Hand, Foot, and Mouth Disease: What Parents Should Expect

In short

This common, usually mild viral illness of early childhood follows a fairly predictable course, but knowing how long it stays contagious and which signs cross into dehydration territory helps parents know when to worry.

Emergency if: Very drowsy or hard to wake, difficulty breathing, a seizure, jerky movements or new weakness, or no urine in 12 hours: call emergency services now or go to an emergency department now.

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What It Is

Hand, foot, and mouth disease is a common viral illness, most often caused by a coxsackievirus, that mainly affects children under five. It causes painful mouth sores and a rash, sometimes with small blisters, on the hands, feet, and often the buttocks or legs. In 2022 the illness nicknamed tomato flu or tomato fever, after its red blisters, was described by the national health ministry (MoHFW) as a clinical variant of hand, foot, and mouth disease.

Fever and reduced appetite frequently accompany the rash and mouth sores, especially in the first day or two. It spreads easily in group childcare and preschool settings, which is why outbreaks often cluster among classmates.

The Typical Course

Illness usually starts with fever, sore throat, and a drop in appetite, with mouth sores appearing a day or two later, followed by the skin rash on hands and feet. Discomfort peaks around the mouth sores, which can make eating and drinking genuinely painful for a few days.

Most children recover on their own within seven to ten days with rest, fluids, and comfort measures, and no specific antiviral treatment is generally needed for typical cases.

Contagion, Honestly

The virus spreads through saliva, fluid from blisters, and stool, and a child remains contagious for some time even after the fever and rash fade, particularly through stool, which can shed virus for several weeks. This means strict handwashing matters well past the point a child looks better.

Avoiding shared cups and utensils, frequent handwashing, and keeping a symptomatic child home while feverish or with open mouth sores reduce spread, though given how contagious it is, transmission can't be eliminated entirely, especially in group childcare settings.

Managing Mouth Sores and Discomfort

Cool, soft, bland foods and cold drinks, ice pops, yogurt, smoothies, tend to be easier to tolerate than acidic, salty, or crunchy foods when the mouth is sore. Encouraging frequent small sips of fluid matters more than pushing a full meal for a few days.

When It's More Than HFMD

Signs of dehydration, very few wet diapers, no tears when crying, a dry mouth, or unusual lethargy, along with refusal of all fluids or a fever persisting beyond a few days, go beyond a routine case and warrant a same-day call to the pediatrician. A child who is very drowsy or hard to wake, has difficulty breathing, has a seizure, jerky movements or new weakness, or has not passed urine in 12 hours needs emergency care: call emergency services or go to an emergency department now.

When to act

Emergency — act now

Very drowsy or hard to wake, difficulty breathing, a seizure, jerky movements or new weakness, or no urine in 12 hours: call emergency services now or go to an emergency department now.

Same-day — call promptly

Refusing all fluids, fewer wet nappies, no tears or a dry mouth, a very high temperature, or fever lasting more than 3 days: see a doctor today.

Routine — see a doctor

Mouth sores and rash in a child who is drinking: comfort care at home; see a doctor if not improving after 7 to 10 days, or if you are pregnant and catch it.