“I’m Only Human” #003: Hand, Foot & Mouth
Hand, foot, and mouth disease is a common viral illness of infancy and young childhood. It is typically mild and resolves with time, though for some it can cause dehydration and secondary skin infections.
#003: Hand, Foot & Mouth
Welcome back and thank you for being here! “I’m Only Human” is Little Spuds Pediatrics educational series designed just for parents. Here, you will receive all the bullet point details you need to know about the very common, very contagious viral illness of infancy & childhood called hand, foot, and mouth disease (HFMD).
Quick Facts: HFMD
A viral illness common in infants and children under 7 that causes painful red blisters in the mouth, on the soles of the hands, palms of the feet and in the diaper area
Caused by the coxsackievirus
Occurs less commonly in teens and adults
Most often occurs during the summer and fall, though can occur any time of the year
Spreads easily in places where kids gather such as daycares, schools, summer camps and households
Spreads through: direct contact with the rash or contact with stool, saliva, and respiratory secretions (sneezing, coughing, runny nose)
Incubation period typically 3-5 days after exposure
Sores begin resolving in 3-4 days and typically lasts no more than 7-10 days
Most infectious during the first week of illness, though the virus can shed for weeks to months in the stool and 1 - 3 weeks in respiratory secretions
Symptoms include:
painful small raised red bumps that may or may not look like a blister on the palms and soles. The bumps often spread over onto the sides/tops of the hands and feet. Over 7-10 days, the bumps evolve from small 3-5mm bumps to a blister appearance, to an open blister, to a scab and then heal
small ulcerations/sores on the tongue & inside of the cheeks, sometimes around the lips on the face
some infants & children will develop a sudden onset fever: temperature >100.4F or higher
sometimes kids will also have ulcerations/sores in the back of the throat (herpangina)
sometimes the rash will also be in the diaper/genital area
sometimes kids will have vomiting, diarrhea and stomach pain, though this is less common
There is no special test required to diagnose, it is easily identified on examination
Does not require specific medication to treat, typically resolves on its own with supportive care
Complications
Common complications can include:
dehydration because the mouth sores are painful and it hurts to drink
secondary skin infections from scratching the sores on the skin surface and introducing bacteria
Less common complications specific only to certain HFMD strains can include:
nail loss 1-2 months after infection
palm/sole skin peeling 1-3 weeks after infection
more extensive skin involvement (all over the body and bigger blisters/sores with a purple color)
children with eczema may get a more severe form
severe illness with neurologic involvement
Treatment & Home Care
Does not require treatment with antiviral medication and typically resolves with supportive care in 7-10 days.
Supportive care at home includes: pain & fever medication & good hydration
acetaminophen (tylenol) & ibuprofen (motrin) can help reduce pain and encourage drinking
cold drinks, ice cream & popsicles may help soothe a painful mouth
soft foods like pudding and jello may be less painful to eat
Prevention
Alcohol based hand sanitizers may not be 100% effective so the best way to prevent spreading HFMD is good handwashing with soap and water after using the bathroom, after changing diapers, before eating and after direct contact with the rash or respiratory secretions
Shared surfaces and toys infected children touch should be disinfected
Avoid sharing food, drinks, utensils, linens and bath towels
Open sores should be covered if possible until they crust over
Return to School
Children may return to school when:
the fever has been gone for 24 hours without use of fever-reduction medications
the child feels well enough to participate in regular activities
open, weeping sores and excessive drooling may further exclude some infants and young children from attending daycare or school
Signs Your Child Needs Re-Evaluation:
they are not beginning to improve as expected in 2-3 days
their symptoms are getting worse
they are developing new, unexpected symptoms
they have signs of dehydration: they are not drinking well and have not peed in 6-8 hours
they have signs of a skin infection: deep red areas around sores that continue to get larger with or without creamy, yellow, green or brown drainage
Summary
HFMD is a common viral illness of childhood that typically resolves with supportive care in 7-10 days. The illness is very contagious, but preventable with good hand washing and adequate disinfection practices. Common complications can include dehydration and skin infections. Treatment includes pain management, good hydration, and monitoring for the need to return for additional medical evaluation when symptoms worsen, there are signs of dehydration, signs of a skin infection, or the child is not behaving normally. Worried your child may need an evaluation? Book a visit with Little Spuds HERE to have your child’s acute illness evaluated in the comfort of home.
**Information in this article not intended to be direct medical advice, for general educational purposes only.**
References
Romero, J. R., Edwards, M. S., & Blake, D. (2024, June 27). Hand Foot Mouth Disease and Herpangina. UpToDate. https://www.uptodate.com/contents/hand-foot-and-mouth-disease-and-herpangina?search=hand+foot+mouth&source=search_result&selectedTitle=1~32&usage_type=default&display_rank=1#H456270631
Shope, T. R., & Aronson, S. S. (2020). Managing infectious diseases in child care and schools: A quick reference guide. American Academy of Pediatrics.
Washington State Department of Health. (2024). Infectious Disease Control Guide for School Staff: Washington State. Washington State Department of Health.