Hand, Foot and Mouth Disease: Causes, Symptoms, Treatment & Prevention

Hand, Foot, and Mouth Disease (HFMD) is a common viral illness that primarily affects young children but can also occur in adults. While the name might sound alarming, HFMD is usually mild and self-limiting. However, understanding its symptoms, causes, and treatment options is essential for parents, caregivers, and even adults who might contract it.

This guide takes a deep dive into HFMD, covering everything from what it is, how it spreads, its symptoms, possible complications, and effective prevention strategies. By the end, you’ll have a complete understanding of this illness and how to deal with it effectively.

What is Hand, Foot and Mouth Disease?

Hand, Foot, and Mouth Disease is a contagious viral infection caused by a group of viruses known as enteroviruses. The most common culprits are Coxsackievirus A16 and Enterovirus 71 (EV71).

The disease gets its name from the characteristic rash and blisters that appear on the hands, feet, and inside the mouth. While HFMD is not typically severe, it can be uncomfortable, and in rare cases, complications may arise. HFMD should not be confused with Foot-and-Mouth Disease (FMD), which affects livestock such as cattle, sheep, and pigs. HFMD only affects humans and is not related to the animal disease.

Who is Most Affected by HFMD?

Children under 5 years are the most affected group because of their developing immune systems and close contact with peers in daycare or school settings.
Older children and adults can also contract HFMD, but their symptoms are usually milder.
Parents, caregivers, and teachers can catch HFMD through close contact with infected children.

Causes of Hand, Foot and Mouth Disease

HFMD is caused by viruses from the enterovirus family. These viruses live in the digestive tract and can spread through several means:

Person-to-person contact – touching an infected person’s saliva, mucus, or blister fluid.
Respiratory droplets – when an infected person coughs or sneezes.
Fecal-oral route – coming into contact with stool, especially during diaper changes.
Contaminated objects and surfaces – toys, doorknobs, and shared utensils can harbor the virus.

Symptoms of Hand, Foot and Mouth Disease

The symptoms of HFMD usually appear within 3 to 6 days after exposure to the virus (incubation period). The disease often begins with general signs of illness before progressing to its distinctive symptoms.

Early Symptoms:

Fever
Sore throat
Loss of appetite
Fatigue and irritability in children

Later Symptoms:

Painful mouth sores – Small red spots appear inside the mouth, especially on the tongue, gums, and inner cheeks. These can turn into blisters and make eating or drinking painful.
Skin rash – A rash of flat or raised red spots develops on the palms, soles, and sometimes buttocks, knees, or elbows. These may blister but usually don’t itch.
General discomfort – Children may become cranky and refuse food or fluids due to pain.

Most children recover in 7–10 days without medical treatment.

Complications of HFMD

While HFMD is usually mild, some rare but serious complications can occur:

Dehydration: Painful mouth sores may make it difficult for children to drink enough fluids, leading to dehydration.
Viral meningitis: In rare cases, HFMD viruses can cause inflammation of the membranes around the brain and spinal cord.
Encephalitis: Very rarely, HFMD may lead to swelling of the brain, a life-threatening condition.
Nail shedding (Onychomadesis): Some children may experience temporary fingernail or toenail loss a few weeks after recovery.

How is Hand, Foot and Mouth Disease Diagnosed?

Doctors usually diagnose HFMD based on:

Medical history – recent exposure to infected individuals.
Physical examination – checking for the distinctive rash on hands, feet, and mouth.
Lab tests (rarely needed) – stool, throat swabs, or blood samples may be tested if complications are suspected.

Stages of Hand, Foot and Mouth Disease

Hand, Foot, and Mouth Disease typically progresses through several stages. Understanding these stages can help parents and caregivers recognize the illness early, manage symptoms effectively, and monitor for complications.

Stage 1: Incubation Period (3–6 Days After Exposure)

The virus enters the body, usually through the mouth, nose, or broken skin.
No symptoms appear yet, but the virus is already multiplying inside the body.
The infected person can begin spreading the virus even before symptoms show.

