Progression of hand, foot and mouth disease

A child may first seem tired, lose interest in food or develop a fever. Small painful sores can then appear inside the mouth, making drinking uncomfortable. A skin rash may follow on the palms, soles, fingers or toes; spots can also occur around the buttocks or legs. The rash may be flat, raised or blister-like. Symptoms usually change over several days, and the skin findings can remain visible after the child starts feeling better. Peeling or temporary nail changes can occasionally appear later.

Offer frequent small drinks, especially if mouth sores make swallowing difficult. Cool fluids and soft foods may be easier than spicy, salty or acidic foods. Encourage rest and follow the label or a clinician’s advice for any age-appropriate fever or pain medicine. Keep blisters clean, wash hands after toileting or nappy changes, and avoid sharing cups, towels or cutlery. A child should stay away from nursery or school while unwell and follow local guidance about returning.

Arrange prompt medical advice if your child is drinking very little, passing much less urine, has a dry mouth, is unusually sleepy or cannot be settled. Seek urgent help for trouble breathing, a seizure, confusion, a severe headache, a stiff neck or a child who is difficult to wake. A fever that concerns you, symptoms that worsen rather than ease, or a very young baby with fever also merits medical assessment. A Child Health Consultation can help assess hydration, fever and the rash.

Ask whether the mouth sores are affecting hydration, which pain relief is suitable for your child’s age, and when they can return to childcare. Tell the clinician when the fever and rash began, how much your child is drinking and whether urine output has changed.