Hand, Foot, and Mouth Disease in Children
Content reviewed against published CDC, AAP, AAP guidelines
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Hand, foot, and mouth disease (HFMD) is a common, highly contagious viral illness primarily caused by Coxsackievirus A16 and Enterovirus 71. It causes painful sores in the mouth and a characteristic rash with blisters on the hands, feet, and sometimes the buttocks and legs. It is most common in children under 5, with outbreaks peaking in summer and early fall. HFMD is generally mild and self-limiting but can cause significant discomfort.
Key takeaways
- Hand, foot, and mouth disease (HFMD) is a common, highly contagious viral illness primarily caused by Coxsackievirus A16 and Enterovirus 71.
- Duration: Fever lasts 2-3 days. Mouth sores heal in 5-7 days. Skin rash/blisters resolve in 7-10 days. Fingernail/toenail shedding may occur 4-8 weeks later but is harmless and temporary.
- Go to ER if: Signs of significant dehydration (no urine for 8+ hours, no tears)
- No vaccine currently available
Symptoms
How It Presents by Age
0-6 months
Can occur but less common. May present with fever, irritability, feeding refusal, and oral blisters. Rash distribution may be atypical. Monitor closely for dehydration.
Risk level: Low to moderate
6 months-2 years
Very common age group. Fever followed by painful mouth sores causing drooling and food refusal. Blisters on hands and feet may be subtle. Diaper area rash common. Dehydration risk from poor intake.
Risk level: Moderate — dehydration risk
2-5 years
Peak age group. Classic presentation with mouth ulcers and rash on hands, feet, and buttocks. May have widespread atypical rash in some strains. Can describe pain.
Risk level: Low to moderate
5-10 years
Less common but still occurs. Usually milder. Can present with just mouth sores or just skin rash. Nail shedding may occur 4-8 weeks after illness.
Risk level: Low
Treatment
Pain management
Acetaminophen or ibuprofen (6+ months) for fever and pain from mouth sores. Give 20-30 minutes before meals to facilitate eating.
Hydration
Cold fluids, popsicles, and ice chips to soothe mouth pain while maintaining hydration. Avoid acidic or salty foods. Priority is preventing dehydration.
Topical oral relief
Oral numbing agents for older children. Avoid benzocaine in children under 2. Cool foods and liquids provide natural numbing.
Skin care
Blisters on hands and feet typically do not require treatment. Keep clean and dry. Do not pop blisters. Calamine lotion if itchy.
Home Care
- Offer cold foods and drinks (popsicles, smoothies, cold milk)
- Avoid acidic, salty, or spicy foods
- Give soft, bland foods when child is willing to eat
- Use a syringe for small frequent amounts of fluid in reluctant drinkers
- Monitor wet diapers (at least 3-4 per day)
- Keep blisters clean — do not pop them
- Wash hands frequently, especially after diaper changes
- Honey (over 1 year) in cool water may soothe mouth sores
When to Worry
Go to the ER if:
- Signs of significant dehydration (no urine for 8+ hours, no tears)
- Difficulty breathing
- Seizure
- Extreme drowsiness or child cannot be aroused
- Severe headache with vomiting and stiff neck (meningitis risk with EV71)
- Very young infant (under 2 months) with fever
Call your doctor if:
- Suspected HFMD with significant mouth pain affecting intake
- Fever lasting more than 3 days
- Decreased wet diapers or signs of mild dehydration
- Child under 6 months with suspected HFMD
- Blisters appearing infected
- Widespread or unusual rash pattern
Keep an eye on:
- Unable to drink any fluids for more than 12 hours
- Signs of dehydration (dry mouth, no tears, sunken eyes)
- High fever (104°F+) or fever lasting more than 3 days
- Blisters becoming red, swollen, or oozing pus (secondary infection)
- Extreme lethargy or difficulty waking
- Headache with stiff neck and high fever
Prevention
- Frequent handwashing with soap and water
- Disinfect frequently touched surfaces and shared toys
- Avoid close contact with infected individuals
- Do not share cups, utensils, or towels
- Proper diaper hygiene and handwashing after changes
- Keep sick children home from daycare during acute illness
- Teach children to cover coughs and sneezes
Contagion & Incubation
Incubation
3-6 days after exposure
Contagious for
Most contagious during the first week of illness. Virus can be shed in stool for weeks to months after recovery. Respiratory shedding typically 1-3 weeks.
Duration
Fever lasts 2-3 days. Mouth sores heal in 5-7 days. Skin rash/blisters resolve in 7-10 days. Fingernail/toenail shedding may occur 4-8 weeks later but is harmless and temporary.
Frequently asked questions
How long does hand, foot, and mouth disease in children last?
How does hand-foot-and-mouth disease (hfmd) spread?
When should I take my baby to the ER?
Can hand-foot-and-mouth disease (hfmd) be prevented?
When can my child return to daycare?
Sources
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources
Related Illnesses
Bottom line
Hand, Foot, and Mouth Disease in Children is a viral illness that typically resolves on its own. Seek emergency care if signs of significant dehydration (no urine for 8+ hours, no tears).
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.