Your child has suddenly developed red spots on their hands, small blisters in their mouth, and refuses to eat. Could it be hand, foot, and mouth disease? This common childhood illness often worries parents, but it is almost always completely harmless.

Here is a reassuring and complete guide to hand, foot, and mouth disease (HFMD) in children and babies — from the first symptom to full recovery.

What is hand, foot, and mouth disease?

Hand, foot, and mouth disease (HFMD) is a common viral infection that affects children, particularly those under 5 years old. The illness is caused by enteroviruses, most often Coxsackievirus Group A (especially type A16) or Enterovirus 71.

The disease is most common in late summer and fall, and often causes outbreaks in daycare settings. It is highly contagious but usually mild and resolves on its own within about a week.

Hand, foot, and mouth disease is not the same as foot-and-mouth disease (which affects livestock). Despite the similar name, these are two completely different illnesses — one affects humans and the other affects animals.

Who gets it?

Children under 5 are most susceptible, but older children and adults can also be infected. Adults often have milder symptoms or no symptoms at all. After an infection, a person becomes immune to that specific virus strain, but can be reinfected by a different enterovirus type.

Symptoms of hand, foot, and mouth disease

The illness has a typical course with recognizable signs. Symptoms usually appear in this order:

Early signs (days 1–2)

Moderate fever — usually 100.4–102.2°F (38–39°C)
Sore throat and mouth pain — baby or child may become fussy and irritable
Reduced appetite — eating and drinking are painful
General feeling of being unwell — the child seems tired and off

Rash and blisters (days 2–4)

After 1–2 days of fever, most children develop the characteristic rash:

In the mouth — red spots and small, painful blisters (aphthous-like sores) on the tongue, inside the cheeks, and on the gums
On the hands — small red spots with blisters, especially on the palms and along the fingers
On the feet — similar rash on the soles of the feet and toes
Possibly on the buttocks and thighs — some children develop a rash there too

The blisters are usually 2–5 mm in size, gray-white with a red border, and may be tender.

The rash on the hands and feet usually does not itch. The blisters in the mouth, however, are often painful and are the main reason children refuse to eat or drink.

Symptoms in babies

Infants can be harder to assess because they cannot say where it hurts. Watch for:

Refuses the breast, bottle, or pacifier
More drooling than usual
Fussy, irritable, and hard to settle
Rash on hands, feet, or around the mouth
Fever

Transmission and incubation period

How does it spread?

HFMD spreads in several ways:

Direct contact — through nasal and throat secretions (mucus, saliva)
Fecal-oral route — through stool (e.g., during diaper changes)
Respiratory droplets — possible through coughing and sneezing
Indirect contact — via toys, doorknobs, and other surfaces contaminated with the virus

Incubation period

The incubation period is approximately 3–7 days. This means your child may have been exposed up to a week before symptoms appeared.

How long is the child contagious?

The child is most contagious in the days just before and just after symptoms begin. However, the virus can be shed in stool for 4–6 weeks after the child appears to have recovered. Good hand hygiene after diaper changes is therefore important long after the child looks well.

Home treatment

There is no specific treatment for HFMD. The illness is caused by a virus, so antibiotics have no effect. Treatment focuses on relieving symptoms while the body fights the virus.

Pain relief and fever reduction

Acetaminophen (Tylenol/Panadol) — given according to your child's weight and age. Relieves mouth pain and reduces fever.
Ibuprofen (Motrin/Advil) — can be used from 3 months of age (over 12 lbs / 5 kg) if acetaminophen is not providing enough relief.

Give pain relief 15–20 minutes before a meal so your child is more comfortable eating and drinking when the pain medication takes effect.

Make sure your child stays hydrated

The most important thing you can do is ensure your child drinks enough. Blisters in the mouth make swallowing painful, and dehydration is the most common complication.

