Hand, Foot, and Mouth Disease (HFMD) is a common viral infection that primarily affects infants and children younger than five years old. This highly contagious illness is most frequently caused by Coxsackievirus A16, though other enteroviruses can also be responsible. HFMD is typically a mild condition, but it causes painful sores in the mouth and a characteristic rash on the hands and feet. While the diagnosis can be alarming for parents, the illness is usually self-limiting, and the main concern is understanding the duration and recovery timeline.
The Typical Course of Hand, Foot, and Mouth Disease
HFMD follows a generally predictable timeline. The incubation period typically lasts between three and six days after exposure to the virus. During this time, the virus is replicating inside the body, but no outward signs of illness are present.
The acute phase begins with flu-like symptoms, including fever, sore throat, and reduced appetite. This initial stage often lasts for one to three days before distinctive symptoms appear. A day or two after the fever starts, painful blister-like lesions form in the mouth, often on the tongue, gums, and cheeks.
The characteristic skin rash then follows, appearing as flat or raised red spots that can develop into small blisters, usually on the palms and soles of the feet. Most people recover fully from acute symptoms within seven to ten days of onset. The rash can take up to ten days to completely disappear, and peeling of the skin on the fingers and toes may occur one to two weeks later.
Guidelines for Contagion and Isolation
The period of contagiousness is slightly longer than the physical symptoms. An infected person is most contagious during the first week of the illness, which includes the time just before the rash appears and while the fever is present. Transmission occurs through close contact, respiratory droplets from coughing or sneezing, and contact with blister fluid or feces.
The virus can continue to shed in the stool for several weeks, even after all visible symptoms have resolved. Public health guidelines for returning to school or daycare focus primarily on the acute symptoms. Most children are permitted to return once their fever has been gone for 24 hours without the use of fever-reducing medication and they feel well enough to participate in activities.
A residual rash or non-weeping sores are generally not a reason for continued exclusion, though policies vary by facility. Proper hygiene, particularly thorough handwashing, remains the most effective way to prevent transmission during the entire period of viral shedding.
Strategies for Symptom Management at Home
Since HFMD is caused by a virus, there is no specific cure, and care focuses on managing discomfort until the illness runs its course. Managing pain and fever can be achieved using over-the-counter medications such as acetaminophen or ibuprofen. These medications help lower the fever and reduce the pain associated with mouth sores, making eating and drinking more tolerable.
Maintaining adequate hydration is a concern, as painful mouth sores can cause children to refuse to drink. Offering cold liquids, ice pops, or soft, bland foods can help soothe the mouth and encourage fluid intake. It is best to avoid acidic and spicy foods and beverages, such as citrus juices or soda, which can irritate the raw sores.
Good hygiene practices limit the virus’s spread within the household. Frequent handwashing with soap and water for at least 20 seconds is important for both the infected person and caregivers, especially after using the toilet or changing diapers. Cleaning and disinfecting frequently touched surfaces and shared objects also helps prevent the spread of the virus.
Signs That Warrant a Doctor’s Visit
While HFMD is usually a mild illness, certain signs indicate that the infection may be more severe or that complications are developing. The most common complication to monitor is dehydration, signaled by a decrease in urination, excessive lethargy, or a dry mouth and tongue. If a child is unable or unwilling to drink any fluids, medical attention should be sought immediately.
A high fever that lasts longer than three days, or symptoms that do not begin to improve after ten days, also warrant a visit to a healthcare provider. Though rare, severe complications such as viral meningitis or encephalitis can occur. Signs of neurological involvement, including severe headache, neck stiffness, confusion, or seizures, require immediate emergency care.