Hand, foot, and mouth disease usually stays hidden for several days after a child catches it, then unfolds in a fairly predictable order over about a week. It typically starts like an ordinary cold or flu, and the sores that give it its name come a little later. Children can pass the virus on before anyone knows they are sick, so it often spreads through a classroom before the first case is spotted.1PubMed Central. Current status of hand-foot-and-mouth disease
How Long After Exposure Symptoms Start
The wait between catching the virus and the first symptom is typically about 4 to 6 days. For kindergarten-age children the middle value is about 4.4 days.2PubMed Central. Estimating the incubation period of hand, foot and mouth disease for children in different age groups For primary-school children it is about 4.7 days, and for secondary-school children about 5.7 days.3PubMed Central. Estimating the incubation period of hand, foot and mouth disease for children in different age groups Younger children tend to show symptoms slightly sooner than older ones. If your child shows nothing a week or so after a known exposure, they likely escaped this round.
When a daycare sends a notice, count day zero as the last day your child shared space with the sick child. Watch most closely from about day 3 to day 7. Adults in the house may notice nothing at all, because many adults catch it with mild or no symptoms. They can still carry and spread the virus. Siblings exposed at the same time may start on slightly different days, and each family member’s countdown begins from their own exposure.
The exposure date is often a guess. By the time a notice arrives, the sick child may have been contagious for days, so the true date could be earlier. When the date is uncertain, treat the days as a range rather than a single deadline.
The Day-by-Day Order of Symptoms
The illness begins with a fever, often around 101 to 103°F, plus tiredness and poor appetite.4Intown Pediatric & Adolescent Medicine P.C. What to Expect with Hand, Foot, and Mouth Disease (HFMD) A sore throat is common, and some children have a runny nose, vomiting or a few loose stools.5Northwestern Medicine. A Parent’s Guide to Hand, Foot and Mouth Disease Because swallowing hurts, many children stop wanting to eat.6Intown Pediatric & Adolescent Medicine P.C. What to Expect with Hand, Foot, and Mouth Disease (HFMD) If a daycare notice has named HFMD, it is reasonable to start checking the mouth daily as soon as a fever appears.
One or 2 days after the fever starts, painful sores appear in the mouth.7Iowa Department of Public Health. Hand, Foot and Mouth Disease Fact Sheet They begin as tiny red spots on the tongue, gums and inner cheeks that are easy to miss.8Vinmec. The Four Stages of Hand, Foot, and Mouth Disease These turn into small blisters of 2 to 3 mm that burst quickly, causing pain and drooling.9Vinmec. The Four Stages of Hand, Foot, and Mouth Disease A rash of tiny red or pink bumps then follows on the palms, soles, buttocks and sometimes knees.10Northwestern Medicine. A Parent’s Guide to Hand, Foot and Mouth Disease The rash may itch slightly and can turn into oval blisters with a red base.11Vinmec. The Four Stages of Hand, Foot, and Mouth Disease Most children start feeling better around days 7 to 10 as the blisters dry out and crust over.12Northwestern Medicine. A Parent’s Guide to Hand, Foot and Mouth Disease13Northwestern Medicine. A Parent’s Guide to Hand, Foot and Mouth Disease14Centers for Disease Control and Prevention. About Hand, Foot, and Mouth Disease
To check for early spots, use a flashlight and gently ask your child to open wide. Look at the tongue, gums, inside of the cheeks and the back of the throat. Spots at the back of the throat can explain a refused bottle or meal, and drooling in a child who no longer drools is a clue.
Not every child gets every sign. Some have mainly mouth sores and little rash, while others have a rash with few mouth sores. The rash can also show up on the legs, arms or around the mouth.
When Your Child Is Contagious
The virus can be found in the throat and stool in the days before illness starts.15PubMed Central. Current status of hand-foot-and-mouth disease Children are usually most contagious in the first week after symptoms begin.16PubMed Central. Current status of hand-foot-and-mouth disease But virus can keep showing up in stool for 3 to 11 weeks, though it lasts a shorter time in saliva.17Epidemiology & Infection. Human enterovirus 71 and hand, foot and mouth disease It can also survive on surfaces such as wood for up to about 7 hours,18PubMed Central. Stability and infectivity of enteroviruses on dry surfaces: Potential for indirect transmission control and these viruses resist many cleaners better than cold and flu viruses do.19Epidemiology & Infection. Human enterovirus 71 and hand, foot and mouth disease
Hygiene steps that match how it spreads help most. Wash hands with soap and water after every diaper change and bathroom trip, since the virus is found in stool, and keep doing so for weeks after recovery. Hand sanitizer is a weaker backup than soap and water. Wipe toys, high chairs and tabletops often, especially items that go into mouths. During the first week, avoid sharing cups and utensils, and hold off on kisses on the face.
Returning to Daycare or School
Children can attend child care or school if they have no fever, feel well enough to take part, and have no uncontrolled drooling from mouth sores.20CDC. Hand, Foot, and Mouth Disease Some local health departments ask for 24 hours without fever and without fever-reducing medicine.21Marin County Health and Human Services. School and Child Care Guidance for Hand, Foot, and Mouth Disease Remaining sores or rash alone don’t have to keep a child home.22Marin County Health and Human Services. School and Child Care Guidance for Hand, Foot, and Mouth Disease Rules vary, so check your center’s policy.
