Hand, foot and mouth disease: what parents need to know
Last updated September 3, 2026.
Hand, foot and mouth disease is a common, usually mild childhood virus that looks alarming and mostly needs time, fluids, and pain relief. Caused by coxsackieviruses, it sweeps through nurseries and preschools, mainly hitting children under 10. It is unrelated to foot-and-mouth disease of farm animals, despite the name. Most children are better within 7-10 days.
What does it look like?
It usually starts with 1-2 days of fever, a sore throat, and a child off their food. Then the signature: small red spots and blisters on the palms and soles, sometimes on the buttocks and around the mouth, plus painful ulcers on the tongue, gums, and inside the cheeks. The mouth pain is the main practical problem, because it stops children drinking. Some children get only the mouth ulcers, others only the spots. Fingernail and toenail changes (lines or temporary nail shedding) can appear 3-4 weeks later; they regrow normally and need nothing.
How contagious is it?
Very, through saliva, nasal mucus, blister fluid, and feces. It is most contagious in the first week, but the virus keeps shedding in stool for several weeks, which is why nursery outbreaks smolder. Children can return to nursery or school once they feel well enough and have no fever; there is no need to wait for every spot to fade, and excluding them longer does not meaningfully stop spread because of the prolonged stool shedding. Hand washing after diaper changes and before food is the control measure that actually works.
What actually helps?
- Keep them drinking: this is the whole ballgame. Cold fluids, ice pops, and milkshakes go down easier than acidic juices. Watch for wet diapers or urination at least every 6-8 hours.
- Pain and fever relief: acetaminophen or ibuprofen at standard pediatric doses. Ibuprofen works better for mouth pain in many children. No aspirin under 16.
- Soft, bland food: yogurt, mashed potato, pasta, ice cream. Skip salty, spicy, or acidic foods that sting the ulcers.
- No antibiotics: it is a virus. Antibiotics do nothing unless a bacterial skin infection complicates the blisters.
- Adults can catch it too: usually milder, but parents and pregnant women should be careful with hygiene; tell your midwife or doctor if you are pregnant and exposed, especially near term.
When is it an emergency?
The emergency is dehydration: a child who will not drink anything, has had no wet diaper or urination for 8 hours or more, is listless, or has a dry mouth with no tears needs same-day assessment, and some need hospital fluids. Also seek urgent care for a fever over 39C (102.2F) lasting more than 3 days, a stiff neck, severe headache, or unusual drowsiness (rare complications), blisters that become red, warm, and oozing pus, or any symptoms in a baby under 1 month. Pymander's escalation routing is built and tested specifically for this class of decision; see the safety architecture working paper.
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Common questions
When can my child go back to nursery or school?
Once they feel well enough to take part and have no fever. Official guidance (including the NHS) does not require the rash to be gone, because children shed the virus in stool for weeks after recovery, so keeping a well child home until every spot fades changes nothing for other families. Individual nurseries sometimes have stricter policies, so check theirs. The exceptions: keep them home while they have fever, feel unwell, or drool uncontrollably from mouth pain.
Can adults get hand, foot and mouth disease?
Yes. Most adults had it (or the related viruses) as children and carry some immunity, so adult cases are less common and usually milder, but parents do catch it from their children, sometimes with impressively painful mouth ulcers. The same care applies: fluids, pain relief, time. Pregnant women exposed late in pregnancy should mention it to their midwife, mainly so the team is aware around delivery.
Is hand, foot and mouth the same as foot and mouth disease in animals?
No, they are completely different diseases with confusingly similar names. Human hand, foot and mouth disease is caused by coxsackieviruses and other human enteroviruses. Foot-and-mouth disease is a livestock virus of cattle, pigs, and sheep that does not infect humans. You cannot catch one from the other, and a child with hand, foot and mouth poses no risk to animals and vice versa.
How long does hand, foot and mouth last?
The typical course: 1-2 days of fever and sore throat, then spots and mouth ulcers that peak around days 3-5 and fade by day 7-10. Mouth pain is usually the last symptom to settle. Nail changes, when they happen, show up 3-4 weeks after the illness and resolve on their own as the nail grows out. A child still unwell or feverish beyond 10 days should be checked for complications or a different diagnosis.
Can you get hand, foot and mouth disease twice?
Yes. Several different viruses cause it (coxsackievirus A16 and enterovirus 71 are the classics, but there are others), and immunity to one does not protect against the rest. Children can genuinely get it more than once, though repeat bouts are often milder. It is also possible for a second episode to be a different lookalike illness entirely, which is worth mentioning if the pattern seems off.
Do the spots need cream or treatment?
No. The skin spots and blisters need nothing: no creams, no popping, no antiseptics. They do not usually itch or hurt (the mouth ulcers are the painful part), and they heal without scarring on their own. The only skin care needed is watching for signs of bacterial infection from scratching or broken blisters: increasing redness, warmth, swelling, or oozing, which would then need a clinician's look and possibly antibiotics.
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