Hand, foot and mouth disease
This is one of the most ordinary childhood infections: ulcers in the mouth, spots and small blisters on the palms and soles, a modest temperature and a child…
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Medicines commonly prescribed for Hand, foot and mouth disease
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 1 gActive substance: paracetamolManufacturer: Qualix Pharma S.L.Prescription requiredDosage form: TABLET, 1 g paracetamolActive substance: paracetamolManufacturer: Ferrer Internacional S.A.Prescription not requiredDosage form: TABLET, 500 mgActive substance: paracetamolManufacturer: Galenicum Health S.L.Prescription not required
This is one of the most ordinary childhood infections: ulcers in the mouth, spots and small blisters on the palms and soles, a modest temperature and a child who refuses to eat. It is caused by gut viruses, most often from the Coxsackie group, and no medicine exists that kills them — the body deals with it unaided in a little over a week. Adults catch it too, less often and usually more mildly. Despite the similar name, it has nothing to do with the foot-and-mouth disease of farm animals. What it asks of parents is not treatment but attention: making sure the child keeps drinking, and knowing the handful of signs that call for a doctor.
How it starts and how long it lasts
From contact with the virus to the first complaints takes roughly three to six days. The beginning is usually vague: the child is listless, off their food, complains of a sore throat and runs a low temperature. At this stage parents are thinking of a cold.
A day or two later come the features that give it away:
- in the mouth, red dots that quickly turn into small painful ulcers on the tongue, gums, inner cheeks and palate; these are what distress the child most;
- on the palms and soles, flat red or pink spots, some of which become little blisters; on darker skin they look deeper than the surrounding skin or greyish;
- often the same spots on the buttocks, in the groin, around the mouth, sometimes on the knees and elbows;
- the rash tends not to itch, but it can be sore, especially on the soles when walking.
All of this lasts seven to ten days and clears on its own without scarring. A temperature, if there was one, usually settles within the first two or three days, while the mouth ulcers take longer than anything else to heal. Some children get almost no rash and suffer only a sore throat, and in some adults the infection passes entirely unnoticed, which does not stop them passing the virus on.
What helps at home
Antibiotics are useless here: they act on bacteria, and this illness is viral. The job at home is to take the edge off the mouth pain so that the child keeps drinking and eating.
- Cool drinks in small amounts and often: water, diluted milk. Acidic juices and fizzy drinks are best set aside, since they sting the ulcers.
- Cold soothes better than any mouthwash: milkshakes, chilled purée, or an ice lolly for an older child all work.
- Soft, cool food — yoghurt, porridge, soft cheese, mashed potato. Hot, salty, spicy and crunchy things come off the menu for a few days.
- Paracetamol or ibuprofen ease the pain and the temperature; the dose is worked out from the child's weight and age rather than guessed, and the amount on the packet is not exceeded. Aspirin is not given to children or teenagers.
- Pharmacies stock gels and sprays that numb the lining of the mouth; ask which of them are allowed at your child's age, because not all are.
- Blisters are not popped and nothing caustic is dabbed on them: they heal by themselves.
There is no need to coax a child into finishing a plate: appetite returns of its own accord, whereas missed fluids are much harder to make up. A few days on milk and soft food will do nobody any harm.
Dehydration, the thing to watch first
Complications of this illness are rare, and almost all of them come down to one thing: the mouth hurts so much that the child stops drinking. Very young children lose fluid quickly, and it needs spotting before the situation becomes serious.
Warning signs:
- noticeably less urine than usual, a nappy that stays dry for many hours in a row, or an older child who has not passed water for half a day;
- crying without tears, a dry mouth and lips;
- eyes that look sunken and, in a baby, a sunken soft spot on the head;
- unusual listlessness or sleepiness, no interest in what is going on;
- cold hands and feet, mottled skin.
If the child refuses fluids altogether, or if these signs have already appeared, seek advice the same day rather than waiting for morning. Often the problem is solved by giving a painkiller and offering a drink half an hour later, but that is worth trying early on, not once the child has already gone quiet.
