Pediatric Associates of Richmond

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Hand, Foot and Mouth Disease

What is it?

Hand, foot and mouth disease (HFMD) is a viral syndrome caused by Coxsackie virus. The most common symptoms include rash, sore throat and fever. Other symptoms may include headache, cold symptoms, belly pain, loose stool and malaise. The rash is very distinct, typically looking like little red blisters. As the name the suggests, the rash is usually on the hands and feet, and in/around the mouth. However, the rash can be anywhere on the body, and won’t necessarily be on the hands or feet. Rash can last 1-2 weeks in some cases. The mouth and throat sores can be extremely painful/uncomfortable, sometimes to the point of refusal to swallow. We see cases of HFMD year round, but most are in the summer.

How does my child get HMFD?

Coxsackie virus is spread by unwashed hands, and shed from an infected person’s saliva, nasal mucous, and stool. The fluid inside the blistery rash has the virus too, but is a relatively minor contributor to contagiousness. Infants and toddlers spread this infection quickly because they like to touch/explore everything, frequently have their hands in their mouths, and are not yet able to wash their hands well enough to get rid of the germs. Parents and caretakers can get and spread the virus by not adequately washing their hands with soap and water after dirty diaper changes.

NOTE: coxsackie virus is not killed by hand sanitizer. SOAP & WATER must be used!

How long from when my child is exposed to when they show symptoms?

The incubation period for HFMD is 3-5 days.

Can I get HFMD from my child?

Yes, while we see it more commonly in young children, people of any age can get it. If your child has HFMD avoid sharing cups, straws, and eating utensils. Do not try to clean your child’s pacifier with your mouth (note: we don’t recommend this even if everyone is well). Be sure to wash your hands well with soap and water prior to eating or touching your mouth.

When can my child go back to school/daycare?

Children are generally contagious for about 5 days from the first symptom of illness. The first symptom could be fever, rash, sore throat, change in temperament or change in appetite. At minimum, the child needs to be fever-free for at least 24 hours and have no open blisters.

Is there a treatment for HFMD?

Unfortunately, no. There is no anti-viral medicine to treat coxsackie virus. Managing HFMD includes use of fever-reducers/pain-relievers such as acetaminophen (Tylenol), and emphasizing/monitoring hydration. Typically the rash is not painful or itchy, so you don’t need to put anything on it. If it does seem to itch, you can apply 1% hydrocortisone ointment (over-the-counter).

When should I call PAR?

If your child has fever and a rash simultaneously, we advise they be seen in the office to determine the underlying cause. Call if you have concerns about dehydration (e.g. dry mouth, less than 3 voids/24 hrs if 1 year or older, less than 4 voids/24 hrs if younger than 1 year, refusal to drink).