Hand foot and mouth disease

Hand foot and mouth disease is a mild, infectious viral illness that most frequently occurs in young children. Symptoms include fluid-filled blisters that appear on the hands, feet and inside of the mouth, which makes diagnosis relatively straight-forward.

No specific medical treatment is required as hand foot and mouth disease is usually short-lasting. Paracetamol is recommended to help relieve symptoms.

General information

Hand foot and mouth disease (HFMD) most commonly affects children under the age of ten years, particularly pre-schoolers. Outbreaks often occur in child-care centres and schools, where there are large groups of children in close quarters, and most often in summer and early autumn.

HFMD in humans is unrelated to the virus that causes foot-and-mouth disease in cattle, sheep and pigs. The condition hand-foot syndrome, which results in swelling in the hands and feet, is also unrelated.

Causes

The virus that causes HFMD is transmitted from person to person by coughing and sneezing, direct contact with the fluid in the child’s blisters, or direct contact with secretions from a child's nose and throat. The virus is also present in the child’s poos, so inadequate hand washing after toileting or changing a nappy can also spread the virus.

Once infection with the HFMD virus has occurred, the time until symptoms appear is usually between three and six days.

HFMD is most contagious in the first week after symptoms appear or while there is fluid in the affected child’s blisters. However, the virus can remain present in the poos for several weeks.

Signs and symptoms

Initial symptoms of HFMD often appear suddenly and include a mild fever and sore throat. A headache may also be present. One to two days later the following symptoms develop:

• Painful ulcer-like blisters in the mouth - particularly on the lining of the cheeks, roof of the mouth, gums and tongue.
• A rash with small fluid-filled blisters on the pads of the fingers and palms of the hands and/or soles of the feet. Occasionally the rash and blisters appear on the buttocks.

In addition, children are often tired and irritable. They may also refuse food and fluids due to the painful blisters in the mouth.

HFMD can be confused with chickenpox . The main difference is that a chickenpox rash will be seen over most of the body. HFMD ulcer-like blisters can also be confused with cold sores in a child’s mouth.

Diagnosis

A diagnosis of HFMD can usually be made based on its characteristic symptoms. If a diagnosis is in doubt, samples can be taken to test for the presence of the virus in the fluid of blisters, nose and throat secretions, or poos.

Treatment

HFMD is usually a mild, self-limiting disease that resolves by itself around seven days after symptoms first appear. However, some strains of the virus may cause more severe symptoms. Recommended treatment may include:

• Paracetamol to relieve pain and reduce fever
• Antiseptic mouthwashes that can soothe the discomfort in the mouth
• Preventing infection of the blisters by trimming a child's fingernails short and washing hands frequently with soap and warm water
• Encouraging fluid intake. Fluids should be sipped frequently during the illness. Ice chips and iceblocks can be soothing on the mouth as well as providing fluid
• Avoid salty or spicy foods as well as acidic foods and drinks (e.g. citrus fruits, fruit drinks and soft drinks)
• Rest is also important in assisting recovery.

There are no anti-viral medications available for treatment of HFMD.

Complications

Complications are rare but it is important to watch out for the signs.

When it is caused by a particular virus strain, HFMD has been associated with the development of viral meningitis and encephalitis (inflammation of the brain). Consult a doctor if a child's fever is particularly high or persists for more than 24 hours; do so immediately if your child seems very sick, confused or difficult to wake, has trouble walking, or has a stiff neck.

Newborn babies can get HFMD from mothers who develop the disease just before giving birth, but the babies will usually develop only mild symptoms. HFMD in healthy adults is uncommon so the likelihood of infection during pregnancy is very low.

In rare instances, HFMD contracted by mothers in pregnancy may result in miscarriage or affect the baby's development. Therefore, women who have contact with someone with HFMD while they are pregnant, or who develop a rash during pregnancy, should see their doctor or maternity carer.

The most common complication of HFMD is dehydration (because the sores inside the mouth and throat make swallowing painful), which is why children with HFMD should be encouraged to drink fluids during the illness.

Prevention

The most effective way of preventing the transmission of the virus is effective hygiene. Hand washing after toileting, changing nappies and before preparing or eating food is particularly important. Avoid contact with the fluid-filled blisters and discourage sharing drinks and toys.

To help prevent the spread of HFMD children should be kept home from school or childcare while the blisters in their mouth and on their hands and feet are present.

There is no vaccine available for the prevention of HFMD.

Further information and support

For further information and support about HFMD contact your GP, public health unit, practice nurse, or contact:

Healthline

Freephone: 0800 611 116 (operates 24 hours a day, 7 days a week)

Website: www.healthline.govt.nz

Plunketline

Freephone: 0800 933 922 (operates 24 hours a day, 7 days a week)

Website: www.plunket.org.nz

References

DermNet New Zealand (2022). Hand foot and mouth disease (Web Page). Hamilton: DermNet New Zealand Trust. http://www.dermnetnz.org/topics/hand-foot-and-mouth-disease/ [Accessed: 12/01/23]

Canterbury District Health Board Community and Public Health (2015). Hand, foot, and mouth disease (Pamphlet). Christchurch: Canterbury District Health Board. http://www.cph.co.nz/wp-content/uploads/med0006.pdf

Mayo Clinic (2022). Hand-foot-and-mouth disease (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/hand-foot-and-mouth-disease/symptoms-causes/syc-20353035 [Accessed: 12/01/23]

Ministry of Health (2020). Hand, foot, and mouth disease (Web Page). Wellington: New Zealand Ministry of Health. Available from: http://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/hand-foot-and-mouth-disease [Accessed: 12/01/23]

Last Reviewed - January 2023

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