Understanding Hand, Foot, Mouth Disease (HFMD)

What is hand, foot and mouth disease?

Hand, foot and mouth disease (HFMD) is a common contagious infection that affects young children and causes sores to form in the mouth, on the hands, feet, buttocks, and sometimes the genitals.

A related infection, called "herpangina", causes sores to form in the mouth. Both infections most often affect children, but adults can get them too.

Both herpangina and hand, foot, and mouth disease are treated the same.

What are the symptoms?

There is a prodromal (early stage) illness which is present before the rash appears and includes:

  • Malaise (feeling ‘out of sorts’)
  • Fever, usually of sudden onset
  • Sore throat
  • Poor appetite
  • Headache
  • Irritability, especially in young children

The rash appears after 1-2 days, and consists of:

  • Small red spots that progress to blisters (vesicles) and then become tender ulcers
  • Blisters in the gums of the mouth and around the mouth
  • Red lumps and blisters on the fingers and palms of the hand, and on the toes and soles of the feet
  • Blisters may also appear on the limbs, the buttocks, and also on the genitals

The sores in the mouth can make swallowing painful. It is possible to get the sores only in some areas. Not every person gets them on their hands, feet, and mouth.

How does HFMD spread?

HFMD is usually transmitted from person to person by the faecal-oral route. However, they also can be transmitted by contact with oral and respiratory secretions, and by vesicle fluid.

The incubation period is typically 3-5 days, and people with HFMD are most likely to spread the infection during the first week of their illness. However, the virus can live in their body for weeks or even months after the symptoms have gone away.

Is HFMD serious?

Usually not. Most children have a mild illness that is shortlived and usually recover in 4-6 days.

When Should I Visit the Doctor?

You should consult your doctor if your child is drinking less than usual and has not had a wet diaper for the past 4 to 6 hours (for babies and young children) or has not needed to urinate in the past 6 to 8 hours (for older children).

You should also also consult your child's doctor if your child seems to be getting worse or is not getting better after a few days.

What is the Treatment?

The infection itself is not treated and it usually goes away on its own within a few days. Medications can be given to provide symptomatic relief.

The sores in the mouth can make swallowing painful, so some children might not want to eat or drink. It is important to make sure that children get enough fluids so that they don't get dehydrated.

  • Fever and pain: Paracetamol and ibuprofen can be used (dosed according to age and weight)
  • Diet: Encourage increased fluid intake and soft foods including jelly, ice-cream, milk, cordial drinks and popsicles
  • Mouth ulcers: Avoid sour foods that can cause stinging of mouth ulcers

How to prevent HFMD?

The most important thing you can do is to wash your hands often with soap and water, even after your child is feeling better. You should teach your children to wash often, especially after using the bathroom. It is also important to keep your home clean and to disinfect tabletops, toys, and other things that a child might touch.

Should I still bring my child to school?

If your child has HFMD, do keep him or her out of school or daycare, especially if your child has a fever or does not feel well enough to go.

Ideally, the child should stay at home until all the fluid in the blisters has dried up.