Hand, foot and mouth disease: the playschool illness that looks alarming

What it looks like

A day or two of fever, sore throat and poor appetite, then small painful ulcers inside the mouth and a rash of flat red spots or small blisters on the palms, soles, and often around the mouth and on the buttocks.

It is caused by a group of viruses (usually coxsackievirus) and is very common in children under five, particularly in crèches and playschools. It spreads through saliva, nose secretions, blister fluid and stool.

It usually lasts seven to ten days. Nails on the fingers and toes sometimes peel or shed a few weeks later, which is harmless and grows back.

The real risk is dehydration

Mouth ulcers make eating and drinking painful, and a small child who stops drinking gets dehydrated fast, particularly in hot weather. This is the reason children with HFMD end up in hospital.

Offer cool and soft: milk, curd, kheer, ice lollies, cold water, khichdi, mashed banana, chilled coconut water. Avoid citrus, tomato, salty, spicy and crunchy foods, which sting the ulcers.

Use a straw if it helps, and offer small amounts constantly rather than a full glass. Paracetamol at the weight-correct dose about 30 minutes before a meal makes eating possible.

Watch the nappies and the urine: fewer wet nappies, dark urine, dry mouth, no tears or an unusually sleepy child mean dehydration and a doctor.

School, siblings and hygiene

Keep the child home while they have fever, open blisters or are unable to manage saliva — most schools ask for this, and returning too early keeps the cycle running in the class.

The virus is shed in the stool for weeks after recovery, so handwashing after nappy changes and before eating is what actually limits spread at home.

Wash toys, doorknobs and shared surfaces. Adults can catch it too, usually mildly, and pregnant women who are exposed should mention it to their doctor.

Do not apply anything to the blisters. They do not need lotion, and they should not be broken.

When to see a doctor

Same-day: a child who is not drinking or has passed no urine for six to eight hours, signs of dehydration, fever lasting beyond three days, a child who is unusually drowsy or irritable, a very sore throat that prevents swallowing saliva, or any child under three months with fever.

Emergency: difficulty breathing, a fit, a stiff neck, severe headache, confusion, unsteadiness, or a rash that does not fade when pressed. Call 108 for breathing trouble.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

Frequently asked questions

Q: Is HFMD the same as foot-and-mouth disease in cattle? — No. Completely different viruses; humans do not catch that one from animals, and the name similarity causes needless alarm.

Q: Can a child get it more than once? — Yes. Several different viruses cause it, so a child can have it two or three times.

Q: How long until they can go back to school? — Once the fever has gone, the child is eating and drinking, and blisters have dried — usually about a week. Check the school's own policy.

Q: Is there a vaccine? — Not available in India for the common causes. Handwashing is the whole prevention strategy.