Can hand, foot and mouth disease occur without a rash?

The illness may start with a sore throat, reduced appetite, tiredness or [fever](/symptoms/fever/). Painful ulcers inside the mouth can be easier to notice than spots on the hands or feet. A rash may appear later, remain mild, or be hidden in the nappy area. Other viruses and throat conditions can cause similar symptoms, so the absence of a rash does not prove or exclude hand, foot and mouth disease.

Offer small, frequent drinks and cool, soft foods; avoid acidic or spicy items if they sting. Watch for wet nappies or regular urination, energy, swallowing and new spots over the next few days. Wash hands after toileting and do not share cups, utensils or towels. Do not give aspirin to a child, and check the label or ask a pharmacist before using another medicine.

Arrange an assessment if mouth pain prevents drinking, urine becomes much less frequent, fever persists or returns, or the child is unusually sleepy or irritable. Get urgent help for breathing difficulty, a seizure, severe weakness or an infant who seems seriously unwell. A [Child Health Consultation](/treatments/consultations-and-assessment/child-health-consultation/) can assess the mouth and hydration even when the skin is clear.

Ask whether the mouth findings fit hand, foot and mouth disease, what alternative causes should be considered, and which fluids or pain-relief options are suitable. Mention contacts, fever, swallowing, urine output and any later skin changes.