Hand, foot and mouth disease

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 15, 2016
StartDiseasesHand, foot and mouth disease

Hand, foot, and mouth disease (HFMD) is caused by a virus that results in sores appearing in the mouth, on the hands, feet, and sometimes the buttocks. It usually occurs in children under age five but can appear in adults. Since it is easily spread, whole groups, such as students at a daycare or school, often come down with the disease.


Definition & Facts

HFMD is caused by a special type of virus called an enterovirus. This enterovirus is an RNA virus that occurs in the gastrointestinal tract, but it causes sores in the mouth and on body extremities.

Outbreaks of HFMD seem to occur most often in the warmer months of the year. Most children with the condition recover within a week or two and have no lasting health complications. A few cases, however, can become severe, requiring hospitalization and may even lead to death.

Symptoms & Complaints

A child who comes in contact with another child who is carrying this disease may also develop symptoms after three to six days. The first sign that a child has contracted this disease may be a fever of 101 degrees Fahrenheit to 103 degrees Fahrenheit. The child may complain of a sore throat, have a poor appetite, and generally feel unwell. At first, these symptoms may seem to be any other virus or flu. This can last for a day or two before other symptoms begin to occur.

Next, painful sores will begin to pop up in the mouth and the throat. After mouth sores, hands and feet will develop a rash and then blisters that will pop and crust over. In more severe cases, sores may also appear on the buttocks and the legs. When an adult contracts HFMD, the symptoms are usually much milder. There may be no fever, and there may only be a few sores.


HFMD is caused by a virus. The Coxsackievirus is the culprit and it is in the enterovirus family of viruses which also includes viruses that cause diseases like hepatitis A and polio. It lives in the digestive system of humans and is easily transmitted via body fluids. In particular, the stool, saliva, nasal discharge, and the fluid in the blisters are the main sources. Thus, when a child touches any of these body fluids and then touches other surfaces, the disease can quickly spread.

For example, when a child is in diapers or potty training, and he touches his stool, it can be spread to toys and other objects. The virus can live on surfaces for several days. Additionally, when a child sneezes or scratches a blister and breaks it open, the virus can also be spread. Since children are often putting their hands in their mouths, they cause further spread of the disease because they may have touched an infected child or something that child has touched.

Though an infected child is most contagious during the first week of being ill, the virus can remain in the system for weeks or months after the child gets well. This means that they can still infect other children with their body fluids even though they no longer show any signs of the disease.

Diagnosis & Tests

At the start of this disease, it may be difficult to tell that a child has HFMD because the originating symptoms are often mistaken for a simple flu. As the rash and blisters begin to appear, however, diagnosis can be performed visually. A doctor can visually inspect the blisters and use the presenting symptoms to diagnose HFMD.

If the diagnosis is unclear for any reason, a throat swab culture or stool sample may be taken. A culture can be done on either of these samples to positively identify the virus. It will take three to six days for the virus to incubate before a culture can be read.

Treatment & Therapy

Because the virus will usually clear up by itself when given time, treatment revolves around alleviating the discomfort and pain as well as relieving fever. A child can be given acetaminophen or ibuprofen to bring the fever down and to alleviate some of the pain caused by the blisters.

Some doctors may recommend topical creams or ointments to help alleviate the pain of the blisters. In addition, warm baths can help soothe the blisters on the body extremities. Children should be given lots of fluids to prevent dehydration, but cool liquids may also make the mouth and throat feel better.

An over-the-counter or prescription syrup, lozenge or spray may be advised to help ease sore throat or mouth pain. Ice pops and ice cream may also help with throat and mouth pain. Avoid any spicy, salty, or acidic foods or drinks such as lemonade, orange juice, or salsa. Rinsing the mouth with warm water, or salt water for those who know how to swish and spit, may also help ease the mouth pain.

The child should feel completely well after seven to ten days of rest and the alleviation of symptoms. If symptoms seem to get worse or do not improve, a doctor should be contacted. Additionally, if the child develops a fever over 102 degrees Fahrenheit, confusion, or neck pain, a doctor should be consulted immediately as these could signal more severe infection that could lead to encephalitis or viral meningitis, both rare but serious conditions.

Prevention & Prophylaxis

There are no immunizations to prevent HFMD. The best way to prevent the spread of the disease is to wash hands properly and often. Hands should always be washed after using the toilet and before eating. In addition, children can be taught to wash hands after sneezing or coughing on them or after touching the blisters.

Isolating the infected child from other children can help avoid the spread of the disease. Since the disease can be spread even after the child is well, all people caring for the child, especially in a daycare or school setting, should be reminded about the importance of frequent hand washing.