Hand-foot-and-mouth disease is a common illness of infants and children. In infants, it starts with fever, fussiness, and poor appetite. Within 2–3 days, painful sores develop in the mouth. A skin rash can also develop shortly after appearance of the mouth sores, usually restricted to the hands and soles of the feet. This disease appears suddenly (acute) and will go away by itself without any treatment (self-limited), usually lasting for a total of 7–10 days. Hand-foot-and-mouth disease is caused by viruses of the enterovirus group, particularly coxsackievirus A16. This virus is highly contagious and is spread from person to person by direct contact with secretions from the nose or mouth or from stool. Outbreaks of hand-foot-and-mouth disease occur more frequently in summer and early fall. Infants in day care often spread it to one another.
While complications associated with hand-foot-and-mouth disease are rare, they can occur. These include infection of the brain, in which case the infant would need to be hospitalized.
Who's At Risk
While anyone can be infected with the virus that causes hand-foot-and-mouth disease, it is mostly children under 10 years of age that display symptoms of the disease. Infants do not usually become infected more than once since they develop immunity to the disease from the first infection, but because there are multiple viruses that cause hand-foot-and-mouth disease, the child may still develop similar symptoms from a related virus.
Signs and Symptoms
Hand-foot-and-mouth disease begins with fever up to 101 degrees Fahrenheit, sore throat, sore mouth, cough, headache, fatigue, loss of appetite, and occasionally joint pain. After 1–2 days, a rash appears.
Small red areas of the lining of the mouth, tongue, gums, or throat develop into blisters and rapidly form open sores (ulcerations). Lesions develop a shallow, yellow-gray base and a red surrounding area. Lesions on arms and legs (extremities) begin as flat red spots that produce oval or football-shaped blisters, surrounded with red coloration. Hand and foot lesions are common on the sides and backs of the fingers and toes. Palms and soles may also be affected.
The skin lesions may be painful.
In about a week the rash will disappear and your child will feel better.
Hand-foot-and-mouth disease is a self-limited viral infection, so it only needs to be treated for bothersome symptoms.
The virus may be present in a person's stool for 1 month. Be careful to avoid passing the infection to other people. Wash your hands and your child's hands frequently, particularly after using the bathroom, doing diaper changes, and before eating.
Although most pregnant women who become infected with hand-foot-and-mouth disease have no symptoms or just a mild illness, a woman infected shortly before delivery could pass the infection to her baby, who may become very ill. Therefore, any infected child should avoid contact with pregnant women, particularly in late pregnancy.
You may choose to keep your child out of school or day care, but it is not clear this will prevent others from becoming infected, as the illness probably infected others before symptoms were noticed.
Acetaminophen (Tylenol®) or ibuprofen may be used for fever and pain. (Do not use aspirin for children under 12.)
Be sure your child drinks plenty of fluids to stay well hydrated. Your child may tolerate cold milk products better than fruit juices.
When to Seek Medical Care
See your child's doctor if fever is present and not brought down to normal by medication; if your child has a severe headache, stiff neck, irritability, reduced awareness (lethargy); or if your child appears very ill.
Treatments Your Physician May Prescribe
Blood tests and procedures to identify the cause of the infection (cultures) are not usually done. If the doctor is concerned that the child might be infected with streptococcus bacteria (strep infection), a throat culture may be done.
Antibiotics do not help. Usually the doctor will only recommend that you give the child fluids and something to relieve pain.
Bolognia, Jean L., ed. Dermatology
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Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine
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