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Pediatric - Hand, Foot, Mouth Disease

Hand-foot-mouth disease

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Does this describe your child's symptoms?

  • A viral infection that causes mouth ulcers and tiny blisters on the hands and feet


  • Small painful ulcers in the mouth, especially on tongue and sides of mouth (in all children)
  • Small, thick-walled water blisters (like chickenpox) or red spots located on the palms, soles, and webs between the fingers and toes (70%)
  • 1 to 5 water blisters per hand or foot
  • Small blisters or red spots on the buttocks (30%)
  • Low-grade fever less than 102° F (39° C)
  • Mainly occurs in children age 6 months to 4 years


  • Coxsackie A-16 virus
  • Not related to animal disease

Return to School

  • Can return to daycare or school after the fever is gone (usually 2 to 3 days). The rash is not contagious.

If not, see these topics

When to Call Your Doctor

Call Your Doctor Now (night or day) If
  • Your child looks or acts very sick
  • Signs of dehydration (e.g., very dry mouth, no tears, no urine in more than 8 hours)
  • Stiff neck, severe headache or acting confused (delirious)
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen
  • Red, swollen and tender gums
  • Fever present for more than 3 days
Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
Parent Care at Home If
  • Probable hand-foot-mouth disease and you don't think your child needs to be seen

  1. Reassurance: Hand-foot-mouth disease is a harmless viral rash.
  2. Liquid Antacid for Mouth Pain:  
    • Use a liquid antacid 4 times per day.
    • For younger children, put ½ teaspoon in the front of the mouth 4 times per day after meals.
    • Children over age 4 can use 1 teaspoon as a mouthwash after meals.
  3. Soft Diet:
    • Encourage favorite fluids to prevent dehydration.
    • Cold drinks, milkshakes, popsicles, slushes, and sherbet are good choices.
    • Avoid citrus, salty, or spicy foods.
    • For infants, give fluids by cup, spoon or syringe rather than a bottle. (Reason: The nipple can cause pain.)
    • Solid food intake is not important.
  4. Fever Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen for fever above 102° F (39° C) or severe mouth pain.
  5. Contagiousness:  Quite contagious but a mild and harmless disease. Incubation period is 3-6 days.  Can return to daycare or school after the fever is gone (usually 2 to 3 days). The rash is not contagious.
  6. Expected Course:  The fever lasts 2 or 3 days.  The mouth ulcers resolve by 7 days. The rash on the hands and feet lasts 10 days.
  7. Call Your Doctor If:
    • Signs of dehydration develop
    • Fever present over 3 days
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 1/19/2009

Last Revised: 10/1/2006

Content Set: Pediatric HouseCalls Online

Copyright 1994-2009 Barton D. Schmitt, M.D.

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