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Hand, foot and mouth disease


Expert reviewer Dr Adrian Raby, General Practitioner
Next review due November 2023

Hand, foot and mouth disease is a common childhood viral illness. It causes blisters on your hands and feet, and ulcers in your mouth. While it may be unpleasant, it’s generally mild and you usually recover within a week or two.

Hand, foot and mouth disease has no relation to foot and mouth disease, which only affects cattle, sheep and pigs.

A woman sitting with her child on her laptop

About hand, foot and mouth disease

Hand, foot and mouth disease is commonest in children under 10, especially those under four. But people of any age can get it, including adults. However, most adults will have had contact with the disease as a child and are immune. In the UK, it’s most common in the late summer and early autumn.

Hand foot and mouth disease is extremely contagious – you can catch and spread it easily. It often spreads through groups of children in nurseries and schools. The viruses that cause the disease are usually spread in droplets of mucus or saliva in the air from coughs or sneezes. You can also get it by direct contact with the fluid from blisters of someone infected. And an infected person can spread the virus if they don’t wash their hands properly after going to the toilet because the virus can be passed in poo.

You are most contagious while you still have blisters and mouth ulcers – which usually last for seven to 10 days. But you can continue to pass the virus in your poo for a number of weeks, so you may still be mildly infectious during this time. You may also be infectious for a few days before the rash appears, which makes the spread of the infection hard to control.

For information on how to reduce the risk of catching or spreading the disease, see our section on prevention of hand, foot and mouth disease. Find out under what circumstances you can send your child to school in our FAQ section.

Symptoms of hand, foot and mouth disease

Symptoms usually appear three to seven days after becoming infected (the incubation period). They generally last for around seven to 10 days.

For the first few days, you may feel generally unwell with:

  • a fever
  • a sore throat
  • a cough
  • loss of appetite
  • pain in your abdomen (tummy)

These early symptoms are similar to many other viral infections. But within a few days, you may start to develop symptoms more typical of hand, foot and mouth disease, including:

  • blisters or ulcers in your mouth
  • spots or blisters on your hands and feet

Mouth ulcers and blisters usually develop within a couple of days from when you started feeling unwell. They’re most common on the roof of your mouth, inside of your cheek and on your tongue. This can make eating and drinking painful.

Spots and blisters on your hands and feet tend to develop soon after the blisters in your mouth. They usually come up on the backs of your hands, the sides of your fingers, and the heels of your feet. Although it is less common, you may get blisters on the palms of your hands and the soles of the feet. Blisters often ulcerate (break down) and crust over. They can also be painful or itchy.

The rash tends to be more widespread in younger children and babies. They are more likely to get the rash on their buttocks and in their groin. Older children may just have spots and blisters in and around their mouths.

Blisters on a child's hand caused by hand, foot and mouth disease

Ulcers on the tongue caused by hand, foot and mouth disease 

You won’t need to see your GP if symptoms are mild because you can usually manage them at home. If you or your child becomes more unwell though, contact your GP surgery for advice.

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Seeking help for hand, foot and mouth disease

You don’t usually need to see your GP for hand, foot and mouth disease, especially if you know it’s been going round your child’s school or nursery. But if your child is becoming more unwell or if you’re not sure what’s causing their symptoms, contact your GP surgery for advice.

Your GP will usually be able to tell if you have hand, foot and mouth disease by checking the spots or blisters on your body and ulcers in your mouth.

Self-help for hand, foot and mouth disease

Hand, foot and mouth disease usually clears up on its own after around seven to 10 days. There isn't any specific treatment, and antibiotics don’t help because the illness is caused by a virus, not bacteria. There are a number of things you can do to help relieve your symptoms.

  • Make sure you drink enough fluids to prevent dehydration.
  • If you have painful mouth ulcers, stick to cold foods such as yogurt or ice-cream.
  • If you need pain relief or have a high temperature, take over-the-counter painkillers such as paracetamol or ibuprofen.
  • You can use teething gels such as Dentinox in babies older than 5 months.
  • You can use dental mouth gels containing lidocaine in children over 4 years old or mouth sprays containing benzydamine to soothe painful mouth ulcers.
  • Adults and children over 13 can use mouthwashes containing benzydamine.
  • Adults and teens over the age of 16 can use choline salicylate gel (for example Bonjela).

Always read the patient information that comes with your medicine. If you need any advice about what types of medicines to use for you or your child’s symptoms, you can check with a pharmacist.

Causes of hand, foot and mouth disease

Hand, foot and mouth disease is usually caused by a group of viruses known as the coxsackieviruses. The one that most commonly causes the disease is coxsackie virus A16.

Another virus called enterovirus 71 (EV71) can occasionally cause a more severe form of hand, foot and mouth disease. EV71 is uncommon in the UK.

The virus is very easily spread. It’s passed from one person to another through coughing or sneezing and from direct contact with fluid from blisters. It’s also passed on in an infected person’s faeces – they can spread it if they don’t wash their hands properly after going to the toilet.

Complications of hand, foot and mouth disease

Hand, foot and mouth disease is usually a mild infection. But occasionally it can lead to more serious problems.

  • Dehydration is the most common complication. Blisters in your mouth can make drinking painful – so you end up not drinking enough.
  • Blisters on your skin can become infected, especially if you scratch them. If one or more areas of your skin becomes very red and you develop a high temperature, see your doctor. You may need antibiotics for a secondary bacterial infection.

