Signs and Symptoms of Hand, Foot, And Mouth Disease (HFMD)

Hand, foot, and mouth disease (HFMD) is a viral infection. Symptoms usually follow the same pattern over a period of one to two weeks. A fever is typically the first symptom, and onset can be sudden; it usually occurs about three to five days after exposure to the virus. A sore throat, mouth sores,  and a rash follow the fever, typically within one to three days. Overall, hand, food, and mouth disease symptoms last about seven to 10 days, then gradually disappear. 

Around 90% of HFMD cases affect young children less than five years old but it can occur in people of all ages. It is most common in the summer and fall but can occur during other seasons.

Most people with HFMD don’t require hospitalization and recover at home. But, it can be very uncomfortable, and it is highly contagious.

Symptoms of HFMD

Symptoms of hand, foot, and mouth disease (HFMD) typically begin a few days after exposure to the virus and last about seven to 10 days.

You are most contagious when you have symptoms like a fever, mouth sores, and a rash. However, you can also spread HFMD in the days leading up to symptom onset.

Fever

The first symptom of HFMD is typically a sudden onset of a moderate fever—around 101-101 degrees. Chills may or may not come before or with the fever.

This fever typically lasts for several days. It can be higher in the morning and lower in the evenings, but it typically remains high throughout the day.

Sore Throat

A sore throat can be an early symptom of HFMD. It can start at the same time as the fever or shortly after. The discomfort can range from mild to severe and is usually worse when you swallow saliva or fluid. 

You may notice infants or young children drooling to avoid swallowing. This symptom typically lasts several days, usually in addition to mouth sores and a skin rash.

Mouth Sores

Mouth sores from HFMD are typically small, red spots on the tongue, gums, inner cheeks, and the back of the throat. These sores can last for seven to 10 days and are usually one of the more uncomfortable aspects of the illness.

Skin Rash

A skin rash usually occurs a day or two after the fever and mouth sores appear. While it’s a common symptom, not everybody gets it. As the name of the disease suggests, the rash primarily affects the hands and feet. Less commonly, it can appear on the buttocks, legs, arms, chest, and back.

Characteristics of a HFMD rash include:

• Primarily occurs on the hands and feet
• Flat, red spots or small blisters that may contain fluid
• Mild redness and inflammation (swelling) around the rash in some cases
• It is not typically itchy or painful
• Lasts about 10 days (if there are blisters, they break about this time) 
• Gradually fades along with other symptoms
• Does not usually leave scars

The fluid in the blisters can contain the virus, which can cause it to spread to others. Try to keep the blisters clean, avoid touching them, and wash your hands immediately if you do touch them.

Loss Of Appetite

Discomfort caused by a sore throat and mouth sores can make eating and drinking painful, causing a loss of appetite or a refusal of food and drink. You may also notice that a child only wants to drink cold liquids as this makes their mouth and throat feel better.

Irritability

The discomfort of HFMD can cause irritability or fussiness. Young children may be hard to console. 

Malaise and Fatigue

Like the flu, HFMD can lead to tiredness and general malaise (just not feeling well). Some people, especially infants and young children, can become weak or lethargic. Seek emergency medical attention if they are not responding to you or their environment.

Dehydration

Because HFMD causes a fever and discomfort when drinking fluids, it also increases the risk of dehydration. This means the body is not getting enough fluid to function correctly. Signs of dehydration include:

• Dry mouth 
• Decreased need to urinate
• Dark urine

Nail and Toenail Shedding

In some cases, the virus causes the shedding of the fingernails and toenails a few weeks to months after symptoms resolve. Grooves along the nails called, Beau’s lines or onychomadesis, may also occur. These are much less common symptoms.

To reduce the risk of spreading HFMD: 

• Wash your hands frequently 
• Avoid close contact like kissing or sharing utensils
• Avoid touching your eyes, nose, mouth, or face (especially with unwashed hands)
• Disinfect surfaces you touch frequently
  

Treating Hand, Foot, and Mouth Disease Symptoms

There are no medications you can take to cure HFMD. Recovery includes rest, hydration (drinking lots of water), and supportive care such as pain relief medication or topical oral pain relief for mouth sores. The fever and pain are usually manageable with over-the-counter (OTC) Tylenol (acetaminophen) or Advil (ibuprofen).

You can also try gargling (but not swallowing) with a mixture of liquid Advil and liquid Benadryl (diphenhydramine) to help coat the mouth sores and ease the pain. If someone can’t gargle, use a sterile cotton swab to coat the sores with this mixture. 

Consult a healthcare provider for dosing instructions before giving infants and young children over-the-counter medications. The American Academy of Pediatrics does not recommend Advil or Motrin (ibuprofen) for infants less than six months old.

When to Contact a Healthcare Provider 

While HFMD typically resolves over the course of seven to 10 days, the following are a few specific situations where you should seek medical attention.

• Your child is not eating or drinking (or has signs of dehydration like dry mouth, sunken eyes, dark pee, or not peeing as much)
• Your child's fever lasts more than three days, or other symptoms last longer than 10 days
• Your child with HFMD is less than six months old
• Severe symptoms are not relieved at home
• Your child between three months and three years old has a rectal temperature greater than 102 degrees
• Your child of any age has an axillary (under the arm) temperature of 103 degrees or higher
• Your child of any age has an oral (mouth), rectal, tympanic (ear), or forehead temperature greater than 104 degrees
• Severe headache or neck stiffness, which are symptoms of meningitis
• Mental changes or confusion (seek emergency medical attention if this symptom is severe)

Those who are pregnant should also notify their healthcare provider if they have been around someone with HFMD or have symptoms. 

Seek emergency medical attention for:

• Difficulty breathing
• Unresponsiveness
• An oral, rectal, ear, or forehead temperature greater than 105 degrees
• Seizures

A Quick Review 

Hand, foot, and mouth disease (HFMD) is a viral infection that typically affects children under age five, but it can occur in people of all ages. 

A fever is typically the first symptom, followed by a sore throat, mouth sores, and a skin rash. Some people also experience loss of appetite, irritability, malaise (not feeling well), and fatigue. Sometimes the sore throat and mouth sores make it difficult to eat and drink. In addition to a fever, this can lead to dehydration (insufficient fluid in the body). 

Most people recover at home with supportive care that includes rest, hydration, and over-the-counter medications. If your child is less than six months old, it’s best to consult a healthcare provider if they have symptoms of HFMD.