Hello, parents!
If you’re concerned about your child’s sudden high fever or the appearance of blisters on their hands and feet, this guide is for you.
We understand that Hand-Foot-Mouth Disease (HFMD) is one of the most feared illnesses, especially in households with young children.
This article provides comprehensive, easy-to-understand information on everything parents need to know about HFMD—from managing symptoms when your child is suffering to taking essential preventive measures.
👶 1. What is Hand-Foot-Mouth Disease (HFMD)?
Hand-Foot-Mouth Disease is an acute viral illness primarily caused by Enteroviruses, such as the Coxsackievirus (most common) and Enterovirus 71 (EV71).
- Key Symptoms: As the name suggests, it is characterized by the presence of distinctive blisters (vesicles) and ulcers on the Hands, Feet, and in the Mouth.
- When It Occurs: It typically spreads during the warm and humid months of summer and early autumn, and it is most common in infants and young children under 6 years old.
- Incubation Period: Symptoms usually appear after an incubation period of about 3 to 7 days following exposure to the virus.
🦠 2. How is HFMD Contracted and Transmitted? (Causes and Routes of Transmission)
HFMD is a highly contagious disease and is mainly spread through the following three routes:
- 1) Direct Contact (Most Common): Direct contact with the respiratory secretions (e.g., saliva, nasal mucus, phlegm) or the fluid from the blisters of an infected person.
- 2) Fecal-Oral Route: The virus enters the mouth through contaminated hands or objects that have come into contact with the patient’s feces (stool). This can easily happen during diaper changes.
- 3) Contact with Contaminated Objects: Touching contaminated surfaces such as toys, doorknobs, or utensils touched by the patient, and then touching the mouth without proper handwashing.
✅ Key Cause: The virus spreads easily in daycare centers, preschools, and kindergartens where children are in close quarters, especially among toddlers who frequently put their hands in their mouths due to their developing immune systems.
🌡️ 3. Symptoms and Management (At-Home Care and When to Seek Medical Help)
1) Primary Symptoms
- Initial Symptoms: The illness often begins with mild cold-like symptoms such as low-grade fever (below $38^\circ\text{C}$ / $100.4^\circ\text{F}$), poor appetite, and a sore throat.
- Characteristic Symptoms:
- Mouth: Red spots or blisters, which quickly turn into painful ulcers, appear on the tongue, gums, and inside of the cheeks. This causes the child to struggle with swallowing and often refuse to eat.
- Hands/Feet: Small, reddish or grayish blisters (vesicles) appear on the palms of the hands, soles of the feet, and sometimes the buttocks. These blisters are usually not itchy.
- Post-Recovery Note: In rare cases caused by Coxsackievirus A6, nail shedding (Onychomadesis) can occur after recovery. However, the nails usually grow back within 3–6 months, and this is generally not a cause for major concern.
2) At-Home Management
There is no specific cure for HFMD; treatment focuses on supportive care to ease the symptoms.
| Category | Management Strategy | Details |
| Pain Relief | Administer Pain Relievers | Use Acetaminophen or Ibuprofen (as directed by a doctor/pharmacist) to manage fever or severe mouth pain. |
| Prevent Dehydration | Encourage Fluid Intake | Due to mouth pain, children may refuse food. Offer lukewarm or cold water, diluted tea, electrolyte drinks, ice cream, or cold milk frequently in small amounts to prevent dehydration. Avoid hot, spicy, or salty irritating foods. |
| Skin Care | Blister Management | Try to avoid popping the blisters. Keep the child cool to prevent heat rash or chafing, and apply prescribed ointments if necessary. |
3) Red Flags: When to Visit the ER Immediately (⚠️ Warning Signs of Severe Complications)
While most cases are mild, some infections, especially those caused by Enterovirus 71, can progress to severe complications such as meningitis, encephalitis, or myocarditis. Seek immediate medical attention if you observe any of the following symptoms:
- Persistent High Fever: Fever over $38^\circ\text{C}$ ($100.4^\circ\text{F}$) lasting more than 24 hours, or a fever over $40^\circ\text{C}$ ($104^\circ\text{F}$).
- Vomiting and Dehydration: Severe vomiting, lethargy, or signs of severe dehydration (e.g., significantly reduced urination).
- Neurological Symptoms:
- Complaining of severe headache or having a stiff neck.
- Weakness in the limbs or difficulty walking.
- Seizures (convulsions).
- Drowsiness or decreased level of consciousness (lethargy).
⏳ 4. How Long is HFMD Contagious, and Can It Recur? (Isolation Period and Recurrence)
1) Isolation and Contagious Period
- Isolation Period: The contagiousness is highest for at least 7 days after the symptoms first appear.
- Return to School/Daycare: Children should generally not return to group settings (school, daycare) until all symptoms have completely resolved (fever is gone, and the mouth ulcers and skin blisters have healed) and clearance is given by a doctor.Note: The virus can continue to be shed through feces for several weeks after recovery, necessitating continued strict hygiene practices.
2) Likelihood of Recurrence
HFMD is caused by multiple strains of Enteroviruses. Therefore, having the disease once does not grant immunity against all types of viruses.
- Recurrence is Possible: A child can absolutely catch HFMD again if they are infected with a different strain of the virus (e.g., infected with Enterovirus 71 after having been infected with Coxsackievirus A6). The risk of reinfection is higher during peak seasons.
🛡️ 5. Essential Prevention Measures for Parents (Vaccines and Hygiene)
Unfortunately, there is currently no commercially available vaccine for HFMD. The most effective method of prevention is rigorous personal hygiene and environmental disinfection.
1) Proper Handwashing:
- The most crucial step! Use soap and water to wash hands thoroughly for at least 30 seconds, covering the areas between fingers, the back of the hands, and the wrists.
- Hands must be washed, especially after changing diapers, using the toilet, before and after meals, and after returning from outside.
2) Thorough Environmental Disinfection:
- Toys, utensils, bottles, and doorknobs that the child uses should be cleaned and disinfected frequently (e.g., boiling or using a chlorine-based disinfectant).
- Items contaminated with the patient’s respiratory secretions (saliva, etc.) or stool must be disinfected immediately.
3) Limiting Contact with the Patient:
- Avoid close physical contact like kissing or hugging, and use separate personal items like towels and eating utensils.
- Keeping the child home from group settings until they have fully recovered is the single most important way to prevent community outbreaks.
4) Mask Usage:
- Encourage children to cover their mouth and nose when coughing or sneezing, and caregivers may consider wearing a mask when caring for the sick child.
📌 Concluding Thoughts
HFMD is highly contagious and can be distressing for children, but most cases resolve without complications within 7 to 10 days. Instead of worrying too much, parents should focus on ‘preventing dehydration’ and ‘recognizing the warning signs of severe complications,’ while maintaining ‘strict hygiene habits’ for prevention. We wish you a healthy and safe life!