By Anita Davies
Here’s what you need to know about the mild but highly contagious illness that often lurks in kids’ classrooms.
The mere mention of “hand, foot and mouth disease” is enough to make any parent shudder. This common childhood illness is incredibly contagious and can tear through playrooms, day care centers and preschool classrooms at an alarming clip. And while its symptoms tend to be relatively mild, hand, foot, and mouth disease can make babies and toddlers (and their caregivers) pretty miserable. Here’s everything you need to know, including how to prevent it in your little one (and yourself!).
What is Hand, Foot, and Mouth Disease?
Hand, foot, and mouth disease is a type of viral infection, explains Sarah Kohl, MD, a clinical assistant professor of pediatrics at the University of Pittsburgh School of Medicine and founder and president of TravelReadyMD. The funny-sounding name is derived from the telltale rash that generally appears on the hands, feet and mouth (as well as blisters surfacing in the mouth) of those infected. The virus usually manifests with a high fever that may spike before the outbreak of the rash.
What Causes Hand, Foot and Mouth Disease?
Hand, foot, and mouth disease is typically caused by the Coxsackie virus—usually, but not always, the Coxsackie 1 virus. It’s most commonly seen in babies and kids younger than 5, because they haven’t been previously exposed to the virus and haven’t developed an immunity to it yet. But older children and adults can also contract hand, foot, and mouth disease—even if they’ve had it before. That’s because the illness can be caused by several different viruses and even different strains of the Coxsackie virus, says Bande Virgil, MD, a pediatrician and creator of The Mommy Doc website. So while you’d become immune to the specific virus that caused the illness the first time around, you’re still susceptible to other strains.
How contagious is hand, foot, and mouth disease?
Very! “These viruses spread quite easily,” says Jeffrey Kahn, MD, director of Pediatric Infectious Diseases at Children’s Medical Center in Dallas. It’s generally contracted through contact with feces, saliva or mucus, and while it can surface year-round, hand, foot, and mouth disease tends to cluster in the summer and fall, according to Jonathan Auth, MD, a pediatrician at CHOC Children’s Hospital in Orange County, California. And because parents may not realize their child is infected at first, it paves the way for the illness to quickly spread through day care centers and nursery schools.
So when is hand, foot, and mouth disease contagious? Here’s the tricky thing: It’s often contagious before any clear signs of the illness are present. “Because the virus can be shed by people without symptoms, it can be impossible to completely avoid exposure,” Kohl says.
Symptoms of Hand, Foot, and Mouth Disease
While an official diagnosis can be made via a mouth swab or stool sample, pediatricians often simply make a determination based on the symptoms of hand, foot, and mouth disease, says Adam Spanier, MD, an associate professor of pediatrics at the University of Maryland School of Medicine in Baltimore—which is why it’s important to call your pediatrician if you suspect your child may have the illness.
The telltale sign is the red rash, but you can’t always rely on it as an indicator. Sometimes, the rash can be quite subtle, Virgil says, or you may not see the rash before you notice a fever. You also may not spot a rash at all, since it can take the form of ulcers hidden inside your child’s mouth or throat.
Here, some symptoms of hand, foot, and mouth disease to look for:
- Fever. A high temperature is usually the first sign of the virus, which may or may not be accompanied by a rash, says Auth.
- Rash. Red spots may appear on the palms of the hands, soles of the feet and around the mouth, as well as on the knees, elbows, torso, buttocks and genital areas.
- Discomfort. Your child may seem a lot more irritable or uncomfortable than usual, even if she doesn’t have a rash or a temperature.
- Lack of appetite. If your child seems especially picky about his food, isn’t eating or doesn’t want to drink, it could be a sign that blisters are bothering him, says Spanier.
- Sore throat. If your little one complains of a “sore throat,” blisters in her throat could actually be the real culprits.
Pregnant moms who have been exposed to the illness and experience any of these symptoms should let their obstetrician know right away. “Fever in pregnancy can be harmful to a fetus, especially in the first trimester,” Virgil notes.
Hand, Foot, and Mouth Disease Treatment
“While there’s no medical cure or treatment for hand, foot, and mouth disease, your pediatrician can help you come up with ways to make your child more comfortable while the illness runs its course,” Auth says. Here, some home remedies for hand, foot, and mouth disease to try.
- Over-the-counter pain relief. Ask your pediatrician about appropriate pain medications, such as ibuprofen (Motrin or Advil) or acetaminophen (Tylenol), and follow the dosage procedures for your child’s age. Taking them half an hour before mealtime can make eating and drinking less painful, Spanier says. Experts also recommend OTC pain relievers to help bring down a fever. Let your pediatrician know if your child’s temperature remains high after taking a pain reliever.
- Plenty of liquids. Make sure your child is hydrating, either with breast milk or formula, or, if he’s older, with water, Auth says. Keep track of urine output: If your child has less than three wet diapers during his waking day or, if toilet trained, goes to the toilet less than three times, call your pediatrician. “Another way to ensure your child is hydrated is to make sure he’s producing wet tears,” Spanier says. ‘If he’s crying without tears, it’s a sign he may be dehydrated and needs to be seen by a pediatrician ASAP.”
- Cold or soft foods. Bring on the ice pops! Foods that are cooling and easy to eat will help soothe a sore throat and painful mouth. Try making breast milk ice pops for baby, and pudding, applesauce, chilled soups or smoothies for an older child.
- Cover mouth blisters. “Many parents I’ve worked with use a combination of Maalox and Benadryl, then use a Q-tip to cover mouth sores with the mixture,” Kohl says. This can help soothe irritation and make it easier for babies and toddlers to drink; but just as with OTC pain relief, ask your pediatrician first before you try this remedy.
- Rest. Your child is likely to feel cranky, especially if she has a temperature or is in pain, so plenty of snuggles and cuddles on the couch are a good hand, foot, and mouth disease treatment.
How Long Does Hand, Foot, and Mouth Disease Last?
The good news: By the time your child’s fever resolves, he may be back to his usual playful self, especially if his blisters are mild. The bad news: If he still has lesions, he may not be welcome back in day care just yet. “Children are usually considered contagious until the lesions resolve, which may take five to seven days out of day care or preschool,” Virgil says.
Following a bout of hand, foot, and mouth disease, peeling nails (and skin on the hands and feet) can sometimes happen, even a few days or even weeks after the illness has run its course. “A lot of parents see this and panic,” Spanier says. “Even though it’s weird, it’s just another effect of the virus and nothing to worry about.” Keep hands and feet clean and moisturized—the nails will grow back and look like normal in a few months.
Hand, Foot, and Mouth Disease Prevention
No matter how hygiene-focused you are, hand, foot, and mouth disease can be tough to avoid, particularly if your little one is in day care, preschool or engages in organized activities with other toddlers. Still, there are some things you can do help prevent it.
- Wipe down surfaces. Make sure all toys and surfaces are wiped down after playtime, washed and disinfected, Kohl says.
- Talk hygiene with your day care. It sounds gross, but hand, foot, and mouth disease is often spread by fecal matter, usually because someone didn’t embrace proper hygiene habits. Make sure your day care center is using disposable gloves and has protocols in place to sanitize hands and changing areas from one child to the next.
- Follow your doctor’s guidelines. While it can be tempting to send your child back to school as soon as she seems better, experts say it’s crucial to make sure she is past the contagion period to avoid passing the illness onto others.