Hand, foot and mouth disease can feel like it arrives out of nowhere: a child who was playing happily in the evening suddenly wakes up cranky, feverish, and refusing even favourite foods. Then come the mouth sores. Then the spots. In India, where daycares, playgroups, and joint-family homes mean lots of close contact, hand, foot and mouth disease spreads quickly.
Most of the time, hand, foot and mouth disease is mild and self-limited. Still, it can be intensely uncomfortable, and dehydration can creep up fast when swallowing hurts. Parents usually want clear answers: what is normal, what needs a doctor, and what to do if someone is pregnant at home.
Hand, foot and mouth disease symptoms: what parents often notice first
Many parents spot a child who seems off: low energy, clingy, irritable, not eating well. A low to moderate fever often comes first, and the mouth-and-skin pattern follows over the next day or two.
Early signs in the first 1–2 days
- Fever, sore throat, runny nose, and reduced appetite may look like any viral cold initially.
- Toddlers may be unusually fussy, sleep poorly, or reject usual meals.
- Babies may feed less, drool more, or cry during feeds because swallowing hurts.
Mouth symptoms: sores that make drinking hard
- Small red spots can turn into painful mouth ulcers (tiny breaks in the lining of the mouth) on the tongue, gums, inner cheeks, and sometimes the palate.
- Pain can feel worse than the number of sores suggests, each sip can sting.
A question to ask yourself: is the child refusing fluids because of pain, or just being picky? With hand, foot and mouth disease, pain is often the main barrier.
Skin symptoms: rash and small blisters on hands and feet
- The typical rash starts as red spots and may become small fluid-filled vesicles (blisters).
- Common locations are palms and soles, some children also get spots on the buttocks, legs, wrists, knees, or around the mouth.
- With certain strains (especially Coxsackie A6), the rash can be more widespread and look dramatic.
Symptom timeline: what can change day by day
- Days 1–2: fever, sore throat, low energy, reduced appetite.
- Days 2–4: mouth ulcers become prominent, rash/blisters appear.
- Days 4–7: fever typically settles, mouth pain slowly improves.
- Days 7–10: most children are near baseline, skin may look dry or flaky while healing.
What hand, foot and mouth disease is (and what it is not)
Hand, foot and mouth disease (HFMD) is very common in early childhood. It spreads easily in close-contact settings, but in most children it resolves on its own.
A common viral illness in young children
Hand, foot and mouth disease is a viral illness caused by enteroviruses. It is most common in children under 5 because they have not built immunity yet and they frequently put hands and toys in their mouths.
HFMD vs foot-and-mouth disease in animals
Despite the similar name, hand, foot and mouth disease is not the same as foot-and-mouth disease in livestock. Different viruses are involved.
Who gets it most often
- Toddlers and preschoolers: most common.
- Older children: can catch it during school outbreaks.
- Adults: may have mild or unusual symptoms (sometimes mostly mouth sores) or none at all, yet still carry the virus home.
Causes: which viruses can trigger hand, foot and mouth disease
Several viruses can lead to the same pattern. Infection with one strain does not guarantee protection against others, so reinfections happen.
- Coxsackievirus A16: classic hand, foot and mouth disease pattern.
- Coxsackievirus A6 / A10: more widespread or “atypical” rashes.
- Enterovirus 71 (EV71): less common, sometimes linked to more severe nervous system involvement.
How it spreads and how long it can be contagious
Hand, foot and mouth disease spreads through saliva, nasal secretions, blister fluid, and stool.
Transmission at home, daycare, and school
- Close contact (kissing, cuddling, sharing cups/utensils).
- Touching contaminated surfaces (toys, doorknobs, phones), then touching the mouth.
- Diaper changes and potty training accidents through faecal–oral transmission.
- Droplets from coughs and sneezes.
Incubation period
Symptoms typically start 3–7 days after exposure.
Contagious period
- Most contagious during the first week, especially with fever, drooling, and fresh blisters.
- Transmission can happen before symptoms are clear.
Viral shedding in stool: what it means in daily life
Even after recovery, the virus can be shed for 2–4 weeks (sometimes longer) in stool.
In practical terms:
- Handwashing after toileting and diaper changes matters even after the rash is gone.
- A child who looks well can still spread hand, foot and mouth disease if hygiene is lax.
Can adults spread it without symptoms?
Yes. Adults can be asymptomatic or mildly symptomatic and still transmit the virus.
Diagnosis: how clinicians confirm hand, foot and mouth disease
Most diagnoses are clinical: the combination of mouth ulcers plus a hand-and-foot rash in a contagious setting.
When tests can be useful
Testing is not routine, but may be considered if the presentation is unusual or severe. Samples can come from:
- Throat swab
- Blister fluid
- Stool
These may be analysed by PCR.
Other conditions that can look similar
- Herpangina
- Herpetic gingivostomatitis (HSV)
- Chickenpox (varicella)
- Impetigo or other bacterial skin infections
- Other viral rashes
- Allergic or medication-related rash
- Scabies
Treatment: what helps children feel better at home
Hand, foot and mouth disease is uncomfortable, but supportive care works well in most cases. The priorities are pain control, fever relief, and hydration.
Is there a cure?
There is no specific antiviral cure for routine hand, foot and mouth disease. The immune system clears it.
Why antibiotics don’t help
Antibiotics treat bacteria, not viruses. They do not shorten HFMD or prevent spread.
Fever and pain relief options
- Paracetamol (acetaminophen) can help with fever and mouth pain when dosed correctly.
- Ibuprofen can be used in many children if they are well hydrated and have no kidney disease, stomach ulcers, or bleeding disorders.
- Avoid aspirin in children and teenagers.
Helping with mouth pain so kids can drink
- Offer cold fluids, chilled curd/yoghurt, smoothies, or ice lollies.
- Choose soft foods: khichdi, dal water, idli, curd rice, mashed banana, oats.
- Avoid acidic, salty, or spicy foods that sting (citrus, tomato gravies, chips, achar).
- Small, frequent sips are often easier.
Hydration strategies and signs of dehydration
Hydration matters more than solids in the worst days.
- Offer fluids frequently, for toddlers, a spoon, syringe, or small cup can help.
- Oral rehydration solution (ORS) is useful if intake is low.
Watch for dehydration:
- Dry mouth, no tears when crying
- Fewer wet diapers or urinating much less
- Sunken eyes, unusual sleepiness, lethargy
- Very dark urine or urinating only rarely
Skin care for blisters
- Keep skin clean and dry.
- Trim nails to reduce scratching.
- Do not pop blisters.
- Watch for increasing redness, warmth, swelling, pus, or worsening pain.
Recovery time
Most children improve within 7–10 days. Mouth pain often peaks early and then eases.
Return to daycare, school, and work
When return is usually considered reasonable
Many childcare settings allow return when:
- Fever has settled without fever medicines.
- The child is drinking well and urinating normally.
- The child can participate in routine activities.
Prevention: reducing spread without blame
Handwashing moments that matter
- After diaper changes or toileting help
- Before meals and snacks
- After wiping nose, drool, or handling tissues
- After returning from daycare/school/playground
Cleaning and disinfection at home
- Clean then disinfect high-touch surfaces.
- Wash pacifiers, teethers, and frequently mouthed toys.
- Avoid sharing towels during illness.
Habits for siblings and shared spaces
- Avoid sharing cups, straws, utensils, toothbrushes.
- Teach handwashing before eating.
Diapering precautions even after improvement
Because stool shedding lasts weeks:
- Wash hands after every diaper change.
- Clean the changing surface regularly.
Complications and special situations
Dehydration and secondary skin infection
- Dehydration is the most frequent complication.
- Secondary bacterial infection can occur if blisters are scratched open.
Nail shedding weeks later (onychomadesis)
Some children develop onychomadesis (nail shedding) weeks after hand, foot and mouth disease. It is usually temporary.
