What is hand, foot and mouth disease (HFMD)?
Hand, foot and mouth disease (HFMD) is a mild illness that usually clears up by itself. If your baby has it, you’ll see little sores on their hands and feet, and in their mouth, hence the name hand, foot and mouth disease. HFMD is most common in children under four years (Tidy 2021).
HFMD passes easily from person to person (NHS 2021). It spreads quickly in families, and in places where lots of young children play closely together, such as playgroups and nurseries (Tidy 2021, UKHSA 2024). Your baby can catch HFMD if someone coughs or sneezes near them, or from contact with traces of poo, saliva, or fluid from the sores (CDC 2023a, NHS 2021). If your baby catches the disease, they will be most contagious just before the symptoms appear, so it can be hard to prevent in places where babies and children mix (CDC 2023a, UKHSA 2024).
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What causes hand, foot and mouth disease?
HFMD is caused by one of a group of viruses that live in the digestive system (enteroviruses) (CDC 2023a). In the UK, HMFD is usually caused by a coxsackie virus (coxsackie A16) or a related enterovirus (enterovirus 71) (Tidy 2021). HFMD has nothing to do with foot and mouth disease, which affects farm animals (NHS 2021, UKHSA 2024).
What are the symptoms of hand, foot and mouth disease?
The most obvious symptoms are the telltale blisters, but before these appear, your baby may have:
- a sore throat
- a fever
- loss of appetite (NHS 2021, Tidy 2021)
After a few days you’ll notice the spots (NHS 2021, Tidy 2021):
- Mouth: you’ll see red spots on your baby’s tongue, and inside their mouth. The spots will turn into larger, yellow-grey blisters rimmed with red.
- Hands and feet: You’ll see small, raised red spots on your baby’s fingers, on the backs or palms of their hands, on the soles of their feet and on their toes. The spots may then turn into sore, itchy blisters with a grey centre.(NHS 2021, Tidy 2021)
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Occasionally, the spots spread to the legs, bottom and groin (NHS 2021, Tidy 2021). These look more like a red, bumpy rash than blisters (Tidy 2021). The spots may be more difficult to see on black or brown skin, particularly in the early stages. It’s best to check inside your baby’s mouth and on the palms of their hands and soles of their feet, where the skin is usually lighter (K Pahl, personal communication, 28 October, 2020, Selner 2023).Your baby may be reluctant to drink or eat because of the mouth sores (Tidy 2021). If your baby has started solids, they may also go off their food (NHS 2021, Tidy 2021).
How can I care for my baby while they have hand, foot and mouth disease?
It will probably take a week to 10 days for your baby to feel better (NHS 2021, UKHSA 2024). By then, their spots should have gone (Leong 2022, Tidy 2021).
In the meantime, your baby will probably be grizzly and hard to settle, but there are things you can do to comfort them:
- If it hurts for your baby to eat or drink, try offering smaller but more frequent feeds of their usual milk (Leong 2022). If you’re breastfeeding, your baby’s mouth blisters won’t spread to your nipples. You’re probably immune anyway. Formula-fed babies can have extra water, too (NHS 2022).
- If your baby has started solid foods, give them soft, easy-to-eat meals, such as mashed potato or soup – nothing spicy or tart, as this could sting their mouth (Tidy 2021).
- Baby teething gel may relieve your baby’s mouth blisters. Rub some gel on their gums, tongue and the insides of their cheeks where you can see sores. You can also try mouth ulcer gel, but speak to your pharmacist first about the best product for your baby (NHS 2021).
- Infant paracetamol or infant ibuprofen may help to relieve pain and reduce fever (NHS 2021). You can usually give your baby paracetamol from two months of age (NHS 2024). You can usually give ibuprofen from three months of age so long as they weigh at least 5kg (11lb) (NHS 2024). Check the packet or ask your doctor or pharmacist for advice on how much to give your baby.
After a bath, pat your baby dry, as the affected areas of skin may be tender. Try not to pop any of your baby’s blisters, as the fluid is infectious (CDC 2023a).If your baby goes to nursery or childcare, keep them at home until they feel better (NHS 2021). You don’t need to wait until the sores have disappeared to send them back (NHS 2021, UKHSA 2024), though your nursery or childminder may have their own policies.
Should I take my baby to the doctor for hand, foot and mouth disease?
You shouldn’t need to take your baby to the doctor. HFMD can’t be treated with antibiotics, because it’s a virus (NHS 2021, Tidy 2021). It just needs to run its course, however miserable it is for your baby and you. Sometimes, though, HFMD causes problems that do need a doctor’s advice. Your baby may become dehydrated if HFMD makes it too uncomfortable to drink (CDC 2023b, Tidy 2021). Take your baby to the doctor if you spot these signs of dehydration (NHS 2021, 2022):
- a sunken soft spot on their head
- drowsiness or irritability
- tearless crying
- fewer wet nappies than usual
- sunken eyes (NHS 2022)
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Keep an eye on your baby’s other symptoms too. Contact your GP surgery if:
- Your baby has a very high temperature or feels hot and shivery.
- The symptoms do not improve after seven to 10 days, such as the sores not healing or looking infected.
- You are worried about their symptoms(NHS 2021).
It’s rare for the sores caused by HFMD to become infected (secondary infection), although it can happen if your baby has scratched at them (Tidy 2021).
Your baby’s skin may peel as they recover from the sores. This usually looks worse than it feels for your baby and the sores will heal without leaving a scar (Leong 2022). However, if your baby is scratching, keep the rash, and their hands and nails clean, or put mittens or socks over the affected areas (Leong 2022). Occasionally, babies and children shed a fingernail or toenail weeks after the infection has cleared, especially if the blisters were big. This may look alarming to you, but your baby shouldn’t be bothered by it. Their nails will grow back by themselves without medical treatment (CDC 2023b, Leong 2022).
Can my baby get hand, foot and mouth disease again?
Yes. Your baby will be immune to the particular strain of virus they’ve had. But, like cold viruses, another strain of virus can come along and set off another bout of HFMD (CDC 2023a, Tidy 2021).You can help to protect your baby against getting HFMD again by being careful with hygiene. Try to stifle coughs and sneezes with a tissue, and throw away tissues after one use (NHS 2021). Wash and dry your hands and your baby’s hands often with soap and water (NHS 2021). There’s no need to use antibacterial soap. Key times to wash hands to prevent viruses like HFMD include:
- Before and after changing nappies.
- After going to the toilet.
- Before breastfeeding or formula-feeding your baby.
- Before mealtimes, if your baby has started solids.
- After touching used tissues. (NHS 2023)
I’m pregnant. Will hand, foot and mouth disease harm my unborn baby?
You’re probably immune to the various strains of the virus that usually cause HFMD. Even if you do get HFMD, it’s likely to be very mild, and your unborn baby should be unaffected (Tidy 2021). However, if you catch HFMD in the weeks before your baby’s due, see your midwife or doctor. There’s a small chance you could pass the infection to your newborn (NHS 2021, Tidy 2021). It’s likely to be a mild infection for your baby too, but it’s helpful for your medical and midwifery team to know if there’s a chance your baby could become infected (NHS 2021). To protect yourself against HFMD:
- Always wash your hands thoroughly with soap and water after going to the toilet, and after changing or handling nappies. The virus can remain live in your baby’s poo for about a month after the sores have cleared up.
- Make sure the toilet and nappy cleaning areas are kept clean.
- Wash soiled bedding or clothing on a hot wash.
- Avoid sharing cups, cutlery or towels. (NHS 2021, UKHSA 2024)
See what hand, foot and mouth disease looks like in our photo gallery of rashes and skin conditions.
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