Should Your Child See a Doctor?

Hand-Foot-And-Mouth Disease (HFMD)

Is this your child's symptom?

  • A viral infection that causes mouth ulcers sores
  • Most children also get tiny blisters on the hands and feet

Symptoms of Hand-Foot-and-Mouth Disease (HFMD)

  • Small painful ulcers in the mouth. Look for them on the tongue and sides of mouth. 100% of children with HFMD have these.
  • Small, thick-walled water blisters OR red spots on the hands and feet. Occurs on palms, soles, and webs of the fingers and toes. This happens in 70% of children.
  • 1 to 5 water blisters per hand or foot
  • Small blisters or red spots on the buttocks 30%
  • Low-grade fever less than 102° F (39° C)
  • Mainly occurs in children age 6 months to 4 years

Cause of HFMD

  • Coxsackie A-16 virus
  • Not related to any animal disease

Severe Form of HFMD

  • In 2012, a severe form of HFMD occurred in much of the world. It's caused by a new Coxsackie A6 virus.
  • The rash spreads to the arms, legs and face. The rash is made up of many small blisters.
  • Children with such a severe rash usually need to be seen. Reason: To confirm the diagnosis. Exception: Close contact with HFMD within the last 7 days.
  • Treatment is the same. Drink enough fluids to prevent dehydration.
  • Peeling of the fingers and toes is common. It looks bad but is harmless. It happens at 1 to 2 weeks. Use a moisturizing cream on the raw skin.
  • Some fingernails and toenails may fall off. It occurs in 4% of severe cases. It happens at 3 to 6 weeks out. Trim them if they catch on things.
  • Fingernails grow back by 3 to 6 months and toenails by 9 to 12 months. They will look normal.

Return to School

  • Can return to child care or school after the fever is gone. Most often, this takes 2 to 3 days.
  • Children with widespread blisters may need to stay home until the blisters dry up. That takes about 7 days.

When to Call for Hand-Foot-And-Mouth Disease (HFMD)

Call Doctor Now or Go to ER

  • Dehydration suspected. No urine in over 8 hours, dark urine, very dry mouth and no tears
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Red, swollen and tender gums
  • Ulcers and sores also on the outer lip
  • Rash spreads to the arms and legs
  • Fever lasts more than 3 days
  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Fingernails or toenails fall off
  • You have other questions or concerns

Self Care at Home

  • Hand-foot-mouth disease and no complications

Estimated Urgent Care Wait Times

These are estimated wait times for each Urgent Care clinic. Wait times are typically longest during the first hour we are open and may not be reflected immediately in the online wait time. Traffic and wait times may be affected by local events or bridge closures. Please check current traffic conditions and advisory alerts on the Seattle Department of Transportation website

Wait times may also vary depending on the severity of the illnesses we are treating. If your child’s illness or injury is life-threating, call 911.

Care Advice for Hand-Foot-and-Mouth Disease (HFMD)

  1. What You Should Know About HFM Disease:
    • Most often, hand-foot-and-mouth disease HFMD is a harmless rash.
    • It is caused by a virus called Coxsackie.
    • Here is some care advice that should help.
  2. Liquid Antacid for Mouth Pain Age 1 Year and Older:
    • For mouth pain, use a liquid antacid such as Mylanta or the store brand. Give 4 times per day as needed. After meals often is a good time.
    • Age 1 to 6 years. Put a few drops in the mouth. Can also put it on with a cotton swab.
    • Age over 6 years. Use 1 teaspoon (5 ml) as a mouth wash. Keep it on the ulcers as long as possible. Then can spit it out or swallow it.
    • Caution: Do not use regular mouth washes, because they sting.
  3. Fluids and Soft Diet:
    • Try to get your child to drink adequate fluids.
    • Goal: Keep your child well hydrated.
    • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
    • Solids. Offer a soft diet. Also avoid foods that need much chewing. Do not give citrus, salty, or spicy foods. Note: Fluid intake is more important than eating any solids.
    • For babies, you may need to stop the bottle. Give fluids by cup, spoon or syringe instead. Reason: The nipple can increase the pain.
  4. Pain Medicine:
    • To help with the pain, give an acetaminophen product such as Tylenol.
    • Another choice is an ibuprofen product such as Advil.
    • Use as needed.
  5. Fever Medicine:
    • For fevers above 102° F (39° C), give an acetaminophen product such as Tylenol.
    • Another choice is an ibuprofen product such as Advil.
    • Note: Fevers less than 102° F (39° C) are important for fighting infections.
    • For all fevers: Keep your child well hydrated. Give lots of cold fluids.
  6. Return to School:
    • HFMD is easily spread to others.
    • However, most often, it's a mild and harmless illness.
    • After contact with HFMD, children come down with symptoms in 3-6 days.
    • Can return to child care or school after the fever is gone. Most often, this takes 2 to 3 days.
    • Children with widespread blisters may need to stay home until the blisters dry up. That takes about 7 days.
  7. What to Expect:
    • Fever lasts 2 or 3 days.
    • Mouth ulcers should go away by 7 days.
    • Rash on the hands and feet lasts 10 days. The rash on the hands and feet may then peel.
  8. Call Your Doctor If:
    • Signs of dehydration occur
    • Fever lasts more than 3 days
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Last Reviewed: 10/20/2014

Last Revised: 10/20/2014

Copyright 1994-2015 Barton D. Schmitt, MD. All rights reserved.