Hand, Foot, and Mouth Disease in Babies & Toddlers
Content reviewed against published CDC, AAP, CDC guidelines
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Hand, foot, and mouth disease (HFMD) is a common and highly contagious viral illness most often caused by Coxsackievirus A16 or Enterovirus 71. It causes painful sores in the mouth and a rash with blisters on the hands, feet, and sometimes buttocks. It is most common in children under 5 and spreads rapidly in daycare settings.
Key takeaways
- Hand, foot, and mouth disease (HFMD) is a common and highly contagious viral illness most often caused by Coxsackievirus A16 or Enterovirus 71.
- Duration: Fever lasts 2-3 days. Mouth sores heal in 5-7 days. Skin rash resolves in 7-10 days. Nail changes may appear 4-8 weeks later.
- Go to ER if: Signs of dehydration — no tears, dry mouth, no wet diaper for 6+ hours, sunken fontanelle
- No vaccine currently available
Symptoms
How It Presents by Age
0-6 months
Less common in very young infants due to maternal antibodies. When it occurs, mouth sores may cause significant feeding difficulties. Watch closely for dehydration.
Risk level: Moderate
6-12 months
May present primarily with fever, irritability, and refusal to eat or drink. Rash may be mistaken for other conditions. Drooling significantly increased.
Risk level: Low to moderate
1-3 years
Classic presentation with mouth sores, hand/foot rash, and fever. Peak age group. Often caught at daycare. Most refuse to eat due to mouth pain.
Risk level: Low
3-5 years
Similar presentation but children can better describe their symptoms. Usually milder with second infections.
Risk level: Low
Treatment
Pain management
Acetaminophen or ibuprofen (6+ months) for mouth pain and fever. Pain control is the most important intervention.
Oral comfort
Cold foods and drinks (popsicles, cold milk, ice chips). Avoid acidic or spicy foods that sting the sores.
Topical relief
Magic mouthwash (mix of Maalox and diphenhydramine) can be applied to sores in older children. Ask your pediatrician for dosing.
Hydration focus
The biggest risk is dehydration from refusal to drink. Offer any fluid the child will accept.
Home Care
- Offer cold foods — popsicles, cold yogurt, smoothies, ice chips
- Avoid citrus, tomatoes, salty, and spicy foods
- Give acetaminophen or ibuprofen 30 minutes before meals
- Offer fluids through a straw or syringe if cups/bottles are refused
- Cold breast milk or formula (refrigerated) may be more soothing
- Rinse mouth with warm salt water (older children)
- Keep blisters clean and uncovered — do not pop them
- Offer soft bland foods (mashed banana, applesauce, pudding)
When to Worry
Go to the ER if:
- Signs of dehydration — no tears, dry mouth, no wet diaper for 6+ hours, sunken fontanelle
- Extremely high fever (over 104°F) not responding to medication
- Stiff neck, severe headache, or excessive sleepiness
- Child unable to swallow saliva (drooling excessively with distress)
- Widespread severe rash with large blisters
- Signs of encephalitis — confusion, seizures, weakness
Call your doctor if:
- Baby under 6 months with suspected HFMD
- Fever lasting more than 3 days
- Child not drinking enough (fewer wet diapers)
- Mouth sores lasting more than 10 days
- Rash looks infected (increasing redness, warmth, pus)
- Child seems more unwell than expected
Keep an eye on:
- Child refusing all fluids for more than 6-8 hours
- Fewer wet diapers than normal
- Fever lasting more than 3 days
- Mouth sores not improving after 7 days
- Rash becoming very widespread or looking infected
Prevention
- Frequent and thorough handwashing, especially after diaper changes
- Disinfect shared surfaces and toys
- Avoid sharing cups, utensils, and towels
- Keep infected children home from daycare during the fever phase
- Teach children to cover coughs and sneezes
- Good diaper hygiene — handwashing after every change
Contagion & Incubation
Incubation
3-6 days
Contagious for
Most contagious during the first week of illness, but virus can be shed in stool for weeks after symptoms resolve
Duration
Fever lasts 2-3 days. Mouth sores heal in 5-7 days. Skin rash resolves in 7-10 days. Nail changes may appear 4-8 weeks later.
Frequently asked questions
How long does hand, foot, and mouth disease 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 is a viral illness that typically resolves on its own. Seek emergency care if signs of dehydration — no tears, dry mouth, no wet diaper for 6+ hours, sunken fontanelle.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.