Child Health · Viral Illness
Hand, Foot & Mouth Disease
Viral illness in young children. Fever + mouth ulcers + spots on hands, feet, bottom. Coxsackievirus. 7-10 days; self-limiting. Hydration most important. Most cases under 5. NHS.
Last reviewed 2 June 2026
Hand, foot & mouth recognition
Is this hand, foot & mouth disease?
Features present
🚨 Red flags — same-day GP or emergency
Classic HFM timeline
- Day 0: Exposure (3-7 day incubation).
- Day 1-2: Fever (38-39 °C), sore throat, off-colour. No rash yet.
- Day 2-3: Painful mouth ulcers / spots inside mouth.
- Day 3-5: Red spots / small fluid blisters appear on hands, feet, sometimes bum/legs.
- Day 7-10: Spots dry up and resolve. Fever usually gone by day 4.
- Weeks 4-8: (Optional) Nails of affected fingers/toes may shed and regrow — normal.
Home care — what helps
- Hydration first. Mouth ulcers make drinking painful but dehydration is the main risk. Cool drinks, ice lollies, smoothies, breast/formula on demand.
- Soft, cool foods. Yoghurt, ice cream, jelly, cool pasta, mashed potato. Avoid hot/spicy/acidic (citrus, tomato) which sting ulcers.
- Paracetamol or ibuprofen for fever and mouth pain (per weight, NICE).
- Mouth gel (e.g. Bonjela for over 4 months) can help. Lidocaine gels NOT under 4 months / use cautiously.
- Loose, soft clothing if hand/foot rash is itchy/sore.
- Keep blisters intact. Don’t pop them. They’ll dry up naturally.
- Calamine lotion for itchy spots on body.
- Rest at home until they feel better and blisters have dried. UK guidance: don’t need to stay off school once well, but most nurseries keep until rash resolved.
Stopping the spread
- Handwashing — thorough soap-and-water washing after nappy changes, before food prep.
- Cover coughs / sneezes.
- Don’t share cups, cutlery, towels, dummies.
- Clean toys / surfaces regularly with normal household disinfectant.
- Avoid pregnant women, newborns, immunocompromised.
- The virus is shed in stool for weeks — nappy-changing hygiene matters even after rash clears.
- Don’t pop blisters — the fluid inside is highly infectious.
Common questions
- “How is HFM different from chickenpox?” — Chickenpox: itchy rash all over body including scalp/under nappy/face, no mouth predominance, crops of new spots in waves over 3-4 days, crusts over. HFM: mouth ulcers + hand/foot/bum rash mainly, no scalp, blisters dry up flat without crusting. Different viruses.
- “Can adults get HFM?” — Yes, especially parents of affected children, nursery workers. Often milder in adults but mouth ulcers can be very painful. Atypical HFM (Coxsackie A6) tends to be more severe in adults.
- “HFM in pregnancy — should I worry?” — Usually mild illness. Very small risk of miscarriage if infection happens late in pregnancy; no clear link to birth defects. Avoid contact with newborns (you can pass it on). Contact maternity unit if you develop severe illness.
- “When can my child return to nursery?” — UK guidance: once they feel well and any fever has gone. Don’t need to wait for blisters to fully clear. But most nurseries have stricter rules — check yours. The child is most infectious in the first week.
- “Do they need antibiotics?” — No — HFM is viral. Antibiotics don’t work. ONLY if blisters become secondarily bacterially infected (rare): hot, red, spreading, pus, fever rising day 4+.
- “What if my baby won’t drink because of mouth pain?” — This is the main complication to watch for. Give paracetamol/ibuprofen 20-30 min before offering drinks. Cold drinks/ice/lollies. Avoid acidic or salty. Wet nappy at least every 6 hours. Call GP if no wet nappy in 12 hours, dry mouth, very listless.
- “Will my child get it again?” — Yes, can. Different strains (A16, A6, EV71, others) each give their own immunity. Many children get HFM 2-3 times in childhood.
- “Is there a vaccine?” — A vaccine against Enterovirus 71 (one severe strain) exists and is used in China/parts of Asia. Not available in UK/EU/US.
