Hand, Foot, and Mouth Disease (HFMD) is a common viral infection, occurring most frequently in infants and young children, though adults can also contract it. The illness is most often caused by enteroviruses, with Coxsackievirus A16 being the most common strain in the United States. HFMD is generally a mild, self-limiting condition that resolves on its own. The disease is highly contagious, but most individuals recover completely within a short period.
The Typical Timeline of Symptoms
The full course of Hand, Foot, and Mouth Disease typically lasts about seven to ten days. The initial phase is the asymptomatic incubation period, which lasts three to seven days after exposure to the virus. Following this period, the first noticeable symptoms begin, often resembling a common cold or the flu.
The illness begins with nonspecific symptoms, including a low-grade fever, malaise, and a sore throat, which may persist for a day or two. The defining feature of HFMD appears next: painful sores developing inside the mouth, often on the tongue, gums, and cheeks. These small, red spots quickly turn into ulcers, making eating and drinking very difficult.
Shortly after the mouth sores appear, the characteristic rash develops, usually on the palms of the hands and the soles of the feet. This non-itchy rash may also appear on the buttocks or legs, presenting as flat red spots or small blisters with a reddish base. The fever usually subsides after two to four days, and the sores and blisters begin to dry up and fade within a week, marking the end of the acute phase of the illness.
Contagion Period and Clearance
Preventing the spread of Hand, Foot, and Mouth Disease requires understanding the period of infectiousness. The virus is most readily passed during the first week of illness, especially when the individual has a fever and active mouth or skin lesions. Transmission occurs through close personal contact, respiratory droplets from coughing or sneezing, and contact with blister fluid or stool.
While the period of active illness is short, the virus can continue to shed from the body for a much longer time. Viral particles can be found in the stool for several weeks and sometimes even months after all visible symptoms have disappeared. This prolonged shedding means that diligent hygiene practices, such as consistent handwashing, remain necessary even after recovery.
Children are generally considered safe to return to school or daycare once they are fever-free for a full 24 hours without the use of fever-reducing medication. Furthermore, any open blisters should be dried or healed, and the child should feel well enough to participate in normal activities. Excluding a child until all viral shedding ceases is impractical, as the risk of transmission significantly decreases once the acute symptoms are gone.
Managing Discomfort During Recovery
Since there is no specific antiviral treatment for Hand, Foot, and Mouth Disease, management focuses on supportive care to minimize discomfort until the virus runs its course. A primary concern is preventing dehydration, which occurs because painful mouth sores discourage drinking fluids. Offering small, frequent sips of cool liquids, such as water or milk, helps ensure adequate hydration.
Over-the-counter pain relievers like acetaminophen or ibuprofen can be used to reduce fever and alleviate the pain associated with the mouth sores. Caregivers should avoid giving children aspirin due to its link with Reye’s syndrome. Cold foods, such as ice cream, sherbet, or ice pops, can be soothing to the throat and mouth.
It is best to avoid acidic or spicy foods and drinks, like citrus juices or soda, as these can irritate the already painful mouth ulcers. Offering soft, easy-to-swallow foods, such as yogurt, pureed fruits, or smooth soups, helps maintain nutrition while the mouth sores are healing. Monitoring for signs of dehydration, such as decreased urination or a dry mouth, is important, and a healthcare provider should be consulted if symptoms worsen or persist beyond the typical ten-day recovery period.