Hand, Foot, and Mouth Disease: What Parents Need to Know Wednesday, July 15, 2015

Lauren Martin, MD, a pediatrician from Children’s Pediatricians & Associates at Foggy Bottom/Capitol Hill, shares the signs and symptoms of hand, foot, and mouth disease, and what you need to know if your child has it.

What is it? 

Hand, foot, and mouth disease (HFM) is an illness caused by coxsackievirus which is spread from person to person. It can affect anybody, but it is most commonly seen in young children. HFM tends to spread more during the summer and fall.

How do I know if my child has it? 

Symptoms can include:

  • Painful mouth and throat sores, that can sometimes be hard to see
  • Drooling (caused by painful mouth and throat sores)
  • Decreased eating and drinking 
  • Rash on the body consisting of small red bumps or fluid-filled blisters, appearing most commonly on hands, feet, and buttocks
  • Low grade fevers (typically less than 102 degrees)

Is it dangerous?

Most children with HFM get better without any complications. The main risk is dehydration as children will often refuse to drink because of the painful mouth sores, but this can usually be managed at home with over-the-counter pain medication. Serious complications, such as meningitis, are rare.

How is it treated?

HFM goes away on its own, and because it is a viral illness, antibiotics will not work. You can, however, treat the symptoms. 

Using the over-the-counter medications acetaminophen (Tylenol®) and ibuprofen (Motrin®/Advil®) to treat and control your child’s pain can be very effective. Ibuprofen can be given to children over 6 months old every six hours, and acetaminophen can be given every four hours. Some children experience the most relief from alternating these medications every three hours (for example, give acetaminophen,  then three hours later ibuprofen, then acetaminophen three hours after that, and so on). 

Do not wake your sleeping child to give medications, but if they wake up uncomfortable, treat them. It is okay if your child does not want to eat much while they are sick, but they do need plenty of fluids. Cold fluids often feel the best on sore throats.  Avoid citrus and salty foods. The rash is usually not bothersome and does not typically need any topical treatments.

When should I call my child's primary care provider?

If you are worried, you are never wrong to call or make an appointment with your child's provider. Call your pediatrician immediately if your child:

  • Is dehydrated: look for dry lips and mouth or decrease in urine output (your child should make urine at least every six hours)
  • Is listless or you are concerned about how sick your child looks, especially if he/she does not perk up after a dose of ibuprofen or acetaminophen
  • Has a stiff neck
  • Has a fever of more than 105 degrees, a fever that lasts more than two to three days, or is under 3 months old with a fever of more than 100.3

How long is my child contagious?

Children are most contagious at the beginning of the illness. Although viruses may last longer, children can go back to childcare once the fever has been gone for 24 hours and they don't have open sores. I typically recommend waiting to return to childcare until after the rash stops spreading, but it does not have to be completely gone. The rash will slowly fade over the course of a week or so. Hand washing and disinfecting surfaces and shared objects are the best ways to help prevent transmission.



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