Hand Foot Mouth Disease

Overview

Hand, foot and mouth disease is a common illness caused by a virus. It brings small, painful sores inside the mouth and a spotty rash or little blisters on the hands and feet. It sounds scary, but for most people it is mild and gets better on its own within about a week to ten days. It has nothing to do with the foot-and-mouth disease that affects farm animals.

Yes, it is very common. It shows up all year round but is seen most often in warmer months, and it spreads quickly in nurseries, playgroups and schools. Most cases are mild.

It mostly affects children under 10, especially those under 5, but teenagers and adults can catch it too. Having it once only protects you against that one type of virus, so a person can get it more than once from a different virus.

Symptoms

Common symptoms

• A high temperature (fever), often the first sign
• Sore throat and feeling generally unwell or tired
• Painful sores or blisters inside the mouth, on the tongue, gums or cheeks, which can make eating and drinking hurt
• Flat spots or small blisters on the palms of the hands and the soles of the feet
• Spots that may also appear on the bottom, thighs, elbows, knees or around the nappy area
• Poor appetite or refusing to eat because the mouth hurts
• Weeks later, the nails (or parts of them) may peel off. This looks odd but is harmless and grows back

Symptoms in children

• Refusing to drink or eat, and drooling more than usual
• Being clingy, tearful or more irritable than normal
• Not wanting to walk or put weight on their feet because the soles are sore
• Being sleepier than usual or harder to settle
• Fewer wet nappies or no wee, which can be a sign of not drinking enough
• Being unhappy to wear shoes or socks

Symptoms in older adults

• Adults often have milder symptoms, and some have none at all
• Painful mouth sores, sore throat, headache and tiredness are the usual complaints
• Some adults get no rash, which can make it hard to spot
• Older adults with a weakened immune system (the body's germ-fighting system) or long-term health conditions should ask a doctor for advice, as they may feel more unwell

Causes

Main causes

• It is caused by a group of viruses called enteroviruses, most often coxsackievirus A16 and enterovirus A71. These are different from the virus that causes foot-and-mouth disease in animals.
• The virus spreads through droplets from coughs and sneezes, contact with the fluid inside blisters, and tiny traces of poo on hands, toys or surfaces.
• It can also spread by sharing cups, cutlery, towels or dummies, or by rubbing the eyes or mouth with unwashed hands.

Risk factors

• Being a child under 5, or being around young children
• Being in a nursery, playgroup or school where infections spread easily
• Living in a busy household with a shared bathroom or kitchen
• Having a weakened immune system
• Caring for someone who is infected without good handwashing

When to see a doctor

See a doctor urgently if:

• A baby or child who will not drink anything, or has no wee for 6 to 8 hours or more
• Signs of dehydration: dry mouth, no tears, sunken eyes, unusual drowsiness
• A fever above 38°C in a baby under 3 months
• A fever lasting more than 5 days
• Symptoms getting worse after day 5, or any severe headache or stiff neck
• Someone who seems much more unwell than you would expect with this illness

Book a routine appointment if:

• You are not sure whether it is hand, foot and mouth disease
• You are pregnant, have a weakened immune system, or have a long-term health condition
• The mouth sores are very painful or keep coming back
• The rash is not settling after a couple of weeks
• You would like advice on pain relief or hydration for a young child

Diagnosis

A doctor or nurse can usually tell it is hand, foot and mouth disease simply by looking at the mouth sores and the rash, and asking about how the illness started. No special test is normally needed.

Tests that may be done

• Most cases: no tests at all
• Sometimes a swab from the throat or a blister fluid sample, if the diagnosis is unclear
• A stool (poo) sample in rare, severe or unusual cases
• Blood tests are only used if someone is seriously unwell

What to expect at your appointment

The appointment is quick and gentle. The doctor may look inside the mouth with a light and check the rash on the hands, feet and bottom. They will also ask about drinking and wet nappies, because keeping fluids going is the main concern. You will usually be sent home with advice on fluids, comfort measures and when to come back.

