Hand, foot and mouth disease

A mild childhood virus with an alarming name. Nothing to do with foot and mouth in animals, and no treatment beyond comfort.

What it is

A common viral infection of young children, usually caused by coxsackievirus. It causes mouth ulcers and a rash on the hands and feet.

It is completely unrelated to foot and mouth disease in livestock, despite the name, and cannot be caught from or given to animals. That reassurance is worth giving first because the name frightens people.

It is mild and self-limiting, clearing in seven to ten days. There is no treatment and no vaccine; care is about comfort and fluids.

The main practical risk is dehydration, because the mouth ulcers make drinking painful. That is what turns a mild illness into a hospital admission in a small child.

Fingernails and toenails sometimes peel or fall off a few weeks later. It is harmless, alarming to parents, and the nails grow back.

Adults can catch it, usually mildly but sometimes with severe mouth ulcers.

In pregnancy it is usually harmless, though infection close to delivery can occasionally cause illness in a newborn, so it is worth mentioning to a midwife.

Signs you might notice

A day or two of fever, sore throat, and being off food.

Painful mouth ulcers on the tongue, gums and inside the cheeks.

A rash of small red or dark spots or blisters on the palms, soles, and often the buttocks and around the mouth. On brown and black skin the spots may be harder to see; feel for the raised blisters.

Not usually itchy, unlike chickenpox.

Urgent, same day: a child not drinking, with fewer wet nappies, dry mouth, no tears when crying, or drowsiness.

999 or A and E: a child who is floppy, very drowsy or hard to wake; a stiff neck, severe headache or a rash that does not fade under a glass; difficulty breathing; or a fit.

How it can affect day-to-day life

The mouth ulcers hurt more than the rash and are the reason children stop drinking. Cold food and drink, ice lollies, yoghurt and smoothies get fluids in when a cup will not.

Exclusion from nursery or school is not recommended in the UK once the child is well enough to attend. The virus is shed for weeks afterwards, so keeping children away does not stop spread and does cost families a great deal.

Hand hygiene, particularly after nappies, and not sharing cups and towels are the useful measures.

Outbreaks in nurseries are common and are not a sign of poor hygiene.

Pregnant staff and parents often worry considerably; the reassurance above is usually all that is needed, alongside telling the midwife.

Supporting someone well

Focus on fluids. Cold drinks, ice lollies, ice cream, yoghurt and smoothies through a straw.

Avoid salty, spicy, acidic or rough foods, which sting the ulcers.

Paracetamol or ibuprofen at the right dose for weight for the pain and fever.

Do not use aspirin in children.

Watch wet nappies and alertness; those are the measures that matter.

Wash hands thoroughly, especially after nappy changes, and do not share cups, cutlery or towels.

Do not burst the blisters.

Send the child back to nursery or school when they are well enough; exclusion is not recommended.

Mention it to a midwife if pregnant.

Where to get help

A pharmacist for pain relief and mouth care advice.

A GP practice or NHS 111 if the child is not drinking, is getting worse after a week, or has a very high temperature.

999 for drowsiness, a non-fading rash, breathing difficulty or a fit.

NHS 111 online for symptom checking out of hours.