Main Symptoms

• 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

• If only has mouth ulcers, see MOUTH ULCERS.
• If only has a rash, see RASHES, WIDESPREAD AND CAUSE UNKNOWN.

(To go directly to these topics, click on the links following this document.)

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 9 and 4) 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

• 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 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.

Parent Care for Pediatric Symptoms. Copyright © 2000. Barton D. Schmitt, MD, FAAP