Quick answer: Hand, foot and mouth disease is a common viral illness in under-5s, caused most often by coxsackievirus A16 or enterovirus 71. It produces mouth ulcers and spots on the hands and feet, lasts 7–10 days, and resolves without treatment in almost all cases.
HFMD is one of the most misidentified childhood illnesses — parents frequently mistake it for chickenpox, an allergic reaction, or a random rash, when the combination of mouth ulcers and hand/foot spots is actually quite distinctive.
Hand, foot and mouth disease (HFMD) is a common viral illness in children under 5, most prevalent in summer and early autumn. It’s usually mild and self-limiting — but the rash, ulcers, and refusal to eat can be alarming for parents encountering it for the first time.
What HFMD Is
HFMD is caused primarily by coxsackievirus A16 and enterovirus 71. It spreads through direct contact with saliva, blister fluid, stool, and respiratory droplets — highly contagious in daycare settings. The incubation period is 3–6 days. Classic presentation: Fever (38–39°C) followed 1–2 days later by painful mouth ulcers (on the tongue, inside the cheeks, and the back of the throat) and a distinctive rash of small, red spots or blisters on the palms of the hands, soles of the feet, and sometimes the buttocks and genitals. The mouth ulcers are often the most distressing feature — they cause significant pain, drooling, and refusal to eat or drink.
How Long It Lasts
The fever typically lasts 3–5 days. The mouth ulcers are usually the most painful in the first 3–5 days and begin healing by day 7–10. The rash on hands and feet evolves from flat spots to blisters and then fades, typically over 7–10 days. Nails may temporarily detach (onychomadesis) 4–8 weeks after the illness — alarming but harmless and the nails regrow. Most children are well within 10 days.
Managing Symptoms at Home
Pain and fever: Paracetamol or ibuprofen at age-appropriate doses — prioritise pain relief over fever control, since the mouth ulcers cause the most distress. Fluids are the priority: The main risk with HFMD is dehydration from the combination of fever and refusal to drink due to mouth pain. Offer cold drinks frequently — ice pops, cold milk, cold water. Cold soothes the ulcers. Avoid acidic drinks (orange juice) which worsen pain. Eating: Soft, cold, neutral foods. Don’t force eating — fluids are far more important than solid nutrition for the duration of illness. Mouth ulcers: Topical anaesthetic gels (benzocaine-containing gels are not safe for children under 2 — use paracetamol instead). Saline mouthwash for older children.
When to Seek Medical Attention
Go to hospital or call urgently for: dehydration signs (no wet nappy for 8+ hours, no tears when crying, very dry mouth, extreme lethargy), inability to keep any fluids down for more than 8 hours, fever above 40°C, stiff neck, severe headache, difficulty breathing, unusual drowsiness or confusion, or rash that’s spreading rapidly and non-blanching (does not fade when pressed with a glass — a different condition requiring emergency evaluation).
Contagion and Return to Nursery
HFMD is contagious from approximately 2 days before symptoms start until all blisters are dried and crusted. Most guidance (UK UKHSA, US CDC) states that children do not need to be excluded from nursery or school once they are well enough to attend and all blisters have dried — the contagious period cannot be reliably defined by a fixed number of days. Inform the nursery so other families can monitor for symptoms. Good handwashing is the primary prevention measure.
Frequently Asked Questions
Can adults get hand, foot and mouth disease?
Yes — adults can get HFMD, typically with milder symptoms (or none at all). Most adults have some immunity from childhood exposure. Pregnant women should avoid close contact with confirmed HFMD cases, particularly in the first trimester, though serious complications in pregnancy are rare.
Is there a vaccine for HFMD?
An EV-71 vaccine (targeting one of the main strains) has been developed and is licensed in China, where EV-71 causes more severe disease than in Western countries. No HFMD vaccine is currently available in the US or UK.
My child’s fingernails are falling off 6 weeks after HFMD — is that normal?
Yes — nail shedding (onychomadesis) following HFMD is a well-documented and harmless delayed complication. The nails separate from the nail bed due to temporary disruption of nail growth during the acute illness. They regrow completely over the following months. It’s alarming-looking but requires no treatment.
Related Reading
- Rashes in babies: a visual guide to common skin conditions
- Baby fever: temperature chart, when to go to ER
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