Hand, Foot and Mouth Disease

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Hand, foot and mouth disease is usually a short mild illness that mainly affects children. Most children fully recover within a week. Serious complications occur rarely. This disease is NOT related to the disease with a similar name which affects animals.

Hand, foot and mouth disease (HFMD) is due to an infection that usually causes a typical illness, including a typical rash. It is most commonly caused by the Coxsackie A16 virus. Some cases are caused by a different, but related, virus called enterovirus 71. Rarely, the same illness is caused by other strains of Coxsackievirus.




In about 3 in 4 cases, spots also develop on the skin. This is typically a day or so after the mouth ulcers develop. The spots are small lumps that are a few millimetres in diameter and usually appear on the hands and feet. Spots sometimes also appear on the buttocks, legs and genitals. They rarely develop on other parts of the body. The spots are similar to chickenpox, but are smaller. Unlike chickenpox, they are not usually itchy but can be quite tender.

For a list of websites that contain pictures of skin conditions including HFMD see www.patient.co.uk/showdoc/1097/

Usually not. The fever and spots usually clear within a few days. The mouth ulcers can be painful, and may last up to a week. The sore mouth may make a child miserable for a few days. In a very small number of cases, the virus affects the heart, lung or brain to cause a serious inflammation of the heart, lung or brain, which is fatal in some cases. But it has to be stressed - these serious complications are rare.

There is no treatment that will take away the virus. The aim is to ease symptoms and make the person as comfortable as possible until the illness goes away (which it normally does within a week or so). Treatment is the same for children and adults.

Make the person comfortable

A fever can make anyone feel uncomfortable and irritable. The following are things that you can do that may bring the temperature down and make them feel more comfortable:

  • You can give paracetamol or ibuprofen. Both of these medicines can lower a temperature. You can buy these medicines in liquid form for children. They come in various brand names. An alternative is to give soluble paracetamol in a drink. The dose for each age is given with the medicine packet. Note: these medicines do not treat the cause of the fever. They merely help to ease discomfort. You do not need to use these medicines if the person is comfortable and not distressed by the fever.

    Note: do not give both paracetamol and ibuprofen at the same time. However, on occasions, if a fever is difficult to control then, for each time a medicine dose is given, a doctor or nurse may advise alternating one of these medicines with the other. It is best only to do this alternating dose regime after assessment by a doctor or nurse.

    Note: do not use ibuprofen for:
    • People known to react (have hypersensitivity) to ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs).
    • People in whom attacks of asthma have been triggered by an NSAID.
    • Children with chickenpox. This is because some research has shown that ibuprofen or other NSAIDs may increase the risk of developing serious skin infection complications in children with chickenpox.
  • Take clothes off the child if the room is normal room temperature. It is wrong to wrap up a feverish person. The aim is to prevent overheating or shivering.
  • Give lots to drink. This helps to prevent dehydration. You might find that the person is more willing to have a good drink if they are not so irritable. So, if they are not keen to drink, it may help to give some paracetamol or ibuprofen first. Then, try them with drinks half an hour or so later when their temperature is likely to have come down. If breast-feeding a child then keep breast-feeding, as breast milk is the best fluid. However, you can offer feeds more often to increase the amount of fluid.

Do not cold-sponge a child who has a fever. This used to be popular, but it is now not advised. This is because the blood vessels under the skin become narrower (constrict) if the water is too cold. This reduces heat loss, and can trap heat in deeper parts of the body. The child may then get worse. Many children also find cold-sponging uncomfortable.

Some people use a fan to cool a child. Again, this may not be a good idea if the fanned air is too cold. However, a gentle flow of air in a room which is room temperature may be helpful. Perhaps just open the window, or use a fan on the other side of the room to keep the air circulating.



However, children can still be mildly infectious for several weeks longer, as the virus may be passed out with the faeces (stools) for several weeks after the symptoms have gone. Therefore, it is sensible to maintain good hygiene to reduce the chance of passing on the virus. For example:

  • Soiled clothes, bedding, and towels should be washed on a hot cycle of the washing machine.
  • It is best not to share cups, eating utensils, towels, etc whilst ill with this infection and for several weeks afterwards.

What about going to school?


Original Author:
Dr Tim Kenny
Current Version:
Peer Reviewer:
Dr Beverley Kenny
Document ID:
4260 (v41)
Last Checked:
Next Review:
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