot and Mouth Twice?

Dr. Oelberg says you can get the virus more than one time, even in the same season. 

“It 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,” Dr. Oelberg says.

While it’s most common in young children, Dr. Oelberg says adults and older children can get the virus, too. Hand, foot and mouth symptoms in adults and older children are the same as the symptoms babies and toddlers experience, however, they’re often milder in the older age groups.

Hand, Foot and Mouth Disease Treatments

Dr. Oelberg says since this is a viral illness, antibiotics aren’t effective in treatment. 

“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 you child swish with the “magic mouthwash” and spit in the sink. It’s okay for them to swallow small amounts, as long as the dose of Benadryl is appropriate for their age/weight.

4 Warning Signs of 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.