Young children are especially prone to dehydration. Signs that your child (or you) may be dehydrated include feeling thirsty, having a dry mouth and not passing urine as often. It’s important to keep your child hydrated and you should contact your doctor if you think they are dehydrated. This is because severe dehydration in babies or young children may need hospitalisation so fluids can be given through a drip.

More serious complications are much rarer and are generally related to a more severe type of hand, foot and mouth disease caused by enterovirus 71 (EV71). Most people in the UK won’t have this form of the disease.

Contact your doctor for advice if you or your child become more unwell, don’t get better after a week or so, or if you are concerned.

Pregnancy

Doctors don’t think getting hand, foot and mouth disease when you’re pregnant will cause any risk to your developing baby. But it makes sense to try to avoid close contact with anyone with any infection, especially if you’re getting close to your due date.

If you get hand, foot and mouth disease within three weeks of being due to give birth, you could pass the infection to your new-born baby. So, if you have symptoms such as a rash when you’re pregnant, talk to your midwife or GP for advice. They may need to examine you to determine which kind of rash you have.

Prevention of hand, foot and mouth disease

Hand, foot and mouth disease spreads very easily. Here are some tips to reduce your risk of catching or spreading it.

  • Wash your hands thoroughly with soap and water before you eat and after going to the toilet.
  • Cover your mouth and nose when you cough or sneeze – use a tissue and wash your hands afterwards.
  • Clean surfaces that may have been in contact with saliva or faeces with cleaning products containing bleach. (If you use disinfectant on a changing mat, rinse it off afterwards.)
  • Dispose of used tissues and nappies properly after changing your baby.
  • Wash soiled clothing, towels and bedding on a hot machine wash with laundry bleach.
  • Don’t share cups, utensils or towels with people who are infected.
  • The virus is contained in the spots and blisters, so don’t deliberately squeeze or pierce them.
  • Try to avoid contact with other people – particularly pregnant women – as much as you can while you have symptoms.
  • Remember that the virus can be in poo for a number of weeks after you’ve had the infection.

The following video illustrates how to wash your hands effectively in 20 seconds.

Frequently asked questions

  • The main difference between chickenpox and hand, foot and mouth disease is where you get blisters.

    With hand, foot and mouth disease, you tend to get blisters on your hands and feet, and blisters or ulcers in your mouth.

    With chickenpox, you’ll usually get spots all over your body, face, scalp, arms and legs. The spots gradually progress to blisters – and then eventually crust over. They’re also very itchy, whereas the blisters you get with hand, foot and mouth disease don’t tend to itch as much.

    Like hand, foot and mouth disease, chickenpox is caused by a virus, which means it’s managed in a similar way. Antibiotics don’t work for viruses. You can generally manage both infections at home, by making sure you’re drinking enough and taking paracetamol to reduce any fever.

    Very occasionally, chickenpox can become more serious – particularly in adults and people with lowered immunity. If you have severe chickenpox or you’re at risk of complications, your GP may prescribe medicine help reduce your chance of developing complications.

    If you’re concerned about your symptoms, contact your GP surgery for advice. 

  • Children should only stay home if they are unwell. Official guidance is that they don’t need to be kept away from nursery or school if they feel well. Different child-care providers may have their own rules though, so you should check with your child’s nursery or school.

    Ideally, it’s best to limit contact with other people as much as you can if you have hand, foot and mouth disease. But keeping your child off school for a few days won’t completely stop the risk of the infection spreading. Your child may still be infectious for several weeks after having the illness, even after their symptoms have cleared up. This is because they may still pass the virus in their poo. They can then pass this on to others if they don’t wash their hands properly after going to the toilet.

    To reduce spread to other children, it’s better to teach your child good hygiene – like washing their hands after using the toilet or blowing their nose.

  • It’s possible, although most adults are immune to the viruses that most commonly cause the disease.

    If you get hand, foot and mouth disease, you become immune to the specific virus that caused it. This means you won’t get that particular virus again. However, there are several different viruses that cause hand, foot and mouth disease. Even if you’re immune to one, you could become infected with another – and you may then develop hand, foot and mouth disease again.



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Related information

    • Hand, foot and mouth disease. NICE Clinical Knowledge Summary. cks.nice.org.uk, last updated November 2015
    • Hand-foot-and-mouth disease. BMJ Best Practice. bestpractice.bmj.com, last reviewed September 2020
    • Oxford Handbook of General Practice (5th edition) Oxford Medicine Online. oxfordmedicine.com, published June 2020
    • Dentinox teething gel. Electronic Medicines Compendium. medicines.org.uk, last updated September 2018
    • Hand, foot and mouth disease. Patient patient.info, last updated July 2015
    • Benzydamine hydrochloride. Nice British National Formulary for Children. bnfc.nice.org.uk, accessed October 2020
    • Choline salicylate. Nice British National Formulary for Children. bnfc.nice.org.uk, accessed October 2020
    • Chickenpox. NICE Clinical Knowledge Summary. cks.nice.org.uk, last updated August 2018
    • Hand, foot, and mouth disease. Center for Disease Control and Prevention. cdc.gov, last reviewed July 2015
    • Factsheet on hand, foot and mouth. Public Health England. nationalarchives.gov.uk, last reviewed August 2013

  • Reviewed by Liz Woolf, Freelance Health Editor and Marcella McEvoy, Health Content Team, November 2020
    Expert reviewer, Dr Adrian Raby, General Practitioner
    Next review due November 2023

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