Hand, Foot and Mouth Disease

When to get help

Most cases need no medical contact at all. Ask for an urgent GP appointment, or call NHS 111 in the UK, your GP out-of-hours service in Ireland, your paediatrician in the US or Canada, healthdirect on 1800 022 222 in Australia or Healthline on 0800 611 116 in New Zealand, if:

• your baby has a very high temperature, or feels hot, cold or shivery — and note the age thresholds that override everything else: 38°C (100.4°F) or higher under three months, 39°C (102.2°F) or higher from three to six months;
• your baby is peeing less than usual, which may mean they are becoming dehydrated;
• you are worried about their symptoms.

Call emergency services — 999, 112, 911, 000 or 111 depending on where you live — for the signs that apply to any unwell baby: a rash that does not fade under a pressed glass, difficulty breathing, blue, grey or mottled skin, a baby who is floppy or cannot be roused, or a first seizure. Those are not features of hand, foot and mouth disease, which is exactly why they matter if they appear.

See a GP non-urgently if symptoms have not improved after 7 to 10 days, or if you are pregnant and catch it. Check with the surgery before going in, since it spreads easily and they may offer a phone consultation instead.

What it looks like, in order

The NHS describes two stages. First come a sore throat, a high temperature and not wanting to eat. A few days later come mouth ulcers, which can be painful, and a raised rash of spots on the hands and feet, sometimes also in the groin and on the bottom.

The spots can look pink, red, or darker than the surrounding skin depending on skin tone, and can turn into blisters that may be grey or lighter than the surrounding skin. The CDC's summary is the same: fever, sore throat, painful mouth sores that blister, and a rash commonly found on the hands and feet. It notes a rash on the palms and soles is a common sign.

Symptoms are usually mild, and the NHS notes they are the same in adults and children. Most people get better on their own in 7 to 10 days. Complications, says the CDC, are rare.

The complication that actually matters

It is not the rash. It is the mouth. Ulcers make swallowing painful, a baby with a painful mouth drinks less, and a baby who drinks less gets dehydrated. The CDC puts this front and centre: mouth sores can make it painful to swallow, so make sure your child drinks enough to stay hydrated.

Signs of dehydration in a baby, from the NHS: a sunken soft spot on top of the head, sunken eyes, few or no tears when crying, fewer wet nappies than usual, and being drowsy or irritable. Any of those is a reason to seek advice today rather than tomorrow.

Getting fluids in

• Keep breastfeeding or bottle feeding as normal, and offer smaller amounts more often.
• Offer cool fluids to soothe the mouth. Avoid acidic drinks such as fruit juice, which sting ulcers.
• For babies on solids, offer soft foods such as yoghurt, and avoid hot, salty or spicy food.
• Paracetamol or ibuprofen can ease a sore mouth or throat if your baby is distressed — check the label for suitability at their age and weight, or ask a pharmacist.

A pharmacist can also advise on mouth ulcer gels, sprays and mouthwashes, and tell you which are suitable for children. Many are not licensed for babies, so ask rather than assume.

There is no cure, and that is fine

The NHS is direct: you cannot take antibiotics or other medicines to cure hand, foot and mouth disease. Antibiotics do nothing against a virus. The CDC notes there is no vaccine in the United States against the viruses that cause it. Treatment is comfort and fluids, and the illness runs its course.

Nursery, and the rule people get wrong

Keep your baby away from nursery or childcare while they are too unwell to go. But as soon as they feel better they can go back — there is no need to wait until the blisters have healed. The NHS adds the reasoning: keeping your child away from other children for longer is unlikely to stop the illness spreading. UKHSA guidance for education and childcare settings takes the same approach for this infection.

That surprises people who assume visible spots mean visible risk. The virus spreads from a few days before symptoms appear, and you are most likely to pass it on in the first five days after symptoms start — which is usually before anyone knows what it is.

Stopping it spreading

It spreads in coughs, sneezes, poo, and the fluid in the blisters, and you can catch it more than once. Wash hands often with soap and water, including your baby's; use tissues and bin them quickly; do not share towels, cups or cutlery; and wash soiled bedding and clothing on a hot wash. The CDC adds cleaning and disinfecting frequently touched surfaces and shared items, including toys and door handles.

If you are pregnant, avoid close contact with anyone who has it. The NHS notes there is usually no risk to the pregnancy or baby, but catching it shortly before giving birth can mean a baby is born with a mild version. Speak to a GP or midwife if you have been in contact with someone who has it.