Many parents may be unfamiliar with hand, foot, and mouth disease, but it’s actually very common among young children. The good news is that it’s typically mild, and it can be easy to treat and prevent. However, hand, foot, and mouth disease may cause parents and caregivers to worry and perhaps even cringe a bit. But why exactly?
It’s a highly contagious viral disease that predominantly affects children age five and under, but it can also affect older children and adults. The most common symptom is a rash in the mouth, and on the hands and feet. Other common symptoms include fever, painful sores and ulcers, muscle aches, dehydration due to painful swallowing, general fussiness from discomfort, and in some cases diarrhea and gastrointestinal problems. It’s known to spread rapidly, especially in daycare centers and schools, and it causes great pain and discomfort for kids.
Carolina Pombar, MD
In this Q&A, Carolina Pombar, MD, a pediatrician and Assistant Professor, Icahn School of Medicine at Mount Sinai, explains what causes hand, foot, and mouth disease, how long it’s contagious, and tips for prevention.
What causes hand, foot, and mouth disease?
It’s caused by a group of viruses referred to as enteroviruses. The most common cause is the Coxsackie A6 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, a child can get the virus more than once. Adults may not be immune to the virus, so as a result, children can transmit it to their parents and caregivers.
How does it spread?
The virus is spread easily through:
- Person-to-person contact with droplets when an infected person talks, coughs, or sneezes. These droplets can land on objects or be rubbed into eyes, nose or mouth. These droplets do not stay in the air (like COVID-19) and do not travel more than three feet.
- Touching skin lesions (kissing, hugging) or coming into contact with objects and surfaces that have been contaminated.
- Coming in contact with an infected person’s poop, such as changing diapers, and then touching the eyes, nose, or mouth.
- Touching objects and surfaces that have the virus on them, like doorknobs or toys, and then touching your eyes, nose, or mouth.
What are the signs and symptoms of hand, foot, and mouth disease?
The signs and symptoms include:
- Fevers
- Rashes appear like red pimples that can transform into blisters mainly on the palms/between fingers/feet and around the mouth. Other common places are knees and elbows and diaper area. Children who have eczema are more susceptible and can have a more widespread and aggressive rash. Rashes normally scab over and heal without scarring, although some discoloration where the spots where can last for some time.
- Mouth sores, similar to cold sores that you can see, can develop inside the mouth and tongue but mainly at the back of the throat. This can worsen appetite due to discomfort, so dehydration is a concern in a child who cannot tolerate fluids orally.
- Diarrhea can occur before, during, or after the skin rash appears.
- Nail shedding and loss of nails can occur weeks to a few months after onset. While alarming, this is not painful or dangerous, and the nails regrow on their own.
How do you treat hand, foot, and mouth disease?
There is no specific treatment for the virus. It needs to run its course, and this normally takes 7 to 10 days. Here are some suggestions about how to treat the symptoms in kids:
- For fevers and discomfort, over-the-counter medicines like acetaminophen and ibuprofen can be used. (Note: Aspirin should not be used in children.)
- It’s important to drink plenty of fluids to prevent dehydration. Cold foods like ice cream, smoothies, and popsicles also help by numbing the area in the mouth. Soft foods like yogurt, pudding, and mashed potatoes can help, and these all can be a nice treat for kids who have trouble swallowing. Avoid hot drinks, sodas, and acidic juices or foods because they can make the pain worse.
- Get plenty of rest.
- If mouth sores are particularly bothersome, ask your doctor for treatments that may ease discomfort like lidocaine gel or magic mouthwash (usually not used in kids younger than 6 years of age).
- For skin rashes, a physician may recommend moisturizers. Symptoms do get better within 7 to 10 days for most people. Children with blisters on their hands or feet should keep the areas clean and uncovered. Wash the skin with lukewarm soap and water, and pat dry to keep it clean. If a blister pops, dab on a bit of antibiotic ointment to help prevent infection, and cover it with a small bandage.
- Try to stay as comfortable as possible, and prevent transmission by washing hands and using good hand hygiene.
How do you prevent hand, foot and mouth disease?
There are some steps you can take to prevent this condition. These include:
- Wash hands with soap and water often.Hand washing is especially important after using the toilet, after changing diapers or potty training, before and after eating, and before preparing food.
- Keep hands away from the eyes, nose, and mouth.
- Avoid close contact with anyone who has it.
- Disinfect surfaces if an infected person came in contact with them.
When can my child return to school or daycare?
A child can return to school if:
- There is no fever for 24 hours
- There are no new skin lesions or open blisters (most lesions should be scabbing over).
- They appear well enough and active.
When should I call my doctor?
You should call the doctor if:
- Your child is not able to drink normally and you’re worried they might be getting dehydrated (very sluggish, urine less than three times a day, sunken eyes).
- The fever lasts longer than three to four days.
- Symptoms do not improve after 10 days.
- Your child has a weakened immune system (body’s ability to fight germs and sickness).