Hand, foot, and mouth disease (HFMD) is a viral illness commonly seen in kids ages 5-7 (Olarte, 2025; Zhu et al., 2023); however, it can also affect older kids and adults (Guerra et al., 2025; Hussain, 2025). HFMD typically resolves within 7 to 10 days without complications (Guerra et al., 2025).
Coxsackie Virus
HFMD is caused by several enteroviruses, including coxsackievirus (Guerra et al., 2025). Kids older than five may exhibit atypical rashes linked to coxsackievirus, like blisters or lesions on the limbs, trunk, and face. Skin blisters and lesions may be more extensive in kids with eczema in regions with prior skin barrier damage, such as sunburn, dermatitis, or skin trauma (Starkey et al., 2024).
Is Hand, Foot, & Mouth Disease contagious?
Yes! HFMD is a contagious illness commonly spread in the fall and winter via oral ingestion of infected fluid, typically from talking, coughing, or sneezing (Guerra et al., 2025), or via the fecal-oral route (Hussain, 2025). The best way to limit HFMD is to practice good handwashing skills.
Most kids develop symptoms within 3 to 6 days and are most infectious during the first week (Guerra et al., 2025; Hussain, 2025). However, the virus has been detected in stool up to several months after infection (Olarte, 2025). HFMD can recur, meaning your child can have repeat infections (Hussain, 2025).
HFMD Prevention
- Practice good hand washing skills and model behavior for little ones
- Frequently clean shared toys
- Keep sick kids home and separated from other kids to minimize the spread of the infection.
- Teach children to cover their mouths and noses when sneezing or coughing with a tissue or the sleeve of their shirt.
- Avoid sharing food, drinks, and personal items.
- Disinfect surfaces that your sick child touches.
Signs & symptoms of coxsackie infection
- High fever
- Blisters on throat, mouth, tongue, palms of hands, soles of feet
- Headache
- Muscle aches
- Sore throat
- Abdominal discomfort
- Nausea
- Mouth sores
An often-overlooked sign of HFMD is mouth sores. Mouth sores help us to differentiate a coxsackie infection from other illnesses. When determining whether or not your child has HFMD, look for sores on the outer lips. Gently pull back the upper and lower lips. Pull back the cheeks on each side and examine the inside of the cheeks with a flashlight. Shine a flashlight into the back of your child’s mouth while your child says, “ahhh.” With HFMD, you will likely see red or white spots in the throat or on the tongue.
Hand, Foot, & Mouth Signs & Symptoms
- Fever
- Muscle aches
- Headache
- Runny nose
- Sore throat
- Reduced appetite
- Abdominal discomfort
- General malaise
- Mouth or throat pain
- Rash on the hands, feet, or mouth
- In some cases, a rash on the genitals or buttocks
- Blisters or lesions on the throat, mouth, tongue, palms of hands, soles of feet, trunk, or limbs
- Nail changes
Diagnosis
PCR diagnosis of coxsackievirus and enteroviruses includes a swab of your child’s lesion (Guerra et al., 2025); however, providers can typically determine HFMD by looking at your child’s rash or lesions (Hussain, 2025).
Treatment
There is no vaccine or established antiviral treatment for hand, foot, and mouth disease (Zhu et al., 2023). Antibiotics will not fight coxsackievirus, as antibiotics only work on bacterial infections. Acetaminophen (Tylenol) will relieve some of your child’s discomfort. It’s essential to stay hydrated by drinking plenty of fluids. Kids usually recover within a few days.
Soothing Mouth Sores
- Stay hydrated!
- Soothing foods like Popsicles, slushies, or frozen juice can help reduce inflammation and help with hydration.
- Acidic or spicy foods may be painful for your child. Stick to bland, soft meals while your child gets better.
- Rinse the mouth with lukewarm salt water.
Optional Medications
- Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for pain and fever
- Benadryl: This antihistamine is available over the counter. It can reduce swelling and help your kid get some rest.
- Topical Mylanta/Benadryl/Xylocaine mix (only if age-appropriate): This is a very effective regimen that will soothe and numb the sores temporarily. The first two are over-the-counter, and the third is a prescription. A pharmacist can mix them for you. These medications should only be used by children old enough to rinse and then spit them out. Do not swallow Xylocaine.
- Acyclovir (for severe cases): This prescription antiviral ointment can be rubbed onto external sores and only works for sores on the outer lips or face. It works best if started at the first sign of a sore, typically as soon as it begins to itch.
When To Contact My Pediatric Healthcare Provider
- You suspect that your child is dehydrated (lethargy, dry mouth, fewer tears or wet diapers, sunken eyes, sunken soft spot in infants, dark urine)
- Severe lethargy
- Lesions last longer than two weeks
- A fever higher than 100.7°F for infants younger than one month or higher than 103.5°F for older kids if they aren’t responding to fever reducers.
- A fever has lasted for more than 3 days.
Due to the contagious nature of HFMD, if your child is diagnosed with HFMD, be sure to let their school, daycare, or other families who have been in contact know.
Finally, don’t confuse hand-foot-mouth with hoof-and-mouth disease, common in farm animals. Humans can’t get the hoof-and-mouth disease from animals, and animals cannot get hand, foot, and mouth disease from humans.