Stage 2: Early Symptoms (Day 1–2 of Illness)

Fever: Often mild to moderate (around 38–39°C or 100–102°F).
Sore throat: The child may complain of pain while swallowing.
Loss of appetite: Eating and drinking become uncomfortable.
Fatigue and irritability: Especially noticeable in young children.

Stage 3: Appearance of Mouth Sores (Day 2–3)

Painful red spots appear on the tongue, gums, and inside of cheeks.
These spots may develop into small blisters or ulcers.
Mouth sores cause discomfort and make eating or drinking difficult.
Children may drool more than usual due to mouth pain.

Stage 4: Rash on Hands, Feet, and Other Areas (Day 3–5)

A rash of flat red spots, sometimes with small blisters, appears on the palms of hands and soles of feet.
Rashes may also appear on the buttocks, knees, elbows, or genital area.
Unlike chickenpox, HFMD rash is not usually itchy, but it may be tender or uncomfortable.

Stage 5: Peak of Illness (Day 5–7)

Fever usually subsides, but mouth sores and rashes may still be painful.
The child may still be irritable, refuse food, and need comfort and hydration.
This is the most contagious stage.

Stage 6: Recovery Stage (Day 7–10)

Mouth ulcers begin to heal.
Rash starts to fade, though peeling of skin may occur as blisters heal.
Children usually regain appetite and energy.
Some children may experience temporary nail loss (onychomadesis) a few weeks after recovery, but nails grow back normally.

Key Points for Parents

HFMD is most contagious during the first week, but the virus can remain in stool for weeks after recovery.
While most children recover fully in 7–10 days, parents should watch for warning signs such as persistent high fever, dehydration, stiff neck, or unusual sleepiness.
Good hygiene should continue during and after recovery to prevent spreading the virus.

Treatments for Hand, Foot and Mouth Disease

Currently, there is no specific antiviral medication that cures Hand, Foot, and Mouth Disease. Since it is caused by viruses (mainly Coxsackievirus A16 and Enterovirus 71), antibiotics are not effective. Most cases resolve on their own within 7–10 days. However, doctors may recommend treatments to ease symptoms and prevent complications.

1. Fever and Pain Relief

Acetaminophen (Paracetamol): Helps reduce fever and ease mild to moderate pain.
Ibuprofen: Can also be used for fever, headache, and body pain (not recommended for infants under 6 months unless prescribed).
Aspirin should not be given to children, as it increases the risk of Reye’s syndrome.

2. Relief for Mouth Sores

Topical Oral Anesthetics: Gels or sprays containing lidocaine or benzocaine may provide temporary relief from painful ulcers (only under medical supervision).
Mouth Rinses: For older children and adults, doctors may recommend a medicated mouth rinse with antihistamines or antacids to reduce pain and inflammation.

3. Hydration Support

Doctors stress the importance of keeping children well-hydrated.
In cases of severe dehydration, hospitalization may be required for intravenous (IV) fluids.

4. Treatment of Severe Cases

If HFMD is caused by Enterovirus 71, the illness can sometimes be more severe. In such cases, hospitalization may be necessary to monitor for complications like viral meningitis or encephalitis.
Supportive treatments may include IV fluids, antiviral research medications (in rare, severe cases), and careful neurological monitoring.

5. Management of Secondary Infections

If blisters become infected due to scratching, a doctor may prescribe antibiotic ointments or oral antibiotics to treat bacterial skin infections.

6. Hospitalization (Rare Cases)

Hospital admission may be required if:

The child cannot swallow fluids due to severe mouth ulcers.
There are neurological symptoms (severe headache, stiff neck, seizures).
The child shows signs of serious dehydration.
Complications like encephalitis or viral meningitis are suspected.

Home Remedies for Hand, Foot and Mouth Disease

While there is no specific medicine to cure HFMD, supportive care at home can ease discomfort and help speed recovery. The goal is to reduce fever, relieve mouth pain, and prevent dehydration.

1. Hydration is Key

Encourage your child (or yourself) to drink plenty of fluids to avoid dehydration.
Offer cool water, coconut water, soups, or milk.
Avoid acidic juices like orange or lemon, which can irritate mouth sores.

2. Soothing Cold Foods

Cold or soft foods help relieve mouth pain.
Options include yogurt, smoothies, ice cream, mashed bananas, or popsicles.
Avoid spicy, salty, or crunchy foods that may worsen mouth ulcers.

