7 Key Symptoms of Hand Foot and Mouth Disease You Should Know

Hand, foot, and mouth disease (HFMD) is a common viral infection that primarily affects infants and children under 5 years old, though adults can also contract it. Caused by enteroviruses, most commonly coxsackievirus, this contagious condition spreads through direct contact with infected bodily fluids, respiratory droplets, and contaminated surfaces. Understanding the symptoms of HFMD is crucial for early detection and proper management.

While the disease is usually mild and self-limiting, recognizing its characteristic signs can help parents and caregivers take appropriate precautions to prevent its spread. The symptoms typically appear in stages, beginning with general illness indicators before progressing to the distinctive rash that gives the disease its name. Let’s explore the key symptoms of hand, foot, and mouth disease in detail.

1. Fever

Fever is often the first symptom of hand, foot, and mouth disease and typically appears during the early stages of infection. The elevated body temperature usually ranges from 101°F to 103°F (38.3°C to 39.4°C) and can last for 2 to 3 days.

This initial fever may appear 3 to 6 days after exposure to the virus, marking the beginning of the incubation period. Parents may notice their child becoming irritable, lethargic, or uncomfortable. The fever often occurs before any visible rash or sores appear, making it an important early warning sign.

Key characteristics of HFMD fever:

• Sudden onset, often without other obvious symptoms initially
• May be accompanied by general malaise and reduced appetite
• Usually resolves within 2-3 days, even as other symptoms develop
• Can range from low-grade to moderate in intensity

2. Sore Throat and Painful Swallowing

A sore throat is one of the earliest and most uncomfortable symptoms of hand, foot, and mouth disease. Children and adults with HFMD often experience significant throat pain that makes swallowing difficult and unpleasant.

This symptom typically develops shortly after or concurrent with the fever. The throat pain is caused by the viral infection affecting the mucous membranes and is often a precursor to the mouth sores that will develop. Young children may refuse to eat or drink due to the discomfort, which can lead to concerns about dehydration.

The sore throat associated with HFMD differs from a typical cold-related sore throat because it’s often more intense and accompanied by visible lesions in the mouth. Parents might notice their child drooling more than usual or complaining specifically about pain when trying to swallow food or beverages.

3. Painful Mouth Sores and Blisters

Painful sores and blisters inside the mouth are hallmark symptoms of hand, foot, and mouth disease. These lesions typically appear 1 to 2 days after the fever begins and are one of the most distinctive features of HFMD.

Characteristics of mouth sores in HFMD:

• Begin as small red spots that develop into painful ulcers
• Commonly located on the tongue, gums, inside of cheeks, and back of the throat
• May start as tiny blisters before breaking open to form shallow, painful sores
• Can range from a few lesions to numerous sores throughout the oral cavity
• Typically measure 2-5 mm in diameter with a red border and grayish center

These mouth sores are particularly problematic because they make eating and drinking extremely painful. Children may refuse food, especially acidic, salty, or spicy items. Cold, soft foods and liquids are often better tolerated. The pain from these sores usually peaks within the first few days and gradually improves over the course of a week.

4. Skin Rash and Blisters on Hands and Feet

The characteristic rash on the hands and feet gives this disease its name and typically appears within 1 to 2 days after mouth sores develop. This symptom is often the most visually distinctive feature that helps healthcare providers confirm a diagnosis of HFMD.

The rash typically presents as follows:

• Flat red spots or raised bumps that may develop into blisters
• Commonly appears on the palms of hands and soles of feet
• May also affect the back of hands, fingers, toes, and occasionally the buttocks and genital area
• Blisters contain clear or cloudy fluid and are surrounded by a red halo
• Usually not itchy, unlike many other childhood rashes

In the early stages of hand, foot, and mouth disease, these spots may be subtle and easily missed. They can range from just a few lesions to dozens of blisters covering the affected areas. The mild early stage hand foot and mouth disease may show only scattered red spots, while more severe cases display numerous fluid-filled blisters.

The blisters on the hands and feet are generally less painful than the mouth sores, though they can cause discomfort, especially when walking or gripping objects. These lesions typically crust over and heal within 7 to 10 days without leaving scars.

5. Loss of Appetite

A significant decrease in appetite is a common and concerning symptom of hand, foot, and mouth disease, particularly in young children. This symptom is directly related to the painful mouth sores that make eating and drinking uncomfortable.

