The Bottom Line

Hand, foot, and mouth disease (HFMD) is a very common, usually mild viral illness that mostly affects children under age 5. It causes painful sores inside the mouth and small blisters on the palms, soles, and sometimes the buttocks. Most children recover fully within 7–10 days with rest and fluids. There is no specific antiviral treatment—supportive care at home is usually all that is needed. Rarely, it can cause serious complications, especially with the enterovirus 71 strain.

What Is Hand, Foot, and Mouth Disease?

Hand, foot, and mouth disease (HFMD) is a viral infection caused by enteroviruses—most commonly coxsackievirus A16 and enterovirus 71. It is one of the most frequent childhood illnesses, affecting 1–10% of children under age 5 globally, with rates as high as 10–20% in tropical climates. It spreads easily through schools and daycares, with household contacts having a 30–50% chance of getting infected if proper hygiene is not maintained.

Despite the name, HFMD has nothing to do with foot-and-mouth disease in cattle—they are caused by completely different viruses and cannot be transmitted between humans and animals.

Signs and Symptoms

HFMD follows a predictable pattern:

Days 1–2 (Prodrome):

  • Fever (38–39°C / 100–102°F)
  • Sore throat
  • Reduced appetite and fussiness
  • General feeling of being unwell

Days 2–5 (Rash and sores):

  • Mouth sores: Painful ulcers inside the mouth, on the tongue, gums, and the roof of the mouth. These affect 80–90% of children and are often the main reason children stop eating and drinking.
  • Skin blisters: Small (1–5 mm) blisters or flat red spots on the palms of the hands, soles of the feet, and often on the buttocks. They are typically not itchy.
  • Swollen lymph nodes in the neck in 40–50% of cases

Resolution: Most children feel better within 7–10 days. Post-viral fatigue may persist for 1–2 weeks in about 30% of children.

Nail changes (delayed): In 5–10% of cases, nails may become loose or temporarily fall off (onycholysis) about 4–6 weeks after the illness—this looks alarming but is harmless. Nails regrow completely within 3–4 months.

What Causes HFMD?

HFMD is caused by enteroviruses, a large family of viruses that replicate in the gut before spreading to the skin. The two main causes are:

  • Coxsackievirus A16: The most common cause in most countries. Usually causes mild disease.
  • Enterovirus 71 (EV71): More common in East and Southeast Asia. Associated with rare but serious neurological complications (viral meningitis, encephalitis, paralysis).

The virus spreads mainly through the fecal-oral route (80–90% of transmission)—contaminated hands touching the mouth—and through respiratory droplets (10–20%). The virus continues to shed in stool for 3–4 weeks after recovery, though peak contagiousness is during the first week of illness.

Treatment Options

There is no specific antiviral medication for HFMD. Treatment is supportive:

  • Pain and fever relief: Acetaminophen (15 mg/kg every 4–6 hours, up to 5 doses per day) or ibuprofen (10 mg/kg every 6–8 hours) for children old enough to take it. Avoid aspirin in children.
  • Staying hydrated: This is the most important goal. Mouth sores make eating and drinking painful. Offer cool, soft foods—yogurt, ice cream, applesauce, cold water—and avoid acidic (citrus juice), spicy, or hot foods that irritate ulcers. Popsicles are especially helpful.
  • Topical anesthetics: A small amount of viscous lidocaine applied to mouth sores before meals can temporarily ease pain in older children. Ask your doctor before using this.
  • IV fluids: Rarely needed, but may be required if a child becomes severely dehydrated from inability to drink.

School and Daycare

Current guidance recommends keeping children home while they have a fever and cannot eat or drink normally—typically 3–5 days. Once the fever is gone and the child can eat and drink, returning to school is appropriate even though viral shedding continues. Thorough handwashing after diaper changes and before meals reduces household spread by 60–70%.

When to See a Dermatologist or Pediatrician

  • Your child is not able to drink fluids and shows signs of dehydration (dry mouth, no tears when crying, no urination for 8+ hours)
  • High fever (above 39.5°C / 103°F) lasting more than 3 days
  • Your child is very lethargic, unusually floppy, or difficult to wake
  • Severe headache, stiff neck, or loss of coordination (possible neurological complication)
  • Worsening rash or new symptoms develop after day 5
  • The diagnosis is unclear or the rash is spreading significantly
  • An infant under 6 months has HFMD (higher risk of serious illness)

Frequently Asked Questions

Can adults get hand, foot, and mouth disease?

Yes—adults can get HFMD, though it is less common because most adults have already developed immunity from childhood exposure. When adults do get it, symptoms are often milder. Adults are frequently infected after exposure to a sick child at home. Good hand hygiene—especially after diaper changes—is the best protection.

How long is HFMD contagious?

HFMD is most contagious during the first week of illness. The virus continues to shed in saliva for about 7–10 days and in stool for up to 3–4 weeks (sometimes longer). This is why handwashing remains important even after a child returns to school. However, the risk of transmission drops significantly once the active illness resolves.

Do the blisters leave scars?

No. HFMD blisters heal without scarring. They crust over and fade within 7–10 days. The only unusual after-effect is temporary nail loosening in a small percentage of children (5–10%), which occurs 4–6 weeks after illness and resolves completely as new nails grow in.

Is HFMD the same as foot-and-mouth disease in animals?

No—these are completely different diseases. HFMD in humans is caused by enteroviruses (coxsackievirus A16, enterovirus 71). Foot-and-mouth disease in cattle is caused by aphthovirus. The two viruses cannot be transmitted between humans and animals. The similar names cause frequent confusion, but there is no connection.

References

  1. Solomon T, et al. Virology, epidemiology, pathogenesis, and control of enterovirus 71. Lancet Infect Dis. 2010;10(11):778-790.
  2. Ooi MH, et al. Human enterovirus 71 disease in Sarawak, Malaysia: a prospective clinical, virological, and molecular epidemiological study. Clin Infect Dis. 2007;44(5):646-656.
  3. Shin JU, et al. Hand, foot and mouth disease: a systematic literature review of transmission patterns. Epidemiol Infect. 2016;144(12):2527-2536.
  4. CDC. Hand, Foot, and Mouth Disease (HFMD): Information for Public Health Professionals. Centers for Disease Control and Prevention. 2023.

Trusted Resources

Always consult a board-certified dermatologist for diagnosis and personalized treatment recommendations.