- “Atypical HFM — what does that mean?” — Coxsackie A6 strain causes a more dramatic, widespread rash than classic HFM, including the face, the limbs, and especially areas with eczema (“eczema coxsackium”). Spots can be larger, longer-lasting, sometimes purple/scabbed. Same management. Can scare parents but is essentially the same illness.
- “My child’s nails are falling off weeks later — is this normal?” — Yes — called onychomadesis. Happens 4-8 weeks after HFM (especially Coxsackie A6). The disturbance in nail growth from the infection leaves a horizontal line, and the affected nail shedding is normal. New nail grows back in months. Painless.
- “Should I pop the blisters?” — NO. The fluid is highly infectious and popping can cause secondary infection. They dry up on their own in days.
- “How long is HFM contagious?” — Most contagious in the first week of symptoms, while fever and active blisters are present. Virus shed in stool for several weeks — rigorous handwashing after nappies.
- “Mouth ulcers without rash — could it still be HFM?” — Possibly herpangina (related Coxsackie illness with mouth-only blisters); could also be primary herpes (HSV-1) gingivostomatitis (more severe gums + lip blisters + bigger lymph nodes) which may need aciclovir. GP review if uncertain.
Educational tool only — not medical advice. If your child is dehydrated, has any neurological symptoms, severe breathing problems, or is under 3 months with this illness — same-day medical assessment.
What does this mean?
Hand, foot and mouth disease is one of the most common viral illnesses of nursery age — almost every child catches it at some point, and most catch it more than once because there are several different enterovirus strains (mainly Coxsackie A16, classically, and Coxsackie A6, which causes the more dramatic “atypical HFM”). The classic pattern is fever for 1-2 days, then painful mouth ulcers, then red spots and small blisters on the hands, feet, and often around the bum/nappy area. It looks alarming but is essentially mild and self-limiting; almost all children recover fully in 7-10 days with home care alone. The single most important practical issue is preventing dehydration. Mouth ulcers can make drinking so painful that small children refuse fluids, and dehydration — not the virus itself — is the most common reason kids end up in A&E with HFM. Strategies: paracetamol or ibuprofen 20-30 min before drinks, cold drinks (ice, lollies, slushy drinks), avoid acidic / salty things that sting, soft cool foods (yoghurt, ice cream, jelly), and a low bar for offering tiny sips frequently. Watch for at least one wet nappy every 6 hours. Common myths worth dropping: (1) Antibiotics don’t treat HFM — it’s viral; antibiotics only have a role if a blister becomes secondarily bacterially infected. (2) Don’t pop the blisters — the fluid is highly infectious and popping can lead to secondary infection. (3) Children CAN get HFM more than once because different strains each give their own immunity. (4) Nails falling off 4-8 weeks later is normal (onychomadesis) — the temporary disruption in nail growth from the infection leaves a horizontal line and the nail sheds painlessly. New nail grows back. The red flags that warrant urgent medical review are dehydration (no wet nappy for 12 hours, very listless, sunken eyes/fontanelle), neurological signs (very rare but serious — severe headache, neck stiffness, drowsiness, fits, limb weakness, suggesting enteroviral meningitis/encephalitis), respiratory distress, persistent high fever beyond day 3-4 or rising again (possible secondary bacterial infection), rash becoming purple or non-blanching, and any HFM-like illness in a baby under 3 months. In pregnancy, HFM is usually mild; very small late-pregnancy miscarriage risk; no clear link to birth defects. Avoid contact with newborns while symptomatic. The most contagious phase is the first week; virus is shed in stool for several weeks afterwards, so rigorous nappy-and-handwashing hygiene matters even when the rash has gone.
Classic pattern
- 1-2 days fever + feeling unwell.
- Painful mouth ulcers / spots inside mouth.
- Red spots / blisters on palms, soles, bottom, sometimes legs / elbows.
Caused by coxsackievirus (mostly A16 / EV71). Mostly under 5.
How long
- Total ~7-10 days.
- Incubation 3-6 days.
- Fever 1-2 days.
- Mouth ulcers 4-7 days.
- Skin spots 7-10 days.
- Most contagious 1st week; virus shed in stool for weeks after.
Home care
- Hydration crucial (cool fluids, ice lollies, smoothies, breastfeeding).
- Bland foods (yoghurt, custard); avoid acidic / spicy.
- Paracetamol / ibuprofen for pain + fever.