When a doctor is needed, and when an ambulance
See a doctor the same day if:
- the patient is a baby in the first months of life or someone whose immune system is weakened;
- the temperature lasts more than three days or climbs again after settling;
- signs of dehydration appear, or the child will not drink;
- the mouth ulcers are so painful that the child cannot even swallow their own saliva;
- nothing has improved after ten days, the blisters have turned septic, the skin around them is red and hot;
- you are pregnant and have either caught it or been in contact with someone who has.
Call an ambulance (in Europe, the single number 112) without deliberating if any of the following appears:
- the child is hard to wake, does not respond as usual, is unusually irritable or, conversely, blank;
- a stiff neck, severe headache, light hurting the eyes, forceful vomiting;
- convulsions, jerks of the whole body, particularly repeated ones as the child falls asleep, tremor, unsteady walking, weakness of an arm or a leg;
- fast or laboured breathing, visible effort with each breath, blue lips;
- a rash that does not fade when pressed with something clear — that points to an entirely different and extremely dangerous infection, and nothing about it can wait.
Keeping it from spreading, and going back to nursery
The virus travels in saliva and in droplets from coughing and sneezing, in the fluid from the blisters and in the stool. A person is most infectious during the first week, but the virus is shed before symptoms appear as well, and for several weeks in the stool after recovery. Blocking transmission completely is impossible; reducing it is perfectly achievable.
- Wash hands with soap more often than usual: adults after nappy changes and after helping a child in the bathroom, the child before eating and after the toilet.
- Cough and sneeze into a tissue, bin it straight away and wash your hands afterwards.
- Do not share cups, spoons, bottles, towels or dummies.
- Wash the patient's bedding and towels separately, at a hot wash.
- Wipe down toys and the surfaces everyone touches, since the virus survives a long time on them.
Keeping a child at home until the last blister has healed serves no purpose: they will be shedding the virus long after that, and such isolation barely affects how the illness moves through a group. The rule of thumb is simple — a child goes back to nursery or school when they feel well enough to be there: no temperature, eating, drinking and playing as usual. It is still worth checking the individual setting's policy in advance. Adults who work with food, with children or with patients are sensible to stay at home while they have a temperature and until the spots have dried.
It can be caught more than once: several different viruses cause it, and immunity to one does not protect against the rest.
If you are pregnant
As a rule this infection endangers neither the pregnancy nor the baby, and most women get through it as easily as anyone else. Even so, close contact with anyone unwell is best avoided, particularly in the final weeks. The reason is that catching it shortly before delivery can pass it to the newborn: usually the baby has a mild version, but in a child only days old the illness can run more heavily.
If you have caught it or been in contact with someone who has, mention it to your doctor or midwife, simply so that it is on record and taken into account when the time comes. No specific treatment is prescribed for it.
What is left afterwards
A week or two after recovery the skin on the palms and soles sometimes starts to flake and peel away in sheets. It looks alarming but is painless, needs no treatment and settles by itself; an ordinary moisturiser helps.
Later still, at a month or two, some children find their fingernails lifting and coming off, less often the toenails. This too is a recognised aftermath of the illness rather than a fungus or an injury: nail growth paused while the infection ran its course. The nails grow back, usually perfectly normal, and nothing will hurry that along. They only need showing to a doctor if redness, pain or pus appears around them.
Online consultation
A remote appointment answers exactly what people book for: whether this really is hand, foot and mouth disease rather than some other rash, and how settled the picture is. The doctor looks at photographs of the spots and the mouth, weighs up how much the child is drinking and passing, advises on numbing the mouth and on the right dose of a fever medicine, and explains what to watch for at home and when to go back to nursery. It is also the place to sort out the peeling skin and lifting nails that turn up a month later and cause alarm. The signs on the ambulance list are not assessed through a screen — those mean calling for help at once.
This material is for information only and does not replace medical advice.
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