Hand, Foot and Mouth Disease Without Fever

Some children have mouth ulcers and spots on the palms, soles, fingers, or toes without a raised temperature. The illness may be mild, and the rash can vary from flat red marks to small blisters. Symptoms can overlap with other causes of rash or mouth pain, so the location, timing, contact history, and general behaviour help a clinician judge the pattern. Fever can also develop later, so check how the child is doing rather than relying on temperature alone.

Offer water or other suitable fluids often, particularly if swallowing hurts. Choose soft foods and avoid flavours that sting ulcers. Keep hands clean, do not share utensils, and avoid breaking blisters. Check urine output, alertness, and willingness to drink. Keep the child away from close contact while unwell and follow nursery or school advice. A rash that does not fit this pattern may have another explanation, including [Chickenpox](/conditions/chickenpox/), [Common Cold](/conditions/common-cold/), or [Cellulitis](/conditions/cellulitis/).

Arrange a clinical review if the child cannot drink comfortably, has fewer wet nappies or toilet visits, seems very sleepy, or the rash is spreading quickly. Seek urgent help for breathing difficulty, confusion, a seizure, severe weakness, or signs of dehydration. Medical assessment is also sensible when the rash is painful, hot, swollen, or leaking fluid, or when there is uncertainty about whether it could be [COVID-19](/conditions/covid-19/) or another infection.

Ask whether the mouth and skin findings match hand, foot and mouth disease, whether testing is needed, and which symptoms should prompt a return visit. Bring a note of when the rash began and any recent contact with an affected child.