3. Saltwater Gargle

For older children and adults, gargling with warm salt water can ease mouth pain and speed healing.
Mix half a teaspoon of salt in a glass of warm water and gargle several times a day.

4. Honey (for children over 1 year)

Honey has natural antibacterial and soothing properties.
A small spoonful can coat mouth sores and reduce irritation.

5. Aloe Vera Gel (for skin rash)

Applying pure aloe vera gel to blisters on hands and feet may provide cooling relief and reduce discomfort.

6. Oatmeal Baths

An oatmeal bath can soothe irritated skin and relieve itching or discomfort from the rash.
Add a cup of colloidal oatmeal to lukewarm bath water and let the child soak for 10–15 minutes.

7. Coconut Oil

Known for its antiviral and soothing properties, coconut oil may be applied lightly to rashes or blisters to ease irritation.

8. Rest and Comfort

Ensure plenty of rest, as the body needs energy to fight the infection.
Keep the child in a calm, comfortable environment.

9. Loose and Comfortable Clothing

Dress in light, breathable cotton clothes to prevent irritation of rashes.

10. Cool Compresses

A clean, cool damp cloth applied to rashes can help relieve burning and discomfort.

Important Note: These remedies provide relief but do not cure HFMD. Always consult a doctor if:

Symptoms last longer than 10 days
The child refuses fluids and shows signs of dehydration
High fever persists
Severe headache, stiff neck, or seizures develop

When to See a Doctor for HFMD?

Seek medical attention if:

The child has persistent fever over 39°C (102°F).
Symptoms worsen or don’t improve after 10 days.
The child shows signs of dehydration (dry mouth, fewer wet diapers, crying without tears).
Severe headache, stiff neck, or seizures occur (possible signs of meningitis or encephalitis).

How to Prevent Hand, Foot and Mouth Disease

Because HFMD spreads easily, prevention focuses on good hygiene and reducing contact with infected individuals.

Preventive Measures:

Handwashing – wash hands thoroughly with soap and water, especially after diaper changes, using the toilet, and before eating.
Disinfect surfaces – clean toys, doorknobs, and shared items with disinfectants regularly.
Avoid close contact – keep infected children home from school or daycare until they recover.
Teach cough etiquette – cover mouth and nose with tissue or elbow when coughing/sneezing.
Don’t share utensils – cups, spoons, and bottles should not be shared.

Hand, Foot and Mouth Disease vs. Other Conditions

HFMD can sometimes be mistaken for other illnesses because of its rash and sores.

Chickenpox: Causes itchy, fluid-filled blisters that spread all over the body, not just hands, feet, and mouth.
Herpangina: Another illness caused by Coxsackievirus, but sores are limited to the mouth and throat.
Allergic rashes: These usually itch and don’t cause mouth sores.

Recovery and Aftercare

Most children recover fully within 7–10 days. After recovery:

Children may feel tired for a few days.
Temporary nail shedding may occur but resolves naturally.
Immunity to the specific virus develops, but children can still catch HFMD again from a different strain.

Myths and Misconceptions About HFMD

Myth: Adults cannot get HFMD.
Fact: Adults can contract it, though symptoms are usually milder.
Myth: HFMD is related to animal Foot-and-Mouth Disease.
Fact: They are completely different and unrelated diseases.
Myth: HFMD always requires hospitalization.
Fact: Most cases are mild and managed at home.
Myth: Children become immune after one infection.
Fact: Immunity is specific to the virus strain; reinfection with a different strain is possible.

Living with HFMD: Parental Tips

If your child has HFMD, here are some practical ways to make the recovery process smoother:

Keep them hydrated with small, frequent sips of cool liquids.
Offer popsicles or chilled fruit to soothe mouth sores.
Dress them in light, comfortable clothing if fever is present.
Keep them home from daycare or school until fever and blisters subside.
Provide extra comfort and reassurance, as children may be irritable and restless.

