Hand, foot and mouth disease (HFMD) is a common, mild viral illness caused mainly by coxsackievirus A16 and enterovirus 71. It causes fever, painful mouth ulcers and a blistering rash on the hands, feet and sometimes the buttocks. It mostly affects children under five, resolves on its own in 7 to 10 days, and has no specific treatment beyond pain relief and keeping the child hydrated.
Key facts
- Incubation: 3–6 days between exposure and first symptoms.
- Duration: most children recover fully within 7–10 days.
- Most contagious during the first week of illness, but the virus can persist in stool for several weeks.
- No antibiotic will help. It is viral. Antibiotics are useless unless a secondary bacterial infection develops.
- Dehydration is the main real risk, because mouth ulcers make drinking painful.
- Adults can catch it, usually with milder symptoms, and can spread it without knowing.
- Not related to foot-and-mouth disease in animals. Completely different virus, no connection.
What are the symptoms, and in what order?
HFMD follows a fairly predictable sequence.
Days 1–2. Fever, often 38–39°C. The child seems tired, irritable and off their food. Some have a sore throat. At this stage it looks like any ordinary viral illness.
Days 2–3. Small red spots appear inside the mouth — on the tongue, gums and inner cheeks. These blister and then ulcerate. This is the painful part and the reason children stop eating and drinking.
Days 3–5. A rash appears on the palms, soles, and often around the buttocks, groin and knees. The spots are flat or slightly raised, red, sometimes blistering. They are usually not itchy, though they can be tender.
Days 7–10. Fever settles, ulcers heal, rash fades. The child is back to normal.
Weeks 3–8. Occasionally the fingernails and toenails peel or shed. It looks alarming and is harmless. The nails grow back normally.
How do I manage it at home?
There is no antiviral for HFMD. Care is about comfort and fluids.
Keep fluids going. This is the priority. Cold drinks, ice lollies, chilled yoghurt, milk and smoothies go down more easily than hot or acidic drinks. Avoid orange juice and anything salty or spicy, which sting open ulcers. Offer small amounts frequently rather than large volumes.
Control the pain. Paracetamol or ibuprofen at the correct weight-based dose makes a real difference and often gets a child eating again. Do not give aspirin to children.
Soft, bland food. Yoghurt, mashed potato, custard, soup at room temperature, ice cream. If the child eats nothing for a day but drinks well, that is acceptable.
Rest. No special treatment needed for the rash. Keep blisters clean and do not deliberately burst them.
When should I take my child to a doctor?
Seek medical assessment if your child:
- Is not drinking, or has had no wet nappy for eight hours or more
- Has a dry mouth, sunken eyes, no tears when crying, or is unusually drowsy
- Has a fever above 38°C in a baby under three months, or a fever lasting more than three days
- Has a stiff neck, severe headache, confusion, or is difficult to wake
- Is breathing quickly or seems short of breath
- Has blisters that become hot, swollen, red beyond the edge or start weeping pus
- Simply seems much more unwell than the illness should account for
The last point matters most. Parents are usually right when they feel something is wrong.
How contagious is it, and for how long?
HFMD spreads through saliva, nasal secretions, blister fluid and stool. That means coughs, shared cups, unwashed hands after nappy changes, and toys that go in mouths.
The child is most infectious during the first week, while fever and blisters are active. The virus can remain in stool for several weeks afterwards, which is why handwashing after toileting and nappy changes stays important well after the child looks well.
Practical prevention: thorough handwashing with soap, disinfecting shared toys and surfaces, not sharing cups or cutlery, and keeping an unwell child home during the acute phase.
When can my child go back to nursery or school?
The general guidance is that a child can return once the fever has settled and they are well enough to take part — not once every blister has disappeared. Waiting for the rash to clear completely would keep children home unnecessarily, and because the virus persists in stool for weeks, exclusion does not reliably stop transmission anyway.
That said, individual nurseries and schools in the UAE set their own exclusion policies and some require a doctor’s fit-to-return note. Check with your child’s nursery directly, and ask your paediatrician for a clearance letter if one is needed.
Can adults get hand, foot and mouth disease?
Yes. Adults often have milder symptoms, sometimes only a sore throat or a few spots, and occasionally no symptoms at all while still being infectious. Parents commonly catch it from their children. In adults it can be more painful than expected, particularly the mouth ulcers, but it follows the same self-limiting course.
Pregnant women who develop HFMD should mention it to their obstetrician. The risk is low, but infection very close to delivery is worth flagging.
Are there complications?
Rare, but they exist. Dehydration is the commonest and the most preventable. Enterovirus 71 in particular has been associated with viral meningitis and, very rarely, encephalitis. Warning signs are stiff neck, severe headache, persistent vomiting, unusual drowsiness, jerky limb movements or difficulty walking. Any of these needs urgent assessment.
Children can get HFMD more than once. Immunity is specific to the strain, and several strains circulate.
Frequently asked questions
How long does hand, foot and mouth disease last? Most children recover in 7 to 10 days. Fever typically lasts 2 to 3 days, mouth ulcers are worst around days 3 to 5, and the rash fades over the following week. Nail shedding, if it happens, occurs weeks later and is harmless.
How long is a child contagious with HFMD? Most contagious during the first week, while fever and blisters are present. The virus can remain in stool for several weeks after recovery, so handwashing after nappy changes and toilet visits should continue even once the child seems well.
Can my child go to nursery with hand, foot and mouth disease? General guidance is to return once fever has settled and the child is well enough to participate, rather than waiting for the rash to clear. UAE nurseries and schools set their own policies and some require a doctor’s clearance note, so check directly with the school.
Is there a treatment or vaccine for hand, foot and mouth disease? There is no specific antiviral treatment and no vaccine widely available outside a few countries. Care focuses on pain relief with paracetamol or ibuprofen and maintaining fluid intake. Antibiotics do not work because the cause is a virus.
What can my child eat with mouth ulcers? Cold, soft, bland foods are easiest: yoghurt, ice cream, ice lollies, milk, smoothies, mashed potato, custard. Avoid citrus juice, salty snacks and spicy food, which sting ulcers. Fluid intake matters far more than food intake in the short term.
Can adults catch hand, foot and mouth disease from their children? Yes. Adults usually have milder symptoms and sometimes none at all, but can still spread the virus. Careful handwashing after contact with a sick child, especially after nappy changes, reduces the risk.
Is hand, foot and mouth disease the same as foot-and-mouth disease? No. They are entirely unrelated. Foot-and-mouth disease affects cattle, sheep and pigs and is caused by a different virus. Human HFMD does not come from animals and does not spread to them.
Ready to take the next step? Book an appointment at Thumbay University Hospital today to consult with our expert Consultant Paediatricians.
