Hand foot and mouth disease is a mild, short-lived viral illness that typically affects children under six years of age, characterised by blisters or sores in the mouth and a rash on the hands and feet. Hand foot and mouth disease has no long-term consequences but it is highly contagious and your child might feel generally unwell for a short time.
Dr Roger Henderson looks at hand foot and mouth disease causes, symptoms, treatment and prevention tips:
What is hand foot and mouth disease?
Hand foot and mouth disease (HFMD) is a common, mild and short-lasting viral illness usually affecting children, which is caused by a group of viruses known as enteroviruses. The most common one causing it is called Coxsackie virus A16 (CVA16) but other viruses that can cause it include enterovirus 71 (sometimes linked to severe infections of the nervous system), echovirus and other multiple different strains of Coxsackie virus.
Hand foot and mouth disease usually infects children under the age of 10, with the vast majority being six years old or younger. Older children and adults can be infected but this is much less common – if it does, it tends to be in pregnant women, the elderly and in people with a poor immune system.
Epidemics are often seen during the late summer or autumn months when a school class may be affected.
Hand foot and mouth disease is sometimes called ‘enteroviral vesicular stomatitis’ by doctors but HFMD is not related to the disease with a similar name that affects animals.
Hand foot and mouth disease symptoms
As with many simple viral infections, when you have hand foot and mouth disease there is usually a day or two of feeling generally unwell, and the typical incubation period is three to six days. Other hand foot and mouth disease symptoms include:
Loss of appetite
Spots in the mouth
Small mouth ulcers
After the initial symptoms, spots may then also appear around the lips and mouth and because these are painful the child may become unhappy and not want to eat or drink.
In many cases, spots also start to appear on the skin a day or two after the mouth ulcers appear. These are seen on the hands and feet (hence the disease name) and may also develop on the buttocks, genitals and legs. They look like chickenpox spots although they are smaller and not itchy.
The raised temperature and spots then slowly settle away over a few days, with the mouth ulcers being the last to clear.
The diagnosis is made on clinical findings, and specific tests or investigations are rarely needed.
Hand foot and mouth disease transmission
Most cases of hand foot and mouth disease are passed on by droplet transmission from coughing and sneezing, and so is spread by person to person contact with infected saliva, nasal secretions, and respiratory droplets. It occurs most commonly in young children because of toilet training, infected nappies, and because small children frequently put their hands in their mouths.
Hand foot and mouth disease is usually infectious until all the spots have cleared but children are still able to pass it on several weeks after their symptoms have settled, and so it is sensible to take certain precautions to help reduce the risk of it being passed on.
How to stop hand foot and mouth disease spreading
Hand foot and mouth disease is highly contagious. Try the following steps to prevent hand foot and mouth disease from spreading:
Make sure children wash their hands well after going to the toilet.
Adults should wash their hands thoroughly after changing a nappy, and before preparing food.
Wash the dirty bedding, towels and clothes of an infected child on a hot cycle.
Regularly disinfect common areas such as kitchens and living spaces as well as shared items such as toys.
Teach children not to put their fingers in their mouths if possible.
Do not be tempted to squeeze or pierce any blisters – the fluid in these is infectious and so can cause increased spread of infection.
Hand foot and mouth disease treatment
Specific treatment for hand foot and mouth disease is not usually needed, and there is no treatment, antivirals or vaccination available for it. The aim of any treatment is supportive to help ease any symptoms that may be present until it clears away by itself. The treatment is the same for any age and includes the following:
✔️ Keep a high temperature down
If your child has a high temperature use paracetamol or ibuprofen at the recommended age dosages, keep bedding and clothing very light, and use a fan in the room where appropriate.
It used to be recommended that using a cold sponge could help lower a high temperature but this is no longer the case as it can make it worse, and is often unpleasant for the child.
✔️ Stay hydrated
Drink enough fluid in order to stay well hydrated. The sore mouth found in HFMD can sometimes make this difficult in small children so use painkillers before offering them drinks. If you are breastfeeding, keep this going as this is excellent fluid replacement.
✔️ Treat a sore mouth
A sore mouth can be the worst symptom for many children. A few ways to ease a sore mouth in children include:
Soft foods such as ice cream, jellies, soups, and mashed potato.
Use a numbing local anaesthetic gel called Lidocaine in the mouth.
Give ibuprofen or paracetamol regularly.
Use a mouth spray called Benzydamine to ease soreness and discomfort. This can be used in children aged 5 and older, and there is also a mouthwash of this that can be used from the age of 12. For people aged 16 and older, Bonjela gel can be used (but not in pregnant women).
Regular warm salt mouthwashes can help reduce discomfort, but always make sure your child is old enough to spit it out.
Do I need to keep my child off school?
It used to be thought that keeping a child with HFMD off school was important but we now know this is not the case. The current guidance is that infected children should not be routinely kept off school if they feel well enough to attend. However, their school should be informed they are infected and if they feel too poorly to go to school they should be kept off until they have recovered.
When to see a doctor about hand foot and mouth disease
HFMD is usually so relatively mild that a medical opinion is unnecessary, but if your child has not been able to drink because of their mouth sores seek medical advice. If after a few days they do not seem to be improving, or if their symptoms worsen then discuss this with your doctor.
Hand foot and mouth disease during pregnancy
There is usually no risk to the pregnancy or baby, but it's best to avoid close contact with anyone who has hand, foot and mouth disease.
If you are pregnant and catch hand foot and mouth disease a month or less before your due date, see your GP as it can sometimes be passed on to your baby when it is born and the midwives should be aware of this possibility.
Last updated: 22-04-2021
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