- Don’t pop blisters.
- Barrier cream on rash.
- Keep home until well + eating normally.
Same-day GP
- Dehydration signs.
- Fever >3 days or worsening.
- Severe mouth pain + refusing fluids.
- Newborn (under 6 weeks).
999 if
- Difficulty breathing.
- Drowsy / unresponsive.
- Severe headache + stiff neck.
- Non-blanching rash.
- Seizures.
- Severe dehydration.
School / nursery return
NHS: child can return when well + spots crusting + drinking properly. No formal 48-hour rule. Usually 3-7 days off. Inform setting; hand hygiene essential.
Pregnancy + HFMD
Usually mild even if pregnant. Late pregnancy contact: possible neonatal infection — mild for most but inform midwife. Newborn assessment if you have HFMD in last weeks before birth.
Can it come back?
Multiple strains. Immunity only to specific strain you had. Can get HFMD more than once from different strains. Usually milder second time.
Drinking refusal — strategies
- Breastmilk / formula often preferred.
- Cold fluids: water, ice lollies, frozen breast milk lollies, smoothies.
- Straw (bypasses tongue sores).
- Small sips often.
- Paracetamol 30 min before feeds.
- Avoid acidic foods.
Atypical HFMD
Coxsackievirus A6 strain: widespread rash, larger blisters, eczema-like, sometimes face. Still viral / supportive care. Nail peeling / Beau’s lines may appear 6-8 weeks after.
Different scenarios
Scenario 1: 2-yo with mouth ulcers + palm spots
Likely HFMD. Hydrate; paracetamol; stay home.
Scenario 2: Refusing all fluids, sunken eyes
Same-day GP. Possible IV fluids.
Scenario 3: 6-wk-old with HFMD spots
Hospital review. Young infants need closer monitoring.
Scenario 4: 36-wk pregnant, toddler at home has HFMD
Hand hygiene; avoid close contact. Inform midwife. Usually mild for newborn but team aware.
Scenario 5: 6 weeks after HFMD, fingernails peeling
Beau’s lines / nail shedding. Temporary. New nails grow.
Care guidance
- Self-limiting 7-10 days.
- Hydration most important.
- Bland soft cool foods.
- Paracetamol / ibuprofen for pain.
- Hand hygiene 3+ weeks post-illness.
- Inform pregnant contacts.
- Can return to school when well + crusted.
Sources
- NHS. Hand, foot and mouth disease.
- UK Health Security Agency. Childhood viral illness exclusions.
- NICE CKS. Hand, foot and mouth disease.
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Frequently asked questions
How do I know if my child has hand, foot and mouth disease?
CLASSIC PATTERN: 1-2 days of FEVER + feeling unwell, then PAINFUL MOUTH ulcers / spots inside mouth, then RED SPOTS / blisters on PALMS, SOLES, BOTTOM, sometimes legs / elbows. CAUSED by coxsackievirus (mostly A16 / Enterovirus 71). MOST cases: ages under 10 (especially under 5). Often outbreaks in nurseries / school. NOT same as foot-and-mouth in cattle.
How long does it last?
Total ILLNESS: ~7-10 DAYS. (1) INCUBATION 3-6 days; (2) FEVER + tiredness 1-2 days; (3) Mouth ulcers 4-7 days; (4) Skin spots 7-10 days resolution. CONTAGIOUS PERIOD: most contagious 1st week; virus shed in stool for several WEEKS post-recovery (good hand hygiene).
Treatment at home?
(1) HYDRATION crucial — mouth ulcers painful, refusing drinks risk = dehydration; (2) COOL fluids — water, ice lollies, smoothies, breastfeeding; (3) BLAND foods — yoghurt, custard; avoid acidic / spicy / salty (oranges, tomatoes); (4) PARACETAMOL / IBUPROFEN for pain + fever (age-appropriate doses); (5) MOUTH care — gentle; (6) DON'T POP blisters; (7) BARRIER cream on rash; (8) Keep child home from nursery / school until well + can eat normally.
When to see GP / 999?