Tips for fluid intake:

Cold drinks — cold water, cold milk, or cooled herbal tea can soothe the pain
Frozen treats — frozen juice pops or yogurt pops cool the mouth and provide fluids at the same time
Soft food — yogurt, smoothies, cold oatmeal, or pureed food is easier to swallow
Avoid acidic food — orange juice, tomato sauce, and spicy food can irritate the sores
Small sips often — better than large amounts infrequently

General care

Let your child rest as needed
Dress your child lightly if they have a fever
Do not pop the blisters — they will dry up on their own
Wash hands thoroughly after diaper changes and toilet visits

When should you contact a doctor?

HFMD is usually harmless and does not require a doctor's visit. But in some situations, medical attention is warranted.

Contact your pediatrician or seek urgent care if:

Your child is drinking very little — signs of dehydration: dry lips, few wet diapers (dry diaper for over 6 hours), sunken eyes, lethargy
Your child is under 3 months old with a fever above 100.4°F (38°C)
High fever above 104°F (40°C) that does not respond to acetaminophen
Fever lasting more than 3 days
Your child is very lethargic and difficult to wake
Symptoms worsen after the child seemed to be improving
Stiff neck, severe headache, or persistent vomiting

Serious complications are rare, but enteroviruses can in very rare cases cause viral meningitis or encephalitis. If you suspect this — stiff neck, severe headache, confusion, or seizures — call 911 immediately.

Daycare and time off

According to the CDC and AAP, children with HFMD do not need to be excluded from daycare based on the rash alone. The key factor is the child's overall condition:

Your child can attend daycare if they feel well, are eating and drinking adequately, and do not have a fever.
Your child should stay home if they have a fever, are tired, are in pain, and cannot participate in normal activities.

Let the daycare know about the diagnosis so they can be extra careful with hygiene. Keep in mind that the virus spreads easily in group settings, and other parents should be informed that the illness is circulating.

Prevention

There is no vaccine for HFMD widely available in most countries. Good hygiene is the most important preventive measure.

Hygiene practices that reduce transmission:

Handwashing — wash hands thoroughly with soap and water, especially after toilet visits, diaper changes, outdoor play, and before meals
Disinfect surfaces — clean toys, changing tables, and doorknobs regularly, especially during outbreaks
Avoid sharing — do not share pacifiers, bottles, cups, utensils, or towels
Cough and sneeze etiquette — teach older children to cough and sneeze into their elbow

During a daycare outbreak, it is a good idea to wash soft toys and stuffed animals at 140°F (60°C). Enteroviruses do not survive high temperatures.

Nail changes after the illness

Some children experience nail shedding or white ridges on the nails 4–8 weeks after having HFMD. This can look alarming but is completely harmless. New, healthy nails will grow back on their own and no treatment is needed.

Frequently asked questions

Can you get hand, foot, and mouth disease more than once?

Yes. You become immune to the specific virus strain you were infected with, but there are several different enteroviruses that can cause the disease. So your child can get HFMD again — but the next time it will be a different virus.

Is HFMD dangerous for pregnant women?

The risk of complications is very low. However, pregnant women who are infected shortly before delivery should inform their midwife or doctor, as newborns can be infected during birth.

Can adults get hand, foot, and mouth disease?

Yes, but adults often have milder symptoms or no symptoms at all. Adults can still transmit the virus to others, even without obvious signs of illness.

How long does the illness last?

Most children recover within 5–7 days. The fever typically resolves after 2–3 days, and the rash gradually fades over a week. Blisters in the mouth can last a little longer.

Can my child bathe normally?

Yes, regular bathing is fine. Warm water can even be soothing. Avoid public swimming pools until the rash has cleared, out of consideration for others.

Sources

CDC — Hand, Foot, and Mouth Disease (HFMD)
AAP — Enteroviral Infections in Children
WHO — Hand, Foot, and Mouth Disease Information Sheet

This article is based on current guidelines from the CDC and AAP, and was last updated March 2026. Always consult a healthcare provider if you are unsure about your child's condition.

Hand, Foot, and Mouth Disease in Children: Symptoms and Treatment