Hand-Foot-and-Mouth Disease

Hand-foot-and-mouth disease is a common viral infection that mainly affects babies and young children, though older children and adults can catch it too. It is named after its most recognisable features: sores in the mouth and a rash on the hands and feet.

It is not related to foot-and-mouth disease in farm animals, which is a completely different illness. In children, hand-foot-and-mouth disease is usually mild and gets better without any specific treatment.

The illness often starts with a fever, a sore throat and a child feeling generally unwell and off their food. Within a day or two, small red spots or blisters appear, classically inside the mouth and on the tongue, and on the palms of the hands and soles of the feet. The rash can also show up on the buttocks, legs and around the nappy area.

The mouth ulcers can be painful and are often the part that bothers a child most, sometimes making them reluctant to eat or drink. Most children are not seriously unwell, and the spots usually fade over a week or so. In some cases, fingernails or toenails may flake or come off a few weeks later, which is harmless and they grow back.

Hand-foot-and-mouth disease is caused by viruses, most commonly coxsackievirus and other enteroviruses. It spreads very easily through coughs and sneezes, contact with the fluid from blisters, and through the stool, for example during nappy changes.

It is most contagious in the first few days of illness, but the virus can still be passed on for some time after a child feels better. Frequent, thorough handwashing is the single most effective way to reduce spread.

A doctor can almost always diagnose hand-foot-and-mouth disease by looking at the rash and mouth sores and asking about the symptoms. The pattern of spots on the hands, feet and mouth is very recognisable, so tests are rarely needed.

Laboratory tests are only used occasionally, for example if the diagnosis is unclear or during an outbreak in a nursery or school.

There is no specific medicine to cure hand-foot-and-mouth disease, so care is about keeping your child comfortable while it passes. Offer plenty of fluids in small, frequent amounts, and choose soft, cool foods such as yoghurt or smoothies that are gentle on a sore mouth. Avoid acidic, spicy or salty foods that can sting. Paracetamol or ibuprofen can ease a fever and mouth pain when given at the correct dose for your child's age and weight.

Do not give aspirin to children. Antibiotics do not help because the cause is a virus. Most children manage well at home and do not need to see a doctor.

Contact a doctor if your child is not drinking and shows signs of dehydration, such as far fewer wet nappies, a dry mouth, no tears when crying, or being unusually sleepy or irritable. Also seek advice if the fever is very high or lasts more than a few days, the symptoms get worse rather than better after 7 to 10 days, or your child is very unwell.

Seek urgent care if your child becomes very drowsy or floppy, has a stiff neck, a severe headache, or any difficulty breathing. Serious complications are rare, but these signs always need prompt assessment.

Because it spreads so easily, hygiene is the key to prevention. Wash hands thoroughly with soap and water after using the toilet, changing nappies and before preparing food, and help young children wash their hands too. Avoid sharing cups, cutlery, towels and toys while anyone is ill, and clean and disinfect shared surfaces and toys.

Keep your child home from nursery or school while they feel unwell or have a fever. There is no need to wait for every blister to disappear, but staying home during the most contagious early days helps protect others.

The outlook is very good. Almost all children recover fully within 7 to 10 days with simple home care, and most have only mild symptoms. Serious complications are uncommon.

Because several different viruses can cause it, a child can catch hand-foot-and-mouth disease more than once. Later infections are usually mild, and lasting effects are rare.