Hand Foot and Mouth Disease
Everything You Need To Know + A Secret Recipe To Cure The Pain
by Steve Silvestro, MD @zendocsteve
You can also listen to this article as a podcast in your favorite podcast app or in the player below.
As a pediatrician, I see first-hand how miserable an experience Hand-Foot-and-Mouth Disease can be for families.
This article will give you everything you need to know to recognize and treat this infection should your child get it—including the Pediatrician’s Secret Recipe for a remedy that we recommend to our patients & you can make at home.
WHAT IS HAND-FOOT-AND-MOUTH-DISEASE?
Hand-Foot-and-Mouth Disease is a viral infection that is usually caused by a virus caused coxsackievirus. It’s most common in young children, though adults can get it, as well.
In the United States, Hand-Foot-and-Mouth Disease is usually a spring & summertime virus, though it can be caught at any time of year.
And while the symptoms are often painful and frustrating, it’s usually a fairly benign illness that typically lasts about 3 to 5 days. For my Pacific readers in Japan, Korea, China, Malaysia, and Australia, however, there is one particular strain caused by a virus called Enterovirus-71 (or EV-71) that can cause some neurologic problems. For those of us in the United States, those associations have luckily been pretty rare in the last 50 years.
SIGNS & SYMPTOMS
Typically, the worst of Hand-Foot-and-Mouth Disease lasts about 3-5 days.
The most common signs and symptoms are fever, rash, and sores in the mouth. It’s important to note that a child doesn’t need to have all three symptoms to be diagnosed with Hand-Foot-and-Mouth Disease, although they often will.
Sores in the Mouth
The most common symptom that I see is the presence of sores in the mouth. These are small blisters or ulcers that can be seen on the gums, the inside of the lips, or near the back of the throat. These things hurt quite a bit & they’re the worst part of Hand-Foot-and-Mouth Disease.
In young kids, you might see that they drool more than usual because it hurts to swallow even their saliva. They might be hungry and may start to eat or drink, but as soon as the food or milk touches those sores, kids will often pop off the breast or bottle or even spit out food because of the pain.
With regard to the rash, it’s interesting because the rash is what contributes the “hand foot” part of the infection’s name, but not all children will get the rash.
The classic rash of Hand-Foot-and-Mouth Disease consists of small, red blisters on palms of the hands and the soles of the feet. (In fact, there are only a small handful of infections that will give a rash on the palms and the soles—most others might be on the back of the hands or the top of the feet, but not the palms and soles—and Hand-Foot-and-Mouth Disease is one of those few infections that will do it).
Some of us nerdy doctors joke that Hand-Foot-and-Mouth Disease should really be called “hand foot mouth and butt” because the rash can track from the feet, all the way up the legs to the buttocks. Sometimes, we’ll also see the same blistery rash around the mouth. We don’t usually see it on the torso or arms, but there was a newly recognized strain that came out a few years ago that is a bit more aggressive, and I’ve seen some kids with that who have blisters on the belly and even shoulders.
The rash can take days to weeks to resolve.
As for the fever, we typically see it in the 101-102 range, although it’s not uncommon for Hand-Foot-and-Mouth Disease to cause fevers as high as 105. (And for more on what to do about fevers, I encourage you to read this article in which I cover when you do & don’t have to worry about fevers). The fever typically sticks around for 1 to 3 days. If your child hits a 5th day of fever, then you’ll want to get in touch with your pediatrician, even if you’ve already done so earlier in the week.
Less Common Symptoms
One strange thing that you can see with Hand-Foot-and-Mouth Disease is changes to the fingernails one or two months later. You might see that the nails are bumpy and have ridges, or perhaps a fingernail or two fall off entirely. Nails are kind of like the rings in a tree—just like how you can cut a tree and see when it might have been sick in years past by looking at changes to the rings inside, changes in the fingernails can sometimes let you know that a hefty infection happened a few months back—and Hand-Foot-and-Mouth Disease is one such hefty infection.
TREATMENT—THE PEDIATRICIAN’S SECRET RECIPE
Okay, so we have all these nasty symptoms, let’s talk about what we can do about them.
Unfortunately, because Hand-Foot-and-Mouth Disease is caused by a virus, we don’t currently have any medicine that can knock out the infection like an antibiotic would for a bacteria. Bummer, right?
What you can do, however, is help your child feel more comfortable.
If the fever has your child feeling uncomfortable, then you can treat the fever and bring it down. (Again, see this article for more on fevers & download my Children’s Medication Dosing Guide.)
The worst part of Hand Foot & Mouth is usually the pain from sores in the mouth. If your child is having a hard time eating or drinking because his or her mouth hurts, then you can make what pediatricians call “Magic Mouthwash.” You can make this concoction at home and apply it before each meal (or before nursing or giving a bottle).
– Maalox (or “Equate”)
Mix equal parts of Children’s Benadryl and Maalox. Dip a cotton swab, paper towel, or washcloth into the mixture, then dab any sores that you see in your child’s mouth or on the gums or tongue. If your child knows how to swish and spit, then you can have them do that instead. Try not to let your child swallow much of the mixture. Assuming that your child does not swallow much, if any, of the Magic Mouthwash, it can be applied prior to each time your child eats.
The reason we care so much about fixing the mouth pain is that the most common negative outcome is dehydration—especially for young babies and toddlers—because they refuse to eat & drink due to the pain.
You might find that cool liquids will feel better for your child. You can even try popsicles if they won’t drink. Hot or very warm liquids and foods, as well as acidic juices or foods, will hurt—so stay away from those.
When trying to soothe the sores in the mouth, DO NOT use oral numbing gels! If a child swallows too much of these, then there’s a risk of causing some pretty nasty things, one of which is a blood disorder called methemoglobinemia. So instead of numbing gels, make Magic Mouthwash to help your child feel better.
WHEN TO CALL YOUR DOCTOR
There are a few times that Hand-Foot-and-Mouth Disease should make you call your pediatrician:
- Your child won’t eat or drink and you are worried about dehydration
- Your child’s fever has lasted 5 days or more
- You can’t make your child’s fever budge (be sure you’re using the correct dose with the chart in the middle of the page here first)
- You aren’t sure whether your child’s infection is Hand-Foot-and-Mouth Disease
HOW TO PREVENT HAND-FOOT-AND-MOUTH DISEASE
Drool & stool—that’s how Hand-Foot-and-Mouth Disease is passed on.
The sores in the mouth contain the virus, meaning that it gets picked up in your child’s drool as the saliva passes over the sores. The virus is also swallowed, and then passed out in your child’s poop.
That’s why the most important way to prevent Hand-Foot-and-Mouth Disease from spreading—and to prevent yourself from catching it—is good handwashing. If your child has it, make her wash her hands frequently, especially if she touches her face often. If your baby or toddler has it, be sure to wash well after changing diapers.
HOW LONG IS A CHILD CONTAGIOUS?
Hand-Foot-and-Mouth Disease is considered contagious until at least 24 hours after fever has gone away.
If there is no fever, then I go by how much a child is drooling. If there is a lot more drool than usual, then that means that there are still some open sores in the mouth, so the virus can still be spread by the drool. If that’s the case, then it’s best to keep your child home until the drooling slows down or stops.
For more on when sick kids can go back to school without being contagious, see my article “When Can a Sick Child Return to School.”
With these tips—and with the Pediatrician’s Secret Recipe to Cure Hand-Foot-and-Mouth Disease Pain—you and your child should be feeling much better within just a few days.