Hand, foot and mouth disease: spots, sores and recovery
It is 2am, your baby has refused every meal today, and you have just spotted small grey blisters on the palms of their hands. Hand, foot and mouth disease is one of those illnesses that looks dramatic at first glance but is, for the vast majority of babies and young children, a self-limiting illness that passes within a week to ten days. Here is what you need to know.
What is hand, foot and mouth disease?
Hand, foot and mouth disease is a common viral illness caused by enteroviruses, most often coxsackievirus A16, though other strains including enterovirus 71 can also be responsible. It is very common in children under five and spreads readily in nurseries and childcare settings where young children are in close contact with one another.
Despite the similar-sounding name, hand, foot and mouth disease has no connection whatsoever to foot-and-mouth disease in animals. They are caused by entirely different viruses and cannot be passed between humans and animals. The name is simply a description of where the rash appears on the body.
The illness circulates year-round but tends to peak in summer and early autumn in the UK. It affects children of all ages but is most common, and can be slightly more severe, in babies and toddlers under two.
How the illness unfolds
The illness follows a fairly predictable sequence, which can be reassuring when you know what to expect. It typically begins with one to two days of fever, usually 38–39°C, alongside general unwellness: your baby may be clingy, off their feeds, and more irritable than usual. At this stage it is easy to mistake for a standard cold or teething.
Sore mouth ulcers then appear, usually on the tongue, gums, and inside the cheeks. These are often the most distressing part of the illness for babies because they make feeding painful. Your baby may refuse bottles, the breast, and food entirely. This is completely understandable on their part and is worth keeping in mind when you are trying to get fluids into them.
Within a day or two of the mouth ulcers appearing, small blisters develop on the palms of the hands, the soles of the feet, and sometimes on the bottom and around the genitals. The full picture of spots in all three locations does not always appear in every child, and some babies only develop spots in one or two areas. The sequence, however, is reliable enough that if you see blisters on the hands and feet following a day or two of fever and a sore mouth, hand, foot and mouth is the most likely explanation.
What the spots look like
The spots that give the illness its name are small, flat or slightly raised, and often have a grey or white blister in the centre. They tend to be a few millimetres in size and can look a little like small oval water blisters. On darker skin tones they may be less easy to spot as they may not have the obvious redness around them that shows more clearly on lighter skin.
The blisters are not usually itchy, which distinguishes them from chickenpox. They can be uncomfortable, particularly on the soles of the feet where the pressure of standing or crawling may cause some pain. Your baby may be reluctant to bear weight on their feet, which can be alarming if you do not know why.
The mouth sores (ulcers) look like shallow, greyish or yellowish oval sores on a red base, similar in appearance to standard mouth ulcers in adults. They can make eating and drinking painful for your baby. The combination of mouth pain and general unwellness is why some babies with hand, foot and mouth eat and drink very little for a few days.
How contagious it is
Hand, foot and mouth spreads through direct contact with an infected person's saliva, blister fluid, or faeces. This means it spreads easily through the things babies and toddlers do naturally: mouthing toys, drooling, and nappy changes. The virus can also live on surfaces for a short time.
The illness is most contagious in the first week, while the fever and blisters are most active. However, an important detail that many parents do not know: the virus can continue to be shed in faeces for several weeks after your baby has otherwise recovered completely. This means that good handwashing after every nappy change remains important even once your baby seems fully better. It is the main route by which the virus spreads within households.
Strict handwashing, particularly after nappy changes and before preparing food, is the most effective prevention step. There is no vaccine for the most common strains circulating in the UK.
Caring for your baby at home
There is no specific antiviral treatment for hand, foot and mouth disease; the goal of home care is to keep your baby comfortable while the illness runs its course.
- Give age-appropriate paracetamol or ibuprofen to manage fever and reduce mouth pain, following the dosage instructions on the packaging for your baby's weight and age. Ibuprofen is not suitable for babies under three months.
- Offer cool, soft foods and cool drinks. Smooth yoghurt, cooled porridge, pureed fruit, or milk feeds (breast or formula) are often easier to manage than anything that requires chewing.
