No parent wants to get that call from daycare, school, or a family friend that your child’s been exposed to Hand, Foot, and Mouth Disease (HFMD). This highly contagious virus causes discomfort, often from blisters/sores and fever, and sets off alarm bells because it is difficult to prevent its spread.
Most cases of HFMD are mild and go away within a couple of weeks. Yet, there is always the risk, especially in children younger than 3 years, of severe complications. We created a guide to HFMD for parents to help clear up what HFMD is, how to treat it, and when to go to urgent care.
What Is Hand, Foot, and Mouth Disease?
Hand, Foot, and Mouth Disease is a highly contagious illness caused by more than 20 enteroviruses. Two of the more common causes of HFMD are coxsackievirus A16 and enterovirus 71.
While this illness can affect all ages, it typically affects children under 5 due to a lack of immunity to these specific viruses. Parents are more likely to find their child getting HFMD during warmer spring, summer, and early fall months, but it can hit at any time of year.
The virus is easily spread through:
- Contaminated surfaces and toys (feces or saliva)
- Feces (diaper changes)
- Fluid from the blisters
- Respiratory droplets
- Saliva (Coughing, drooling, or sneezing)
One myth we hear is that a child got it from a family pet. That doesn’t happen. The virus spreads from person to person.
Recognizing the Signs and Symptoms of HFMD
The progression of HFMD takes several days. Symptoms appear slowly, usually one at a time and not all at once.
Incubation (Days 1 to 3)
After exposure to the virus, there is an incubation period of 3 to 6 days. The first symptom is almost always a fever of 100.4°F or higher. From there, other flu-like symptoms appear.
- Fatigue
- Irritability
- Loss of appetite
- Mouth or throat pain
Mouth Sores (Days 2–4)
Within a couple of days of the fever, painful spots appear in the mouth or on the back of the throat. These spots will form fluid-filled blisters that burst, leaving open sores, and the pain makes it hard to swallow. Most children refuse food and beverages because of the pain.
Skin Rash (Days 3–5)
Mouth sores are quickly followed by a rash on the hands and feet, which is why Hand, Foot, and Mouth Disease gets its name. The rash may also appear on the buttocks, calves, elbows, groin, and knees.
Look for pain or red spots. Children with darker skin tones might have spots that look dark brown, gray, or purple instead. The rash isn’t usually itchy, but it can become slightly uncomfortable.
Tips for Managing Symptoms and Limiting the Spread
Antibiotics are not effective against viruses, so they don’t help with HFMD. You have to let the virus run its course, which can take up to 10 days. Focus on pain management, hydration, skin care, and containment.
Pain Management
Over-the-counter pain relievers for children help dull the pain and reduce fever. This makes it easier for your child to swallow and to get enough rest.
Contact your child’s pediatrician to get the proper doses for acetaminophen or ibuprofen. Dosing is always based on a child’s weight. Do not use children’s aspirin, as that can trigger a rare, serious condition known as Reye’s syndrome.
Hydration
Dehydration is the biggest risk with HFMD because the sores are incredibly painful. Aim for small, frequent sips over full glasses of liquid. Avoid citrus fruit juices, as they can irritate the open sores. Instead, try:
- Cold water
- Electrolyte beverages
- Ice chips
- Milkshakes/smoothies sweetened with bananas or applesauce instead of sugar
- Plant milks
- Popsicles
Skin Care
Any rash on the skin needs to be kept clean and dry. Don’t scrub and pop blisters, as that can release the virus-laden fluid inside and increase the risk of bacterial infection. Keep the rash clean and dry. Calamine lotion helps with mild discomfort.
Containment
Try to limit the spread of HFMD to the rest of the family. If you’re pregnant, you might want to avoid family members with HFMD. There’s usually no risk, but if you’re due to give birth any day now, there is a slight chance of passing the virus to your baby. If your baby does get it, symptoms are usually mild, but it’s best to alert your OB/GYN as soon as possible.
Containment is critical. You need to:
- Disinfect any items or surfaces that multiple people touch, such as counters, door knobs, faucets, remotes, and toilet lids.
- Keep your child from attending daycare, playgroups, or school until all blisters have healed and there’s been no fever for at least 24 hours.
- Wash hands thoroughly after changing diapers, handling shared items, or providing assistance with skin care.
HFMD Recovery and Long-Term Effects
After 10 days, the mouth sores start to heal, rashes clear up, and the fever is gone. Be prepared for two common long-term effects that may appear in the coming weeks.
- Nail Shedding: Up to 8 weeks after the virus is gone, finger or toenails may loosen and fall off. It’s a temporary, painless post-HFMD issue. Nails will grow back.
- Peeling Skin: Up to 3 weeks after the virus, skin on the hands and feet may peel. It’s part of the healing process. Use an unscented, gentle moisturizer to help keep the skin soft.
When to Go to Urgent Care
Most HFMD infections resolve at home without complications. However, there is always a small risk of complications requiring immediate care. While rare, Encephalitis and Neurogenic Pulmonary Edema (NPE) can develop and cause fatalities. The key is to seek urgent care as soon as you see any of these symptoms.
Dehydration
One of the problems with HFMD is that the sores in the mouth are painful. That can make it hard for a child to eat and drink. Dehydration is the most common reason a child with the virus goes to urgent care.
Signs of dehydration include:
- The child is crying but not producing tears.
- The child is lethargic and hard to wake up.
- A child isn’t urinating more often than every 8 hours, or an infant’s diaper is still dry after 6 hours.
- The child’s eyes or soft spot on the head appear sunken.
- The child’s lips are dry and cracked.
- A child’s mouth or tongue is dry and sticky.
Neurological or Systemic Complications
It’s very rare, but certain strains of HFMD enteroviruses (such as EV-71) cause serious complications like encephalitis (brain inflammation) or NPE (fluid in the lungs). Immediate action is necessary. Head straight to urgent care if your child has:
- Confusion or becomes hard to wake up (lethargic)
- Difficulty breathing
- Persistent fever over 103°F or a fever that lasts more than three days
- Seizures or jerking movements
- A severe headache
- A stiff neck
- Sudden loss of coordination
HFMD is certainly challenging, but it’s usually easy to treat at home with rest, fluids, and careful hygiene practices. In time, your child’s immune system successfully fights the infection.
If you feel things are worsening, Premium Urgent Care is here throughout the week, even on evenings and weekends. Walk in without an appointment and see a doctor today. Find your nearest Fresno office and its hours, and check in before you arrive to save time.