Stages of hand, foot and mouth disease

Early illness can look like a general viral infection: a child may be tired, irritable, less hungry or feverish. Mouth ulcers may develop next, often on the tongue, gums or inside the cheeks, and can make swallowing sore. A rash of spots or small blisters may appear on the hands and feet, with possible spots around the mouth, legs or nappy area. The order is not identical for everyone, and a child may not show every feature. After the active illness, the skin heals gradually; peeling or nail changes can occasionally be noticed later.

During the early phase, check comfort, temperature and drinking. When mouth sores appear, offer cool fluids and soft foods, avoiding sharp, spicy or acidic choices. Keep blisters clean and avoid picking them. Wash hands after contact with secretions or stool and do not share household items. As the child improves, continue fluids and rest, even if the rash is still visible. A clinician can advise whether another illness should be considered.

Get medical advice if symptoms are worsening rather than settling, drinking is poor, urination drops, or fever remains concerning. Seek urgent care for breathing difficulty, severe difficulty swallowing, a seizure, confusion, a stiff neck with severe headache, or unusual difficulty waking. Read more about [Fever](/symptoms/fever/) or arrange a [Child Health Consultation](/treatments/consultations-and-assessment/child-health-consultation/).

Ask which stage the symptoms resemble, how to protect drinking while the mouth hurts, when school or nursery attendance is reasonable, and whether peeling skin or nail changes need follow-up.