Special Diet Plan for Children with HFMD

Foods to Include (Gentle, soothing, and easy to swallow)

Cold and soft foods: Yogurt, smoothies, custard, puddings, and ice cream.
Mashed fruits: Bananas, avocados, ripe papaya, applesauce.
Hydrating foods: Watermelon, cucumbers, coconut water.
Soups and broths: Mild vegetable or chicken soup (lukewarm, not hot).
Soft grains: Oatmeal, rice porridge, khichdi, soft idlis, or upma.
Milk-based foods: Cold milkshakes, lassi, or plain milk (avoid if it causes discomfort).
Popsicles or ice chips: Help soothe painful mouth sores.

Foods to Avoid (Irritating, acidic, or hard to chew)

Spicy and salty foods – irritate mouth ulcers.
Citrus fruits and juices (orange, lemon, pineapple, tomato) – cause stinging pain.
Carbonated drinks – fizzy drinks aggravate mouth sores.
Crunchy or hard foods (chips, crackers, toast, nuts) – difficult to chew and may hurt sores.
Hot foods and drinks – increase discomfort and worsen pain.

Sample 3-Day Diet Plan for Children with HFMD

Day 1

Breakfast: Mashed banana with soft oatmeal cooked in milk.
Mid-morning snack: Yogurt with honey (only if child is above 1 year).
Lunch: Soft khichdi with ghee.
Evening snack: Cold fruit smoothie (banana + milk).
Dinner: Mild vegetable soup with soft bread soaked in it.
Bedtime: Lukewarm milk or coconut water.

Day 2

Breakfast: Rice porridge with mashed papaya.
Mid-morning snack: Chilled applesauce or custard.
Lunch: Soft upma with well-cooked vegetables.
Evening snack: Popsicle or ice chips for relief.
Dinner: Dal soup with soft idlis.
Bedtime: Lassi or cold milkshake.

Day 3

Breakfast: Smoothie bowl with mashed avocado and yogurt.
Mid-morning snack: Cold pudding or jelly.
Lunch: Mild chicken or vegetable broth with soft rice.
Evening snack: Watermelon cubes (seedless, chilled).
Dinner: Soft khichdi with curd.
Bedtime: Coconut water or plain milk.

Tips for Parents:

Serve food lukewarm or cold, not hot.
Offer small, frequent meals to avoid overwhelming the child.
Encourage plenty of fluids to prevent dehydration.
Let the child choose what feels comfortable—don’t force eating if it’s painful.

Conclusion

Hand, Foot, and Mouth Disease is a common but usually mild viral illness that primarily affects children under 5. While it can be uncomfortable due to fever, mouth sores, and rashes, most children recover within a week or two with supportive care.

Good hygiene practices like frequent handwashing, cleaning surfaces, and avoiding close contact with infected individuals are the most effective ways to prevent HFMD. Parents and caregivers should monitor symptoms closely and seek medical care if complications arise. Although HFMD can seem concerning, especially when children are uncomfortable, remember that it is generally self-limiting and manageable at home. With awareness, prevention, and proper care, families can handle HFMD with confidence.

FAQ’s

Q. Is Hand, Foot, and Mouth Disease serious?
In most cases, HFMD is mild and resolves on its own within 7–10 days. Serious complications like viral meningitis or encephalitis are rare.

Q. How do you catch HFMD?
HFMD spreads through close contact with saliva, mucus, blister fluid, stool, or contaminated surfaces.

Q. How long does HFMD last?
Symptoms usually last 7–10 days, though the virus can remain in the body for weeks after recovery.

Q. Is HFMD contagious?
Yes, HFMD is highly contagious, especially during the first week of illness. Children should stay home until fever and blisters heal.

Q. Can adults get Hand, Foot, and Mouth Disease?
Yes, adults can contract HFMD, but symptoms are often milder compared to children.

Q. Can you get HFMD more than once?
Yes, because different viruses cause HFMD, a person can be infected multiple times by different strains.

Q. How is HFMD treated?
There is no specific cure. Treatment focuses on relieving symptoms with pain relievers, hydration, soft foods, and rest.

Q. Can children go to school with HFMD?
No, children should stay home until fever and blisters have healed to prevent spreading the virus.

Q. How do I know if my child is dehydrated?
Signs include fewer wet diapers, dry mouth, crying without tears, and unusual drowsiness.

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