Hand, Foot and Mouth Disease (HFMD)

Hand, foot and mouth disease (HFMD) is a very contagious and common viral illness in children that causes a low fever, skin rash and painful mouth sores. It's very common before age 10, but you can catch it at any age.

HFMD gets its name because symptoms are usually easiest to see on the hands, feet and mouth. Most of the time, it’s not serious and will go away on its own within one to two weeks. Around 1 in 8 children who get it never show symptoms.

Even after symptoms fade, HFMD can remain contagious for several weeks. It also spreads quickly. That’s why children can get it so easily in day cares, schools and other childcare settings. And because more than one virus can cause it, you can get it more than once.

What are the symptoms of hand, foot and mouth disease?

HFMD symptoms usually start within a week of catching the virus. The symptoms come in two stages.

The first stage causes vague viral illness symptoms that last a couple days. These include:

• Low fever, usually between 100.4 and 102.2 degrees Fahrenheit (38 to 39 degrees Celsius)
• Feeling tired or unwell
• Sore mouth and throat
• Runny nose
• Stomachache
• Loss of appetite

After a couple days, symptoms often change. They may include:

• Mouth sores: These start as small, red spots in your child’s mouth that turn into small sores. Fluid from these can spread the virus. The sores usually form on your child’s tongue, gums, inner cheeks and the roof of their mouth.
• Skin rash: This happens in 3 out of 4 cases and starts with small, blister-like bumps. These usually form on your child’s hands and feet (especially palms and soles), genitals and buttocks. The rash may hurt (but usually doesn’t on the palms and soles), but it doesn’t itch.
• Swollen lymph nodes: These are usually nodes on your child’s neck or under their jaw.

Most skin symptoms of HFMD usually last about one to two weeks. Some skin peeling on your child’s hands or feet can happen after a couple weeks, but it’s nothing to worry about.

In some cases, older children and adults who catch a virus that can cause HFMD may not show any symptoms.

Hand, foot and mouth disease causes

HFMD is a viral illness, but there’s more than one virus that can cause it. Some viruses are more likely to cause certain symptoms. And there are specific viruses that are more likely to cause severe illness.

The four main viruses that can cause HFMD include:

• Coxsackievirus A16: This is the first virus that scientists confirmed as a cause of HFMD. It’s still one of the most common causes.
• Enterovirus A71: This is another very common cause of HFMD. It's also more likely to cause severe complications, especially ones that affect your nervous system. Cases of this virus mainly happen in Asia.
• Coxsackievirus A6: This strain is more skin-focused, and the rash from it is usually more widespread. It may also cause fingernail complications. This virus is relatively new. Adults who had HFMD before can get it again from this virus because they aren’t immune to it.
• Coxsackievirus A10: This strain is becoming more common. It can cause severe complications, like viral meningitis. It’s more common in Europe and Asia.

Several other viruses can also cause HFMD, but they’re a lot less common. They’re usually types of coxsackievirus, enterovirus or echovirus. Some of the viruses listed above can also cause a similar and related condition called herpangina. Some of these viruses can also cause widespread rashes and fevers, without the classic hand, foot and mouth symptoms.

Is hand, foot and mouth disease contagious?

Yes, the viruses that cause HFMD are extremely contagious. They usually spread in certain ways, like:

• Fecal-oral route (most common): Your child can get the virus through their digestive tract. In there, the virus makes more of itself, and a lot of it ends up in your child’s poop. From there, the germs can travel on your child’s hands to surfaces, objects or your own hands. If those germs end up in your mouth somehow, they can get to your digestive system and give you HFMD.
• Fluids from sores and blisters: If you touch fluid from HFMD skin blisters or mouth sores, the virus can spread to you.
• Respiratory fluids: Coughing, sneezing or just talking can send droplets of fluid — which are too tiny to see — into the air. You can get HFMD if you inhale these droplets.

Risk factors

Babies and children under the age of 5 are most likely to get hand, foot and mouth disease. Infants and children in daycare and schools are more likely to get it. Other risk factors include:

• Being around children: Viruses that cause HFMD spread more easily around children. That puts teachers, childcare workers and families with young children at higher risk.
• Shared space: Living together in larger groups, like in dormitories (college, military, summer camp, etc.), makes it easier to catch HFMD.
• Season: Most cases of HFMD happen in summer and fall. But certain strains don’t follow that trend. Coxsackievirus A6 is an example, as it spreads HFMD in the winter, too.

Complications of hand, foot and mouth disease

HFMD usually doesn’t cause complications. But some strains are more likely to lead to serious issues, including:

• Nervous system conditions, like meningitis, encephalitis and seizures
• Heart and lung conditions, like myocarditis, pulmonary edema or pulmonary hemorrhage
• Nail complications, like Beau’s lines or nail loss (losing nails usually happens a month or two later)

How doctors diagnose hand, foot and mouth disease

Healthcare providers can usually diagnose HFMD with a physical exam alone. But they may also run lab tests to rule out other conditions or issues. They may also use lab tests to find out exactly which virus is causing it. That's because other viruses can appear very similar to HFMD and because some viruses have a higher risk of serious complications.

How is hand, foot and mouth disease treated?

There's no direct treatment for HFMD. Treatment focuses on symptoms and complications. Some examples include:

• Fluids to prevent dehydration
• Acetaminophen or ibuprofen for pain and fever (never give children aspirin as a substitute)
• Topical treatments for pain from mouth sores and skin blisters

Treatment may vary based on complications or other factors. Your child’s healthcare provider can tell you more about what to expect.

What can I expect with hand, foot and mouth disease?

Hand, foot and mouth disease is usually not a dangerous condition. Nearly all children who get it make a full recovery within a week or two. And adults who get it often never show any symptoms.

HFMD typically doesn’t cause long-term effects, either. The skin rash usually doesn’t leave scars, and the mouth sores usually don’t cause lingering issues. For cases that cause nail loss, you can expect your nails to grow back within a month or two.

Serious complications are possible, but they’re rare.

Preventing hand, foot and mouth disease

HFMD is very contagious, but there’s a lot you can do to keep it from spreading:

• Teach and practice good handwashing: Good handwashing is vital to keeping HFMD from spreading, especially after using the bathroom or changing diapers, and before preparing or eating food. Teaching small children good handwashing habits early in life can help, too.
• Cover coughs and sneezes: This limits the airborne spread of the virus. You can also teach children to cover coughs and sneezes (and to wash their hands right after).
• Sanitize items and surfaces: This goes for toys, shared items, tables and counters, doorknobs and more. Change and wash any clothes that have mucus or saliva on them ASAP.
• Keep your hands off your face: Germs can infect you more easily if you touch your face without washing your hands first.
• Keep your distance: If someone you know has HFMD, avoid close contact. That includes hugs, kisses and even handshakes.
• Don’t share certain items: These include toothbrushes, towels, washcloths and other personal items. Don't drink from the same containers or share utensils when eating. Throw tissues away immediately after using them once.

HFMD can still spread through poop for weeks after symptoms end. So, staying vigilant about preventing the spread is still important even when you or your child feel better.