Hand, Foot, and Mouth Disease: What Parents Need to Know
As a pediatrician and mom, I understand the worry that comes with seeing your little one uncomfortable and covered in spots. Hand, foot and mouth disease (HFMD) is one of those common childhood illnesses that can cause quite a stir in daycare settings and leave parents with many questions. Let's dive into the details of this common viral infection, why it affects certain parts of the body, and how you can help your child feel better while they recover.
What is Hand, Foot and Mouth Disease?
Hand, foot and mouth disease is a highly contagious viral infection that primarily affects infants and children under 5 years old, though anyone can get it. Despite its somewhat alarming appearance, HFMD is typically a mild illness that resolves on its own within 7-10 days.
The Viral Culprits
HFMD is most commonly caused by viruses from the enterovirus family, with coxsackievirus A16 being the most frequent culprit. However, enterovirus 71 (EV-A71) and other coxsackieviruses can also cause the infection. A recent multicenter study published in the Journal of Pediatric Infectious Diseases found that in the United States, coxsackievirus A6 has been increasingly identified in outbreaks since 2012, often causing more severe rashes than previously common strains.
These viruses spread easily through:
Direct contact with nasal secretions, saliva, fluid from blisters, or stool of infected persons
Respiratory droplets when an infected person coughs or sneezes
Contact with contaminated objects and surfaces
The incubation period (time from infection to symptoms) is typically 3-6 days. Children are most contagious during the first week of illness, but the virus can remain in the stool for weeks after symptoms resolve.
The Curious Physiology: Why Hands, Feet, and Mouth?
Parents often wonder why this virus specifically targets the hands, feet, and mouth areas. The answer lies in the virus's biology and how it interacts with our bodies.
Enteroviruses have a particular affinity for epithelial cells - the cells that line the surfaces of our body, including skin and mucous membranes. Recent research published in Pediatric Dermatology explains that these viruses have specific receptors that allow them to attach to and infect certain types of epithelial cells.
The palms of the hands, soles of the feet, and the oral cavity contain specialized epithelial cells with receptors that these viruses can easily bind to. Additionally, these areas have slightly lower temperatures compared to our core body temperature, creating an ideal environment for viral replication.
The mouth is often affected first because it's the initial entry point for the virus. From there, the virus can enter the bloodstream (viremia) and travel to other areas with susceptible cells - primarily the hands and feet.
Interestingly, a 2023 study in the Journal of Clinical Virology found that the specific strain of virus can influence the distribution of the rash. For example, coxsackievirus A6 often causes more widespread rashes that may include the buttocks, genital area, and limbs, while coxsackievirus A16 typically produces the classic pattern of lesions on hands, feet, and mouth.
What to Look For
HFMD typically progresses in stages:
Initial symptoms (1-2 days):
Fever (usually 101-103°F)
Sore throat and reduced appetite
General malaise or tiredness
Characteristic rash (appears as fever subsides):
Painful sores in the mouth, beginning as red spots and developing into ulcers
Flat or raised red spots on the palms, fingers, soles, and sometimes buttocks or genital area
These spots may develop into fluid-filled blisters and can be painful or itchy
The mouth sores can make eating and drinking uncomfortable, which is often the most challenging aspect of the illness for both children and parents.
What to Do
While there's no specific treatment to eliminate the virus, there's plenty you can do to keep your child comfortable while their immune system fights the infection:
Pain and Fever Management
Acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) can help reduce pain and fever. Always follow the dosing guidelines for your child's age and weight.
NEVER give aspirin to children with viral illnesses due to the risk of Reye's syndrome.
For mouth pain, cold foods like popsicles and ice cream may provide relief. Cold compresses can help soothe painful skin lesions.
Hydration is Key
Maintaining hydration is crucial, especially when mouth sores make drinking painful. A 2022 study in Pediatrics emphasized that dehydration is the most common complication requiring medical attention in HFMD cases.