Fever usually ends within 2 to 3 days, and that is often the point at which a child begins to seem like themselves again. A child who is still refusing food or drinks because of mouth pain is probably not ready, even without a fever. Let the center know the diagnosis so staff can watch other children.
Easing Symptoms at Home
There is no specific cure, so care focuses on comfort.23Children’s Hospital of Philadelphia. What to Do if Your Child Has Hand, Foot and Mouth Disease The worst mouth pain usually comes in the first 3 to 5 days of illness.24Children’s Hospital of Philadelphia. What to Do if Your Child Has Hand, Foot and Mouth Disease Acetaminophen or ibuprofen can ease pain and fever.25Mayo Clinic. Hand-foot-and-mouth disease Giving pain medicine before meals can help a child drink. Never give aspirin to children.26Centers for Disease Control and Prevention. About Hand, Foot, and Mouth Disease Throat sprays or lozenges with a numbing medicine may help older children with mouth sores.27Mayo Clinic. Hand-foot-and-mouth disease
Soft foods like yogurt, pudding, smoothies and ice pops are easier to swallow.28Children’s Hospital of Philadelphia. What to Do if Your Child Has Hand, Foot and Mouth Disease Water alone gives no energy or salt if your child isn’t eating, so offer a mix of fluids.29Children’s Hospital of Philadelphia. What to Do if Your Child Has Hand, Foot and Mouth Disease Cold milk and smoothies often go down best. Citrus juice and tomato sting open sores, salty or crunchy snacks scrape the mouth, and very hot foods hurt more than cold ones.
Fewer wet diapers or fewer bathroom trips than usual is an early sign that your child isn’t drinking enough. Dry lips, no tears when crying and unusual sleepiness are stronger warnings that fluids are running low. Call the doctor if your child stops drinking despite pain relief.
Warning Signs and Later Surprises
Some cases, especially from the EV71 strain, can lead to meningitis, brain inflammation, paralysis or heart and lung problems.30PubMed Central. Predicting Severe Enterovirus 71-Infected Hand, Foot, and Mouth Disease: Cytokines and Chemokines Very high fever and changes in alertness or behavior are among the signs of a severe case.31PubMed Central. A review of enterovirus-associated hand-foot and mouth disease: preventive strategies and the need for a global enterovirus surveillance network In rare severe cases a child can worsen within hours, so these signs need emergency care.
Call the doctor for fever above 104°F or fever lasting more than 3 days. Seek urgent care for unusual sleepiness, confusion, jerking movements or weakness. Fast or hard breathing, or a stiff neck, also needs prompt medical attention. No urine for 8 hours or more suggests dehydration and calls for medical advice.
Weeks after recovery, fingernails or toenails can develop grooves or come off.32PubMed Central. The Mechanism of Onychomadesis (Nail Shedding) and Beau’s Lines Following Hand-Foot-Mouth Disease This usually appears 1 to 2 months after the illness, about 40 days on average.33PubMed Central. The Mechanism of Onychomadesis (Nail Shedding) and Beau’s Lines Following Hand-Foot-Mouth Disease New nails typically grow back normally.
No treatment is needed for nail shedding. It is not contagious and not a new infection. Keep loose nails trimmed so they don’t catch, and mention the recent illness if you see a doctor.
Strains, Adults and Catching It Again
HFMD is caused by a family of viruses, most often coxsackievirus A16 and enterovirus A71.34PubMed Central. Exuberant Hand-Foot-Mouth Disease: An Immunocompetent Adult with Atypical Findings A newer coxsackievirus A6 type has caused more severe and widespread cases in both children and adults since 2008.35PubMed Central. Exuberant Hand-Foot-Mouth Disease: An Immunocompetent Adult with Atypical Findings In children with this A6 type, most had peak fevers between 39 and 40°C, about 102 to 104°F, usually lasting 2 to 3 days.36PubMed Central. Clinical characteristics of 68 children with atypical hand, foot, and mouth disease caused by coxsackievirus A6: a single-center retrospective analysis In one outbreak with this strain, mouth sores appeared 2 to 3 days after fever, and 6 in 10 children also had cough or runny nose.37PubMed Central. An outbreak of atypical hand, foot and mouth disease associated Coxsackievirus A6 in children from Cape Verde, 2023
In adults, sores may start in and around the mouth before spreading to hands and feet.38PubMed Central. Hand, Foot, and Mouth Disease in Adults Many different viruses cause it, so having HFMD once doesn’t protect against the others.39American Medical Association. What doctors want patients to know about hand, foot and mouth disease A child can get it more than once.40Duke Health. Hand, Foot, and Mouth Disease in Children and Adults: Common Questions Answered
A vaccine against EV71 prevents most EV71 cases but is mainly available in China.41PubMed. Efficacy, safety, and immunogenicity of an enterovirus 71 vaccine in China Infection shortly before delivery can cause severe illness in a newborn, so pregnant people near term should tell their doctor about exposure.42PubMed Central. A Rare Presentation of Hand, Foot, and Mouth Disease During Pregnancy
Chickenpox can look similar at first. HFMD favors the mouth, hands, feet and the area around the lips, while chickenpox spreads over the trunk and is very itchy. Mouth sores early in the illness are one clue that points toward HFMD. A doctor can usually tell by looking, so a visit helps if you are unsure.