Small painful ulcers in the mouth, especially on tongue and sides of mouth (in all children).
Small, thick-walled water blisters (like chickenpox) or red spots located on the palms, soles, and webs between the fingers and toes (70%).
1 to 5 water blisters per hand or foot.
Small blisters or red spots on the buttocks (30%).
Low-grade fever 100° to 102°F (37.8° to 39°C).
Mainly occurs in children age 6 months to 4 years.
Cause
Coxsackie A-16 virus.
See More Appropriate Topic (instead of this one) If
Only has mouth ulcers, see MOUTH ULCERS.
Only has a rash, see RASHES, WIDESPREAD AND CAUSE UNKNOWN.
(To go directly to these topics, click on the links following this document.)
WHEN TO CALL YOUR DOCTOR FOR HAND, FOOT AND MOUTH DISEASE
Call Your Doctor Now (night or day) If
Your child looks or acts very sick.
Signs of dehydration (e.g., very dry mouth, no tears, no urine in more than 8 hours).
Stiff neck, severe headache or acting confused.
Call Your Doctor Within 24 Hours (between 9am and 4pm) If
You think your child needs to be seen.
Red, swollen and tender gums.
Fever persists for more than 3 days.
Call Your Doctor During Weekday Office Hours If
You have other questions or concerns.
Parent Care at Home If
Probable hand-foot-mouth disease and you don't think your child needs to be seen.
HOME CARE ADVICE FOR HAND, FOOT AND MOUTH DISEASE
1. Antacid for Mouth Pain:
Use a liquid antacid 4 times per day.
For younger children, put ½ teaspoon in the front of the mouth 4 times per day after meals.
Children over age 4 can use 1 teaspoon as a mouthwash after meals.
2. Soft Diet:
Encourage favorite fluids to prevent dehydration.
Cold drinks, milkshakes, Popsicles, slushes, and sherbet are good choices.
Avoid citrus, salty, or spicy foods.
For infants, give fluids by cup rather than a bottle (reason: the nipple can cause pain).
3. Fever Medicine: Give acetaminophen (e.g. Tylenol) or ibuprofen for fever above 102°F (39°C) or severe mouth pain.
4. Contagiousness: Quite contagious but a mild and harmless disease. Incubation period is 3-6 days. Can return to daycare or school after the fever is gone (usually 1 to 3 days).
5. Expected Course: The fever lasts 2 or 3 days. The mouth ulcers resolve by 7 days. The rash on the hands and feet lasts 10 days.
6. Call Your Doctor If:
Signs of dehydration develop.
Fever lasts for more than 3 days.
Your child becomes worse or develops any of the "Call Your Doctor" symptoms.
Lucile Packard Children's Hospital is located in Palo Alto, adjacent to Stanford University Hospital, approximately 20 miles north of San Jose, CA and 40 miles south of San Francisco.
