Hand, foot and mouth disease (HFMD) is a common viral illness that mainly affects children under ten, with babies and toddlers being most frequently affected. Despite its alarming name, it is generally mild and self-limiting — most children recover fully within seven to ten days. Understanding the symptoms and knowing how to manage them at home will help you navigate it with confidence.
HFMD is caused by enteroviruses, most commonly coxsackievirus A16 and enterovirus 71 (EV-A71). It is not related to foot-and-mouth disease in animals — they are entirely different infections and there is no connection.
The virus spreads easily through:
It is most contagious in the first week of illness, though the virus can remain in faeces for several weeks after symptoms resolve.
HFMD has a fairly distinctive presentation, though not every child develops all the features.
The illness typically begins with a temperature of 38–39°C, sore throat, reduced appetite, and general irritability. This prodromal phase lasts one to two days before the rash appears.
Small, painful ulcers develop on the tongue, inner cheeks, gums, and roof of the mouth. These are often the most distressing feature for babies and toddlers, making feeding and drinking painful. Your baby may drool more than usual, refuse feeds, or seem very unsettled when trying to eat or drink.
Over the following one to two days, a rash appears on the hands and feet, and sometimes the nappy area, buttocks, knees, and elbows. The rash begins as small red spots which develop into fluid-filled blisters (vesicles). These blisters are typically:
The blisters dry and crust over within a few days and do not usually leave scars.
There is no specific antiviral treatment for HFMD. Management focuses on keeping your baby comfortable and well-hydrated.
Maintaining fluid intake is the priority. The mouth ulcers can make drinking painful, so:
If your baby is on solids, stick to soft, bland foods that do not require much chewing and are not acidic or salty, as these will irritate the ulcers.
A pharmacist may recommend an age-appropriate oral gel to numb the mouth before feeds, such as a teething gel. Check age suitability carefully.
HFMD is highly contagious. The NHS guidance is that children should stay away from nursery or childminder while they are feeling unwell. Unlike chickenpox, there is no fixed exclusion period. Once your baby or child is well enough to attend and no longer has a fever, they can return to nursery — even if the blisters have not fully cleared.
The NHS and Public Health England do not recommend exclusion beyond the period when the child is unwell, as the virus continues to be shed for weeks regardless. Keeping a child home for the entire infectious period is impractical and not advised.
Inform nursery so they can take appropriate hygiene measures and notify other families.
HFMD spreads easily within families. To reduce transmission:
There is no vaccine against HFMD available in the UK. A vaccine against EV-A71 exists in some Asian countries but is not licensed here.
Most cases of HFMD are entirely straightforward, but parents should be aware of the following uncommon complications.
If mouth pain prevents adequate fluid intake, dehydration can develop. Signs include: no wet nappy for 8–12 hours, dry mouth and eyes, no tears when crying, or a sunken fontanelle in babies. Seek medical advice if you are concerned about dehydration.
Several weeks after HFMD, some children experience temporary nail loss or nail changes (onychomadesis). The nails may lift from the nail bed or fall off. This looks alarming but is self-limiting — new nails grow back normally and no treatment is needed.
Very rarely, and more commonly associated with the EV-A71 strain, HFMD can cause viral meningitis, encephalitis, or acute flaccid paralysis. These are serious but exceptionally uncommon in the UK. Seek urgent medical attention if your child develops a severe headache, neck stiffness, persistent vomiting, unusual drowsiness, or any seizure activity.
Contact your GP or call 111 if:
HFMD is unpleasant but almost always resolves without complication. Comfort, fluids, and time are the most effective treatments.
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