- Ice lollies or cold water can soothe a sore mouth in older babies. Offer fluids little and often rather than in large amounts at once.
- Avoid acidic or salty foods (citrus juice, tomato-based sauces, crisps) that irritate ulcers.
- Keep blisters on the hands and feet clean and dry. Do not burst them. They will dry up and fade on their own.
- Wash hands thoroughly after every nappy change for all caregivers. This is the single most important step to prevent spreading the illness within your household.
Your baby will likely feel most unwell in the first three to four days. After that, most babies begin to turn a corner and start accepting feeds again.
When to see a doctor
NHS guidance suggests contacting your GP or calling 111 if any of the following apply:
- Your baby becomes very dehydrated: no wet nappy for six or more hours, a sunken fontanelle (the soft spot on top of the head), no tears when crying, or very dry lips and mouth.
- Your baby has a very high fever that lasts more than three days, or a fever over 38°C in a baby under three months.
- The rash spreads in an unusual way or looks very different from the typical hand, foot and mouth pattern described above.
- Your baby seems unusually drowsy, difficult to wake, or more unwell than you would expect from a routine viral illness.
- You are worried for any reason. You know your baby best, and that instinct matters.
Dehydration is the main complication to watch for, driven by the pain of mouth ulcers making your baby reluctant to drink. Keeping fluids going, even in small, frequent sips, is the most important thing you can do at home.
Returning to nursery
Public Health England and NHS guidance is reassuring here: children do not need to be kept at home until every blister has crusted over. Your baby can return to nursery when they feel well enough and have recovered from the worst of the illness, even if a few fading blisters are still visible.
However, many individual nurseries and childcare providers have their own policies that are stricter than national guidance. Some will ask you to keep your baby home during the acute phase, which typically means the first few days when the fever and blisters are most active. It is worth contacting your childcare provider early to find out what they require, rather than discovering on the morning you want to return.
The fingernail mystery
A few weeks after recovering from hand, foot and mouth, many parents are alarmed to notice that their baby's fingernail or toenail seems to be lifting, separating, or falling off entirely. This is called onychomadesis, and while it looks very worrying, it is a well-recognised, harmless after-effect of the infection.
The virus temporarily interrupts normal nail growth. The nail separates from the nail bed as a result and eventually falls off, revealing healthy new nail growing underneath. The new nail regrows normally over two to three months. No treatment is needed. If you notice it, you can offer your baby reassurance by knowing that their nail will grow back completely and that this is a known and common aftermath of the illness, not a sign that something has gone wrong.
Frequently asked questions
How long is hand, foot and mouth disease contagious?
It is most contagious during the first week of illness. However, the virus can be shed in faeces for several weeks after recovery, so good handwashing after nappy changes is important even once your baby has otherwise fully recovered.
Can adults catch hand, foot and mouth from their baby?
Yes, adults can catch it, though they often experience milder symptoms than young children. If you are pregnant and have been exposed, it is worth mentioning to your midwife. Serious complications in pregnancy are rare, but your midwife can give you personalised advice.
Should my baby go to nursery with hand, foot and mouth?
NHS guidance does not require exclusion from nursery. Your baby can return when they feel well enough, regardless of whether any blisters are still visible. Check with your childcare provider, as their own policy may be more cautious than the national guidance.
Why does my baby's fingernail look odd after hand, foot and mouth?
Temporary nail loss (onychomadesis) after hand, foot and mouth is normal and quite common. The nail separates from the nail bed as part of recovery and regrows fully over two to three months. It looks alarming but is entirely harmless.
What can I give for the mouth pain?
Age-appropriate paracetamol or ibuprofen will help most. Offer cool drinks and soft, smooth foods. Cool yoghurt or ice lollies can also be soothing. Avoid citrus, salty or spicy foods, which will irritate the ulcers further.
How long does hand, foot and mouth last?
Most children recover within seven to ten days. The fever typically lasts one to two days, mouth sores heal within a week, and the skin blisters dry up and fade over seven to ten days. Your baby should be back to themselves within ten days, and often sooner.
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