Hand, Foot, and Mouth Disease in Children: What to Expect and When to Call the Doctor

Few illnesses alarm parents quite like hand, foot, and mouth disease — the sight of blisters on a toddler's hands and feet, combined with painful mouth sores that make them refuse to eat, can feel frightening. At Hummingbird Pediatrics, we want to reassure families across Robbinsville, East Windsor, Plainsboro, and Mercer County that HFMD, while uncomfortable, is almost always a mild, self-limited illness that runs its course in 7–10 days without medical treatment.

Here is everything you need to know about recognizing it, managing it at home, and knowing when to call us.

What Causes Hand, Foot, and Mouth Disease?

HFMD is caused by enteroviruses — most commonly coxsackievirus A16, though coxsackievirus A6 and enterovirus 71 (EV-A71) can also cause it. EV-A71 is associated with a more widespread rash and, rarely, neurological complications, and tends to cause more severe illness.

The disease is most common in children under 5 years old, though older children and adults can get it. In New Jersey, outbreaks most often occur in late spring, summer, and early fall when enteroviruses circulate most actively.

How Does HFMD Spread?

• Direct contact with saliva, mucus, blister fluid, or stool of an infected person
• Touching contaminated surfaces and then touching the mouth
• Close contact (kissing, hugging, sharing cups or utensils)

Children are most contagious during the first week of illness, but the virus can remain in stool for weeks after symptoms resolve. This is one reason HFMD spreads so readily in daycare and preschool settings.

What Does HFMD Look Like?

Phase 1: Fever and Feeling Unwell (Days 1–2)

HFMD usually begins with fever (100–103°F), reduced appetite, sore throat, and general fussiness. Your child may seem clingy and unwell but not yet have the characteristic rash.

Phase 2: Mouth Sores (Days 2–3)

Painful sores (ulcers) develop in the mouth — on the tongue, gums, inside the cheeks, and on the roof of the mouth. These can be quite painful and are often what cause children to refuse food and drinks. The sores look like red spots that develop into small ulcers with gray or white centers.

Phase 3: Skin Rash (Days 3–7)

The characteristic rash appears on the palms of the hands and soles of the feet — though it can also appear on the knees, elbows, buttocks, and genitalia. The spots are flat or slightly raised red bumps that may develop into blisters. Unlike chickenpox, HFMD blisters are not typically itchy and do not usually open or become infected.

The rash fades and crusts over within a week. In some children, fingernails and toenails may temporarily peel or fall off in the weeks following illness — this is harmless and temporary.

Home Care for HFMD

There is no antiviral treatment for HFMD. Management focuses on keeping your child comfortable while the illness resolves:

Managing Fever and Pain - Acetaminophen (Tylenol) or ibuprofen (for children over 6 months) can reduce fever and ease mouth pain - Give medication before meals to make eating and drinking less painful - Do not give aspirin to children

Encouraging Fluids Staying hydrated is the most important home care goal, especially since mouth sores make drinking painful. - Offer cold liquids — cold soothes mouth pain. Popsicles, cold water, cold milk, or cold formula - Avoid acidic drinks (orange juice, lemonade) which sting mouth sores - Offer ice chips to older children - Offer soft, bland foods: yogurt, applesauce, mashed potatoes, smoothies - Avoid salty, spicy, or crunchy foods

Skin Care - Keep blisters clean and dry - Do not intentionally pop blisters - Wash hands frequently to prevent spread within the household

When to Call Hummingbird Pediatrics

• Shows signs of dehydration (no wet diapers in 8 hours, crying without tears, dry mouth, no urine output)
• Has a fever that persists beyond 5 days
• Develops a stiff neck, severe headache, or is unusually difficult to wake
• Has blisters that look infected (increasing redness, warmth, pus)
• Is under 6 months old with HFMD symptoms
• Has a severely widespread rash covering the entire body

Go to the ER if your child has difficulty breathing, seizures, is extremely lethargic, or has weakness in the limbs.

Daycare and School Return Policy

• They are fever-free for at least 24 hours without fever-reducing medication
• They are feeling well enough to participate in activities
• All mouth sores have healed enough that they are not drooling excessively

Children should not be excluded solely because the rash is still visible — non-blistering rash alone is not a reason to stay home.

Can Parents Get HFMD?

Yes. Adults can get HFMD, though they often have milder symptoms or none at all. Pregnant women who are exposed should contact their OB, as infection near delivery carries some risk to the newborn.

Wash your hands frequently, especially after diaper changes, and avoid kissing your child on the mouth while they are infectious.

Prevention

• Frequent handwashing with soap and water, especially after diaper changes and before meals
• Disinfecting frequently touched surfaces and toys
• Avoiding close contact with infected individuals during the contagious period

What About Atypical HFMD?

Some outbreaks — particularly those caused by coxsackievirus A6 — produce a more widespread rash that spreads beyond the hands, feet, and mouth to the arms, legs, trunk, and face. This atypical presentation can look alarming but is self-limited and resolves the same way. Nail peeling (onychomadesis) in the weeks after HFMD is harmless and temporary.

Our team at Hummingbird Pediatrics follows AAP guidance for HFMD management. If you are unsure whether your child's rash is HFMD or something else, or if symptoms seem unusually severe, do not hesitate to call our office. We are here to help you navigate the illness with confidence and know exactly when to escalate care.