Hand Foot and Mouth
Hand foot and mouth disease is a routine childhood illness. Most cases are not serious, but it occasionally needs medical attention, can be uncomfortable, and can lead to several days absence from school/daycare.
Cause
Hand foot and mouth disease is caused by the coxsackie virus. Virtually all children will catch it at some point in their childhood until they're immune, so it's not one of the more worrisome illnesses to be exposed to. But you may wish to avoid catching it at certain inconvenient times (aren't they all?) or when your infant is very young. There are different strains of the virus, so children can catch this more than once, but they'll eventually become immune to the most common ones.
Symptoms
Kids may present with just the rash, just the oral ulcers, or both, with or without fever.
Rash: small to medium sized red bumps (which may blister) on the hands and feet, sometimes around the mouth, diaper area, or arms and legs. It's usually not on the torso or face other than around the mouth. Not all cases have the classic distribution, so some of these areas may not be involved for your child. They usually don't hurt or itch, but can in some cases.
Oral lesions/mouth pain: Some may have multiple oral lesions similar to canker sores, which can be very painful and lead to trouble eating, drooling, and dehydration.
Fever: may be present at the beginning of the illness for up to 3-4 days up to ~101. If fever occurs later in the illness or lasts longer than that it may suggest something else and would warrant evaluation.
After about a week, the rash and lesions are fading, but sometimes can linger for a while.
Treatment
Pretty much all you need to do is keep your child comfortable and hydrated. For pain control (if your child is having mouth pain/sore throat), ibuprofen usually works best but acetaminophen (Tylenol) would be preferred if your child can’t take ibuprofen or is severely dehydrated. With pain under control kids usually hydrate better, and as long as you can keep that hydration up it’s just a matter of waiting it out until it passes. It also helps to keep their skin clean and apply moisturizers to protect from/prevent secondary bacterial infections from developing.
Contagiousness
Coxsackievirus is contagious through secretions or contact with lesions. Once your child has been fever free for at least 24 hours, there are no new lesions within the past 48 hours and the old ones have dried/scabbed, it’s generally considered safe to return to school/daycare. Usually this is somewhere around 7 days or so, but could be longer or shorter. This should suffice for your child’s school/daycare, but if they require a note/physician clearance, please schedule an appointment with us. If we’ve already seen your child for this illness and the symptoms have resolved, you can simply call our office for a note without returning for an additional appointment. We cannot write a note without seeing them at least once for their current illness.
Signs to watch for
Do we need an appointment?
Not necessarily if you see classic mild symptoms after an exposure and your child doesn't have any worrisome signs. But if they are more sick than expected or there are other concerning signs it may be worth having us take a look to check for any complications. Some examples that would warrant an appointment:
Ear pain
Bad cough
Vomiting
Unable to hydrate
Honey colored crust over the lesions
Severe lesions
Fever that is > 101, no resolving in 3-4 days, or appears later in the course of the illness
If you’re not sure what it is/would like us to confirm the diagnosis
If your child meets criteria to return to school (see contagiousness section above) and their school requires a note.
things that need urgent/emergency care:
Typically this illness does not require emergency medical attention. However, as with any illness, rare complications can occur. Seek emergency medical attention if your child has severe/concerning symptoms or signs not typically seen with common illnesses, such as:
Severe lethargy/poor responsiveness
Fever with stiff neck or severe irritability (not responsive to fever reducers)
Muscle weakness/paralysis
Signs of severe dehydration
Chest pain
Respiratory distress
Same-day appointments
For urgent needs, same-day appointments are available Monday through Friday. Please call as early in the day as possible, the more notice we have the easier it is to fit everyone in.
Need help outside of office hours?
Firstly, if your child has an emergency, please call 911 or go directly to the ER - they will contact us if needed once your child has been evaluated.
Urgent Care centers can also be helpful when something needs to be seen outside of office hours but it's not an emergency.
For our list of preferred Urgent Cares and ERs, see our resources page.
And if you have something that might need urgent attention but you're not sure/don't know what to do, we can help: