Symptoms

• Small painful ulcers in the mouth. Look for them on the tongue and sides of mouth. 100% of children with HFMD have these.
• Small, thick-walled water blisters OR red spots on the hands and feet. Occurs on palms, soles, and webs of the fingers and toes. This happens in 70% of children.
• 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

Cause

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

Severe Form of Hand Foot and Mouth Disease (HFMD)

• In 2012, a severe form of HFMD occurred in much of the world. It’s caused by a new Coxsackie A6 virus.
• The rash spreads to the arms, legs and face (but not the trunk). The rash is made up of many small blisters.
• Children with such a severe rash usually need to be seen. Reason: To confirm the diagnosis. Exception: They were exposed to HFMD within the last 7 days.
• Treatment is the same. Drink enough fluids to prevent dehydration.
• Peeling of the fingers and toes is common. It looks bad but is harmless. It happens at 1 to 2 weeks. Use a moisturizing cream on the raw skin.
• Some fingernails and toenails may fall off. It occurs in 4% of severe cases. It happens at 3 to 6 weeks out. Trim them if they catch on things.
• Fingernails grow back by 3 to 6 months and toenails by 9 to 12 months. They will look normal.

Return to School

• Can return to child care or school after the fever is gone. Most often, this takes 2 to 3 days.

1. What You Should Know:
   • Most often, hand-foot-and-mouth disease (HFMD) is a harmless rash.
   • It is caused by a virus called Coxsackie.
   • Here is some care advice that should help.
2. Liquid Antacid for Mouth Pain:  
   • For mouth pain, use a liquid antacid such as Mylanta or the store brand. Give 4 times per day as needed. After meals often is a good time. Age: For children over 1 year old.
   • For children over age 6, can use 1 teaspoon (5 ml) as a mouth wash. Keep it on the ulcers as long as possible. Then can spit it out or swallow it.
   • For younger children age 1 to 6, put a few drops in the mouth. Can also put it on with a cotton swab.
   • Caution: Do not use regular mouth washes, because they sting.
3. Soft Diet:
   • Try to get your child to drink adequate fluids.
   • Goal: Keep your child well hydrated.
   • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
   • Solids. Offer a soft diet. Also avoid foods that need much chewing. Do not give citrus, salty, or spicy foods. Note: Fluid intake is more important than eating any solids.
   • For babies, you may need to stop the bottle. Give fluids by cup, spoon or syringe instead. Reason: The nipple can increase the pain.
4. Pain Medicine:
   • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed. See Dose Table.
5. Fever:
   • For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. See Dose Table. Note: Lower fevers are important for fighting infections.
   • For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.
   • For babies, dress lightly. Don't wrap in too many blankets. Reason: Can make the fever higher.
6. Return to School:  
   • HFMD is easily spread to others.
   • However, it's a mild and harmless illness.
   • After contact with HFMD, children come down with symptoms in 3-6 days.  
   • Can return to child care or school after the fever is gone. Most often, this takes 2 to 3 days.
7. What to Expect:  
   • Fever lasts 2 or 3 days.
   • Mouth ulcers should go away by 7 days.
   • Rash on the hands and feet lasts 10 days. The rash on the hands and feet may then peel.
8. Call Your Doctor If:
   • Signs of dehydration occur
   • Fever lasts more than 3 days
   • Your child becomes worse