GP same-day: (1) DEHYDRATION (dry mouth, sunken eyes, <4 wet nappies / 8h, lethargic); (2) Fever >3 days OR worsening; (3) Severe mouth pain refusing fluids; (4) NEWBORN with HFMD (under 6 weeks); (5) Pregnancy contact (third-trimester maternal infection has risk for baby). 999: difficulty breathing, drowsy/unresponsive, severe headache + stiff neck, non-blanching rash, seizures, signs of severe dehydration.
Should I stay home?
NHS UK: child can return to nursery / school when WELL ENOUGH + spots crusting over + drinking properly. NO MINIMUM 48-hour rule (unlike diarrhoea). PRACTICAL: usually 3-7 days off school typical. HAND HYGIENE essential — virus shed in stool weeks post-illness. NOT formally notifiable but inform nursery / school.
How does it spread?
(1) DIRECT contact with blister fluid; (2) Respiratory droplets (coughs, sneezes); (3) FAECAL-ORAL (nappy changes!); (4) Saliva (shared toys, dummies); (5) STOOL several weeks after recovery. PREVENTION: hand hygiene; clean toys + surfaces; don't share cups / utensils with infected; isolate during fever stage.
Pregnant + exposed — risks?
GENERALLY MILD even if pregnant. RISKS: (1) Late pregnancy (within last weeks): possible NEONATAL infection — mild for most but can be severe in some newborns; (2) MISCARRIAGE not strongly linked; (3) BIRTH DEFECTS: not associated. AVOID close contact during outbreaks if pregnant. INFORM midwife if you develop symptoms. NEWBORN ASSESSMENT if you have HFMD in last weeks before birth.
Can it come back?
MULTIPLE STRAINS of coxsackievirus + enterovirus — IMMUNITY only to specific strain you had. CAN GET HFMD MORE THAN ONCE in life from different strains. USUALLY MILDER second time. ADULT cases possible — often milder; sometimes more severe (atypical HFMD).
What does the rash look like?
RED SPOTS or small fluid-filled BLISTERS (vesicles): (1) PALMS + soles — characteristic; (2) Bottom area; (3) Sometimes legs, arms, elbows, knees. SIZE: ~1-3 mm. NOT itchy usually. MOUTH: painful sores / ulcers / red patches inside cheeks, tongue, throat — can prevent eating / drinking. RESOLVES without scarring usually.
What if my baby refuses to drink?
DEHYDRATION RISK — mouth ulcers painful. STRATEGIES: (1) BREASTMILK / formula often preferred (lubricating); (2) COLD LIQUIDS: water, ice lollies, frozen breast milk lollies, smoothies; (3) STRAW (if old enough — bypasses tongue sores); (4) SMALL SIPS often; (5) PARACETAMOL 30 min before feeds; (6) Bland soft foods: yoghurt, ice cream, custard; (7) AVOID acidic (orange, tomato, vinegar).
Can I prevent it?
PARTIALLY: HAND HYGIENE (yourself + child); avoid known cases; clean shared toys / surfaces; teach older children hand washing; cover coughs + sneezes. NO VACCINE in UK (China has EV71 vaccine — not for A16). OUTBREAKS in nurseries common; very contagious in young children. AVOID pools / shared baths during outbreaks.
Atypical HFMD — what's that?
MORE WIDESPREAD rash sometimes affecting whole body including back, chest, face. SOMETIMES blisters look DIFFERENT (large, peeling, eczema-like). MORE COMMON with Coxsackievirus A6 strain. STILL viral / self-limiting / supportive care. SOMETIMES misdiagnosed as eczema flare. NAIL changes (peeling, lines) sometimes 6-8 weeks AFTER (called Beau's lines).
Long-term complications?
USUALLY NONE. RARE complications: (1) DEHYDRATION needing IV fluids; (2) VIRAL MENINGITIS / encephalitis (very rare); (3) EV71 severe complications (more common in Asia — meningoencephalitis, paralytic disease — extremely rare UK); (4) NAIL CHANGES (Beau's lines, nail shedding) 4-8 weeks AFTER — temporary, resolves; (5) Cardiac involvement extremely rare. MOST children: full recovery.
How does this relate to other calculators on BumpBites?
Companion: /calculators/baby-fever; /calculators/baby-cough; /calculators/oral-thrush (mouth differential); /calculators/muac-cds (dehydration); /calculators/pediatric-dose; /calculators/vaccine-scheduler.