Hand, foot, and mouth disease is a viral illness that most often affects children under age 5, although older children and adults may occasionally be affected. It is caused by viruses in the enterovirus family, most often coxsackie virus A16. Because it is highly contagious, hand, foot, and mouth easily spreads at childcare facilities. The exact incidence is not known because the illness is so common, and the recovery is almost always uneventful. In the US, cases of hand, foot, and mouth peak in the summer and fall months of the year.
People may contract hand, foot, and mouth via close contact with an infected person. The virus spreads specifically through contact with the respiratory secretions or feces of an affected individual, and it may also spread by contact with infected surfaces.
The incubation period (time from exposure until the start of the illness) is typically three to six days. The first symptoms may be mild fever and fatigue although some people do not have these symptoms. The mouth sores and characteristic rash often develop a day or two after the onset of fever. For most people, the illness is self-limited, and the rash and mouth sores resolve within a week.
Symptoms and Duration
Hand, foot, and mouth is diagnosed based upon the symptoms and the characteristic rash. No testing is needed. The symptoms of hand, foot, and mouth may include:
Skin peeling: When hand, foot, and mouth is resolving, the skin on the tips of the fingers and toes may begin to peel. Peeling is generally painless, requires no specific intervention, and resolves without scarring.
Because hand, foot, and mouth disease is caused by a virus, antibiotics are not helpful. The illness must run its course. Comfort care may include fever reducers or pain relievers such as acetaminophen or ibuprofen. Of note, aspirin should be avoided in children. The rash requires no specific treatment as it will resolve spontaneously.
Discomfort due to the mouth sores is the most frequent complaint from hand, foot, and mouth. Foods which are spicy, acidic (citrus juices) or salty may cause increased pain. Cool liquids or foods and drinks that are basic (such as milk) rather than acidic may provide relief. Over-the-counter oral pain relievers may be enough to alleviate the pain, but, if they are ineffective, the pediatrician can offer other strategies to help.
While mouth sores are present, it is important to maintain good hydration. Children should be offered frequent sips of liquids. It is normal for a child’s food intake to decrease during the early days of hand, foot, and mouth. In an otherwise healthy child who is accepting liquids well, this is not generally a concern as the appetite will improve when the illness begins to resolve.