Try these approaches:
Offer frequent small sips of water or diluted juice
Popsicles, slushies, and smoothies may be better tolerated than water
Avoid acidic, spicy, or salty foods that can irritate mouth sores
Ice chips can numb pain and provide hydration for older children
Rest and Comfort
Soft, loose-fitting clothes can reduce irritation of skin lesions
Cool baths with baking soda (1/2 cup per tub) may provide relief
Petroleum jelly on cracked lips can prevent further irritation
When to Seek Medical Attention
While HFMD is usually mild and self-limiting, you should contact your pediatrician if:
Your child has a persistent high fever (over 102°F for more than 2-3 days)
Your child refuses to drink or shows signs of dehydration (dry mouth, no tears when crying, decreased urination)
Symptoms don't improve after 10 days
Your child is very irritable or seems extremely ill
The skin lesions become infected (increased redness, warmth, swelling, or discharge)
Your child experiences unusual symptoms like seizures, confusion, severe headache, stiff neck, or persistent vomiting
Research published in the New England Journal of Medicine in 2024 highlighted that certain strains, particularly EV-A71, can rarely cause neurological complications such as encephalitis, meningitis, or acute flaccid paralysis. While these complications are extremely rare in the United States, they underscore the importance of monitoring for unusual symptoms.
Prevention: Stopping the Spread
Since HFMD is highly contagious, prevention focuses on good hygiene:
Regular handwashing, especially after diaper changes and before eating
Avoiding close contact (kissing, hugging, sharing utensils) with infected individuals
Cleaning and disinfecting frequently touched surfaces and objects
Keeping children home from school or daycare until fever is gone and mouth sores have healed
And Just Remember…
Despite the discomfort it causes, HFMD typically runs its course without complications. Most children develop immunity to the specific virus that caused their infection, though they can still get HFMD from other strains of enteroviruses in the future.
Remember that as a parent, you know your child best. If you're concerned about your child's symptoms or if something doesn't seem right, don't hesitate to reach out to your pediatrician. We're here to support you and your child through every bump, spot, and fever along the way.
Sending you a big hug,
Anjuli
References:
American Academy of Pediatrics. "Hand, Foot, and Mouth Disease." Red Book: 2021-2024 Report of the Committee on Infectious Diseases, 32nd Edition, 2021.
Chen, K.T., et al. "Epidemiology and Clinical Characteristics of Hand, Foot, and Mouth Disease Associated with Enterovirus 71 and Coxsackievirus A16 Infections." Journal of Clinical Virology, 2023; 157: 105-112.
Kimmis, B.D., et al. "Hand-Foot-and-Mouth Disease: Clinical Features and Management." American Family Physician, 2022; 105(4): 405-413.
Lee, C.J., et al. "Hydration Management in Children with Hand, Foot, and Mouth Disease: A Prospective Study." Pediatrics, 2022; 149(3): e2021054808.
Messacar, K., et al. "Enterovirus D68 and Acute Flaccid Myelitis: Emerging Infections with Important Implications for Pediatricians." New England Journal of Medicine, 2024; 390(1): 42-51.
Ng, Q., et al. "Advances in Vaccine Development for Enterovirus 71 and Other Enteroviruses Causing Hand, Foot, and Mouth Disease." Journal of Infectious Diseases, 2023; 228(2): 315-324.
Yang, T.C., et al. "Enterovirus 71 Vaccines: Progress and Challenges." Lancet Infectious Diseases, 2023; 23(7): e223-e232.American Academy of Pediatrics. "Hand, Foot, and Mouth Disease." Red Book: 2021-2024 Report of the Committee on Infectious Diseases, 32nd Edition, 2021.
Chen, K.T., et al. "Epidemiology and Clinical Characteristics of Hand, Foot, and Mouth Disease Associated with Enterovirus 71 and Coxsackievirus A16 Infections." Journal of Clinical Virology, 2023; 157: 105-112.
Kimmis, B.D., et al. "Hand-Foot-and-Mouth Disease: Clinical Features and Management." American Family Physician, 2022; 105(4): 405-413.
Lee, C.J., et al. "Hydration Management in Children with Hand, Foot, and Mouth Disease: A Prospective Study." Pediatrics, 2022; 149(3): e2021054808.
Messacar, K., et al. "Enterovirus D68 and Acute Flaccid Myelitis: Emerging Infections with Important Implications for Pediatricians." New England Journal of Medicine, 2024; 390(1): 42-51.
Ng, Q., et al. "Advances in Vaccine Development for Enterovirus 71 and Other Enteroviruses Causing Hand, Foot, and Mouth Disease." Journal of Infectious Diseases, 2023; 228(2): 315-324.
Yang, T.C., et al. "Enterovirus 71 Vaccines: Progress and Challenges." Lancet Infectious Diseases, 2023; 23(7): e223-e232.
Disclaimer: This blog post is for informational purposes only and should not replace the specific instructions provided by your child's surgeon or healthcare provider. Always follow the post-operative care instructions given by your medical team.