Treatment

There is no medicine that kills this virus. The body fights it off on its own. Treatment means making the person comfortable and making sure they keep drinking, which is the biggest issue for small children with painful mouth sores.

Self-care at home

• Offer drinks often in small sips — water, milk or diluted squash are fine
• Ice lollies, ice cubes or cold, soft foods can numb the mouth and make drinking easier
• Avoid citrus juices, salty, spicy or very hot foods while the mouth is sore
• Try soft, bland foods such as mashed banana, yoghurt, soup or soft pasta
• Let the child rest and keep them home from nursery or school until they feel better
• Wash hands thoroughly with soap and water after changing nappies or helping with the toilet
• Do not pop blisters. Keep the skin clean and dry, and pat rather than rub
• For older children, plain salt water rinses may ease mouth soreness — only if they are old enough to spit it out
• Keep sharing of cups, cutlery and towels to a minimum

Medical treatments

Treatment is supportive. A pharmacist or doctor can suggest pain and fever relief that suits the person's age and weight — always check before giving anything to a young child, and follow the label. Never give aspirin to a child under 16. Antibiotics do not work because this is a viral illness. If drinking becomes difficult, a doctor may advise fluids given in another way. If you are concerned about how much someone is drinking, contact your doctor or local health service.

When is surgery considered?

Surgery is not needed for hand, foot and mouth disease.

Living with this condition

Most of the care happens at home and is about comfort. Expect a few tough days when the mouth is sorest, usually in the first few days, then a steady improvement. Keep the person off nursery or school while they feel unwell and wash your hands often to protect the rest of the household.

Lifestyle tips

• Rest more than usual for the first few days
• Keep nails short and clean, as nail peeling can happen later and is harmless
• Wash toys, dummies, cups and surfaces regularly
• Do not share towels, toothbrushes or drinks
• Wear loose, comfortable clothing if the skin is spotty
• Stay off work if you are unwell, especially if you work with children or in food handling

Diet and exercise

Drinking is far more important than eating during the sore-mouth days. Offer fluids often and don't worry if solid food is refused for a day or two. Cool, soft foods go down best. Skip exercise while there is a fever and let the person rest; gentle play indoors is fine once they perk up.

Mental health and emotional wellbeing

It can be worrying and tiring to look after a child with a painful rash, and broken sleep adds to the stress. Adults who catch it may feel unwell and frustrated at having to take time off. This is a short illness and most families get back to normal quickly. If you are feeling overwhelmed, low, or very anxious, support is available — speak to your doctor or a local mental health service. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line in your country straight away.

Prevention

You cannot completely prevent it, because it is so common and spreads before symptoms show. But good hygiene lowers the risk a lot. Wash hands with soap and water often, especially after nappy changes and toilet visits and before preparing food. Clean shared toys and surfaces. Teach children to cough and sneeze into a tissue or their elbow, and not to share cups or cutlery.

Vaccines

There is no routine vaccine for hand, foot and mouth disease in most countries. A vaccine against one severe strain (enterovirus A71) is used in some parts of the world, but it does not protect against the other viruses that cause this illness. Ask your healthcare provider what applies where you live.

Screening programmes

There is no screening programme for this illness. It is not something that is tested for when there are no symptoms.

Complications

If left untreated

• Dehydration, if mouth pain stops someone drinking — this is the most common concern
• Rarely, a more serious infection of the brain or nervous system, which is why severe headache, stiff neck, confusion or a floppy child must be checked urgently
• Rarely, loss of fluids leading to hospital care for fluids through a drip
• Temporary nail peeling weeks later, which is harmless

Long-term outlook

The outlook is very good. Nearly everyone recovers fully within 7 to 10 days, and serious complications are uncommon. Once someone has had one type of the virus, they are protected against that type, though other types can still cause the illness again later. Keep an eye on drinking and energy levels, and reach out for help early if anything worries you.

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