HFMD with eczema (eczema coxsackium)
Children with atopic dermatitis may develop more clustered lesions in eczema-prone areas. Because it can resemble other skin infections, a clinician may need to examine the child.
Hand, foot and mouth disease during pregnancy: what changes
If you are pregnant and HFMD is circulating at home, worry is understandable. Most of the time, pregnancy continues normally, but fever, hydration, and timing near delivery deserve attention.
Symptoms in pregnant adults can be subtle
Hand, foot and mouth disease in pregnancy may look like:
- Few or no skin lesions
- Mostly mouth sores and sore throat
- Fatigue with fever
The most common maternal issues: fever and dehydration
- Fever increases discomfort and fluid needs.
- Mouth pain can reduce drinking.
Treatment considerations during pregnancy
- Paracetamol (acetaminophen) is typically preferred for fever and pain (follow clinician advice).
- NSAIDs (such as ibuprofen) should be avoided in pregnancy unless advised.
- Supportive mouth care: cool drinks, small frequent sips, soft foods.
Pregnancy timing and infection close to delivery
Early pregnancy: discuss fever promptly with your prenatal team.
Late pregnancy: if symptoms occur close to delivery, tell your maternity team so newborn observation can be planned if needed.
When to contact your doctor during pregnancy
Reach out if you have:
- Fever ≥ 38°C or persistent fever
- Mouth pain making it hard to drink
- Symptoms close to delivery
When to see a doctor (for children or adults)
Reasons to contact a clinician
- Hydration is difficult
- Fever is high or lasts more than a few days
- Significant pain not improving
- Very young infant or worsening symptoms
- Pregnancy with fever or dehydration concerns
Urgent warning signs
Seek urgent care for:
- Dehydration (no urine for many hours, lethargy)
- Trouble breathing
- Severe headache, neck stiffness, confusion, seizures
- Chest pain, shortness of breath, fainting
- Persistent vomiting, severe abdominal pain, or a person who looks seriously unwell
Key takeaways
- Hand, foot and mouth disease is a common enterovirus infection in young children, often causing fever, mouth ulcers, and a rash on palms and soles.
- Incubation is typically 3–7 days. Contagiousness is highest in the first week, stool shedding can last 2–4 weeks.
- Care is supportive: comfort, fever/pain relief, and keeping fluids up. Dehydration is the most frequent practical complication.
- During pregnancy, the main concerns are fever, hydration, and timing near delivery, inform your prenatal care team if symptoms appear.
- Seek urgent medical advice for dehydration, breathing trouble, severe headache/neck stiffness/confusion, chest symptoms, or unusual sleepiness.
- Resources and professionals can support you. For personalised guidance and free child health questionnaires, you can download the Heloa app.
Questions Parents Ask
Can my child bathe with hand, foot and mouth disease?
Yes, a gentle bath is usually fine and can even feel soothing. You can keep it simple: lukewarm water, mild soap, and a soft towel pat-dry. If the skin looks irritated, a short bath may be more comfortable than a long soak. Rassurez-vous: bathing doesn’t “spread the rash” on the body, but avoiding shared towels and washing hands after bath time helps limit spread to others.
Can my child get hand, foot and mouth disease twice?
Yes, it can happen. Hand, foot and mouth disease is caused by different enteroviruses, so immunity after one infection may not protect against another strain. This can feel unfair—especially when you’ve just gotten through a tough week—but reinfection is usually similar or milder. Good hand hygiene and cleaning frequently touched items (toys, doorknobs) can reduce the chances, even if it can’t prevent every exposure.
Why are the sores sometimes worse around eczema (eczema coxsackium)?
Some children with eczema develop clustered, angrier-looking spots in areas where the skin barrier is already fragile. It can look dramatic, but many children still recover well with supportive care (comfort, hydration, simple skin care). If lesions become very painful, oozy, increasingly red, or your child seems unwell, it’s a good idea to check in with a clinician to rule out a secondary skin infection.
Further reading :
