Hand, Foot, and Mouth Disease (Child)

Hand, foot, and mouth disease (HFMD) is an illness caused by a virus. It's usually seen in young children. This virus causes small sores in the throat, lips, cheeks, gums, and tongue. Small blisters or red spots may also appear on the palms (hands), diaper area, and soles of the feet. The child usually has a low-grade fever and poor appetite. HFMD is not a serious illness and usually goes away in 1 to 2 weeks. The painful sores in the mouth may prevent your child from eating and drinking.

It takes 3 to 5 days for the illness to appear in an exposed child. Generally, HFMD is most contagious during the first week of the illness. Sometimes children can be contagious for days or weeks after the symptoms have disappeared.

HFMD can be passed from person to person by:

  • Touching your nose, mouth, or eye after touching the stool of a person who has the virus

  • Touching your nose, mouth, or eye after touching fluid from the blisters or sores of an infected person

  • Respiratory droplets from sneezing, coughing, or blowing your nose

  • Touching contaminated objects such as toys or doorknobs

  • Oral droplets from kissing

To prevent the spread of the virus, be sure to wash your hands with soap and water for at least 20 seconds. Or use an alcohol-based hand sanitizer if no soap and water are available. Always wash your hand before and after taking care of someone who is sick, before, during, and after preparing food, before eating, after using the toilet, after changing diapers, after sneezing or coughing, and after blowing your nose. Help children to learn how to correctly wash their hands.

Home care

Mouth pain

Unless your child's healthcare provider has prescribed another medicine for mouth pain:

  • You can give acetaminophen or ibuprofen to ease pain, discomfort, or fever. But talk with the provider before giving your child either of these medicines. Ask about how much to give and how often. Don't give ibuprofen to a baby 6 months of age or younger. Also talk with your child's provider before giving these medicines if your child has chronic liver or kidney disease or ever had a stomach ulcer or gastrointestinal bleeding. Never give aspirin to anyone under 18 years of age who has a fever. It may cause Reye syndrome or death.

  • You can give liquid rinses to a child older than 12 months of age. Ask your child's healthcare provider for instructions.

Feeding

Follow a soft diet with plenty of fluids to prevent dehydration. If your child doesn't want to eat solid foods, it's OK for a few days, as long as they drink lots of fluid. Cool drinks and frozen treats such as sherbet are soothing and easier to take. Don't give your child citrus juices such as orange juice or lemonade, or salty or spicy foods. These may cause more pain in the mouth sores.

Return to daycare or school

Children may usually return to daycare or school once the fever is gone and they are eating and drinking well. Contact your healthcare provider and ask when your child is able to return to daycare or school.

Follow up

Follow up with your child's healthcare provider, or as advised.

When to seek medical advice

Call your child's healthcare provider right away if any of these occur:

  • Your child complains of pain in the back of the neck, or is difficult to arouse

  • Your child has a severe headache or continued vomiting

  • Your child is having trouble breathing

  • Your child is drowsy or has trouble staying awake

  • Your child is having trouble swallowing

  • Your child still has mouth sores after 2 weeks

  • Your child's symptoms are getting worse

  • Your child appears to be dehydrated. Signs are dry mouth, no tears, and no pee 8 or more hours.

  • Your child has a fever (see Fever and children, below)

Call 911

Call 911 if any of these occur:

  • Unusual fussiness, drowsiness, or confusion

  • Severe headache or vomiting that continues

  • Trouble breathing

  • Seizures

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

  • Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

  • Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

  • Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

  • Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

  • Mouth (oral). Don’t use a thermometer in your child’s mouth until he or she is at least 4 years old.

Use the rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell him or her which type you used.

Below are guidelines to know if your young child has a fever. Your child’s healthcare provider may give you different numbers for your child. Follow your provider’s specific instructions.

Fever readings for a baby under 3 months old:

  • First, ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead: 100.4°F (38°C) or higher

  • Armpit: 99°F (37.2°C) or higher

Fever readings for a child age 3 months to 36 months (3 years):

  • Rectal, forehead, or ear: 102°F (38.9°C) or higher

  • Armpit: 101°F (38.3°C) or higher

Call the healthcare provider in these cases:

  • Repeated temperature of 104°F (40°C) or higher in a child of any age

  • Fever of 100.4° F (38° C) or higher in baby younger than 3 months

  • Fever that lasts more than 24 hours in a child under age 2

  • Fever that lasts for 3 days in a child age 2 or older

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