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PediatricICD-10: B08.4Very common in children under 5; causes millions of infections worldwide annually

Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is a common, highly contagious viral illness primarily affecting infants and children under 5 years old, though older children and adults can also be infected. It is most commonly caused by coxsackievirus A16 and enterovirus 71, and is characterized by a distinctive combination of mouth sores and a rash on the hands and feet. HFMD typically occurs in summer and early fall and usually resolves on its own within 7-10 days.

Symptoms

Fever (usually the first symptom)
Sore throat and painful mouth sores (herpangina) on the tongue, gums, and inner cheeks
Reduced appetite due to mouth pain
Red spots or small blisters on the palms of the hands and soles of the feet
Rash on the buttocks, knees, or elbows in some cases
Irritability in infants and toddlers
General malaise and fatigue

Causes

  • Coxsackievirus A16 (most common cause in the U.S.)
  • Enterovirus 71 (associated with more severe disease and neurological complications)
  • Other enteroviruses including coxsackievirus A6 and A10
  • Spread through direct contact with nasal secretions, saliva, blister fluid, or stool

Risk Factors

  • Age under 5 years (highest susceptibility)
  • Attendance at daycare centers or schools (close contact environments)
  • Weakened immune system
  • Season (summer and early fall outbreaks are most common)
  • Poor hand hygiene practices

Diagnosis

  • Clinical diagnosis based on the characteristic combination of fever, mouth sores, and hand/foot rash
  • Physical examination of the rash distribution pattern
  • Throat swab or stool sample for viral PCR testing in atypical or severe cases
  • No routine laboratory testing is typically needed

Treatment

  • Acetaminophen or ibuprofen for fever and pain relief
  • Topical oral anesthetics (viscous lidocaine) for mouth sore pain
  • Cold foods such as ice pops, yogurt, and smoothies to soothe mouth pain
  • Adequate fluid intake to prevent dehydration
  • Magic mouthwash (mixture of antacid, diphenhydramine, and lidocaine) for older children
  • Supportive care (the illness is self-limiting)

Prevention

  • Frequent handwashing with soap and water, especially after diaper changes
  • Disinfect commonly touched surfaces and toys
  • Avoid close contact with infected individuals
  • Keep infected children home from daycare or school until fever resolves and mouth sores heal
  • Teach children proper hand hygiene and cough/sneeze etiquette

When to See a Doctor

  • Your child is unable to drink fluids or shows signs of dehydration
  • Fever lasts more than 3 days or exceeds 102°F (39°C)
  • Symptoms worsen after the first few days instead of improving
  • Your child develops stiff neck, severe headache, or unusual irritability

Frequently Asked Questions

Related Conditions

Cellulitis

Infectious

Acne Vulgaris

Dermatological

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