Signs and symptoms
The signs and symptoms of hand-foot-and-mouth disease include:
Painful red blister-like lesions on the tongue, mouth, palms of the hands or soles of the feet
Irritability in infants and toddlers
The usual period from initial infection to the onset of signs and symptoms (incubation period) is three to seven days. Fever is often the first sign of hand-foot-and-mouth disease, followed by a sore throat and sometimes a poor appetite and the feeling of being sick (malaise). One or two days after fever begins, painful sores may develop in the mouth or throat. Rash on the hands and feet can follow within one or two days, and may also appear on the buttocks. Hand-foot-and-mouth disease may cause all of the above signs and symptoms or just a few of them.
The most common cause of hand-foot-and-mouth disease is infection due to the coxsackievirus A16. Named after Coxsackie, N.Y., where the virus was discovered, coxsackievirus A16 belongs to a group of viruses called enteroviruses. Other enteroviruses sometimes cause hand-foot-and-mouth disease. Most cases of hand-foot-and-mouth disease aren't serious.
Oral ingestion is the main source of coxsackievirus infection and hand-foot-and-mouth disease. The illness spreads by person-to-person contact with nose and throat discharges, saliva, fluid from blisters, or the stool of someone with the infection. Hand-foot-and-mouth disease is most common in children in child care settings, where diaper changing and potty training are constant, and little hands often are in and out of the mouth frequently.
Hand-foot-and-mouth disease primarily affects preschool children. Children in child care centers are especially susceptible to outbreaks of hand-foot-and-mouth disease because the infection spreads by person-to-person contact with nose and throat discharges, saliva, fluid from blisters, or the stool of someone with the infection. The virus can also spread through a mist of fluid sprayed into the air when someone coughs or sneezes.
Although less common, hand-foot-and-mouth disease can also occur in adolescents and adults. Because they've most often developed immunity, adults and older children are less likely than younger children are to be susceptible to illness from coxsackievirus infection.
Hand-foot-and-mouth disease is most contagious during the first week of illness. However, the coxsackievirus may spread for weeks after signs and symptoms have disappeared. Some people excreting the virus, especially most adults, may have no signs or symptoms of hand-foot-and-mouth disease.
Screening and diagnosis
Your doctor will likely be able to distinguish hand-foot-and-mouth disease from other types of viral infections by evaluating:
The age of the affected person
The pattern of signs and symptoms
The appearance of rash or sores
A throat swab or stool specimen may be taken and sent to the laboratory to determine which virus caused the illness. However, your doctor probably won't need this type of testing to diagnose hand-foot-and-mouth disease.
The most common complication of hand-foot-and-mouth disease is dehydration. The illness can cause sores in the mouth and throat making swallowing painful and difficult. Watch closely to make sure your child consumes adequate amounts of fluids during the course of the illness. If dehydration is severe, intravenous (IV) fluids may be necessary.
Hand-foot-and-mouth disease is usually a minor illness causing only a few days of fever and relatively mild signs and symptoms. However, a rare and sometimes serious form of the coxsackievirus can involve the brain and cause other complications:
Viral meningitis. This is an infection and inflammation of the membranes (meninges) and cerebrospinal fluid surrounding the brain and spinal cord. Viral meningitis is usually mild and often clears on its own in 10 days or less.
Encephalitis. This severe and potentially life-threatening disease involves brain inflammation caused by a virus. Encephalitis is rare.
There's no specific treatment for hand-foot-and-mouth disease, and antibiotics aren't effective because it's a viral infection. The illness simply must run its course. To help lessen discomfort, doctors often recommend:
Plenty of fluids
Over-the-counter pain relievers, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others), if needed
Fever and discomfort caused by hand-foot-and-mouth disease usually improve in three to four days. Mouth and throat blisters clear up in about seven days. The rash on the hands and feet commonly subsides within 10 days.
Certain tactics can help to reduce your chances of becoming infected with hand-foot-and-mouth disease:
Careful hand washing. Be sure to wash your hands frequently and thoroughly, especially after using the toilet and changing a diaper, and before preparing food and eating. When soap and water aren't available, use hand wipes or gels treated with germ-killing alcohol.
Disinfecting common areas. Get in the habit of cleaning high-traffic areas and surfaces first with soap and water, then with a diluted solution of chlorine bleach, approximately 1/4 cup of bleach to 1 gallon of water. Child care centers should follow a strict schedule of cleaning and disinfecting all common areas, including shared items such as toys, as the virus can live on these objects for days. Clean your baby's pacifiers often.
Good hygiene. Teach children to practice good hygiene. Be a positive role model by showing them how to keep themselves clean. Explain to them why it's best not to put their fingers, hands or any other objects in their mouths.
Isolation. Because hand-foot-and-mouth disease is highly contagious, people with the illness should limit their exposure to others. Hand-foot-and-mouth disease is most contagious during the first week of illness. However, the coxsackievirus may spread for weeks after signs and symptoms have disappeared.Keep children with hand-foot-and-mouth disease out of child care or school until fever is gone and mouth sores have healed. If you have the illness, stay home from work.
Certain foods and beverages that can cause burning or stinging may irritate blisters on the tongue or in the mouth or throat caused by hand-foot-and-mouth disease. Try these tips to help make blister soreness less bothersome and eating and drinking more tolerable:
Suck on popsicles or ice chips
Eat ice cream or sherbet
Drink cold beverages, such as milk or ice water
Avoid acidic foods and beverages, such as citrus fruits, fruit drinks and soda
Avoid salty or spicy foods
Choose foods that are soft and don't require a lot of chewing
Rinse your mouth with warm water after meals
If your child is able to rinse without swallowing, rinsing the inside of his or her mouth with warm salt water may be soothing. Mix 1/2 teaspoon of salt with 1 cup of warm water. Have your child rinse with this solution several times a day, or as often as needed to help reduce the pain and inflammation of mouth and throat sores caused by hand-foot-and-mouth disease.
Measles study stresses importance of routine vaccination
Chickenpox vaccine: Is it always effective?