Children with HFMD may refuse their favorite foods, turn away from meals, or cry when attempting to eat. Infants may refuse to nurse or take a bottle. This reduced food intake can be frustrating for parents and caregivers, especially when it persists for several days.

Managing appetite loss in HFMD:

• Offer cold, soft foods like yogurt, ice cream, or smoothies
• Avoid acidic juices, citrus fruits, and salty or spicy foods
• Provide plenty of cool liquids to prevent dehydration
• Offer small, frequent meals rather than large portions
• Use a straw for drinking if it’s more comfortable

While the loss of appetite can be concerning, it’s important to focus primarily on maintaining adequate hydration. Most children will naturally return to normal eating patterns as the mouth sores begin to heal, typically within 5 to 7 days.

6. Irritability and General Malaise

Children with hand, foot, and mouth disease often display increased irritability and general feelings of being unwell. This symptom can appear during the early stages of the infection and may persist throughout the illness.

The combination of fever, pain, and discomfort makes children fussier than usual. Infants and toddlers who cannot verbally express their discomfort may cry more frequently, have difficulty sleeping, or seem unusually clingy. Older children might complain of feeling tired, achy, or simply “not right.”

This general malaise is the body’s response to fighting the viral infection. It may include:

• Fatigue and decreased energy levels
• Increased need for sleep or rest
• Reduced interest in play or normal activities
• Mood changes and emotional sensitivity
• General body aches and discomfort

Parents should expect their child to be more demanding of attention and comfort during the active phase of HFMD. This irritability typically improves as other symptoms resolve, usually within 7 to 10 days.

7. Headache and Body Aches

While more commonly reported in adults with hand, foot, and mouth disease, headaches and body aches can also affect older children with HFMD. These symptoms are part of the general systemic response to the viral infection.

The headache associated with HFMD is typically mild to moderate and similar to what one might experience with a common cold or flu. It usually accompanies the fever and may be one of the first symptoms adults notice when they contract the disease.

Body aches, or myalgia, can affect various muscle groups and contribute to the overall feeling of discomfort. Adults with HFMD often describe feeling similar to having a mild flu, with general achiness throughout the body.

These symptoms in different age groups:

• In adults: More likely to experience noticeable headaches and body aches; symptoms may be more severe than in children
• In older children: May complain of specific aches or headaches but might not articulate them as clearly as adults
• In young children: Less likely to report these symptoms specifically, though increased irritability may indicate discomfort

What Causes Hand, Foot, and Mouth Disease?

Hand, foot, and mouth disease is caused by viruses from the enterovirus family. Understanding the causes and transmission methods can help prevent the spread of this contagious infection.

Primary viral causes:

• Coxsackievirus A16: The most common cause of HFMD in the United States and many Western countries
• Enterovirus 71 (EV71): Another frequent cause that can occasionally lead to more severe complications
• Other enteroviruses: Various other members of the enterovirus family can also cause HFMD

How the disease spreads:

• Person-to-person contact: Direct contact with saliva, mucus, blister fluid, or feces of an infected person
• Respiratory droplets: Through coughing, sneezing, or talking, releasing viral particles into the air
• Contaminated surfaces: Touching objects or surfaces that have the virus on them, then touching the mouth, nose, or eyes
• Fecal-oral route: Particularly important in childcare settings where diaper changing occurs

Risk factors for contracting HFMD:

• Age: Most common in children under 5 years old, though anyone can get it
• Childcare settings: Increased exposure in daycare centers, preschools, and schools
• Compromised immune system: Higher susceptibility in those with weakened immunity
• Close contact with infected individuals: Family members and caregivers are at higher risk
• Seasonal factors: More common in summer and fall in temperate climates

The virus is most contagious during the first week of illness, but individuals can continue to shed the virus in their stool for weeks after symptoms resolve. This extended shedding period contributes to the spread of HFMD, especially in settings where hygiene practices may be inconsistent.

Prevention of Hand, Foot, and Mouth Disease

While there is no vaccine to prevent hand, foot, and mouth disease, several practical measures can significantly reduce the risk of infection and prevent its spread to others.

Personal hygiene practices:

• Frequent handwashing: Wash hands thoroughly with soap and water for at least 20 seconds, especially after using the bathroom, changing diapers, and before eating or preparing food
• Hand sanitizer: Use alcohol-based hand sanitizers when soap and water aren’t available, though handwashing is preferred
• Avoid touching face: Teach children not to touch their eyes, nose, and mouth with unwashed hands
• Cover coughs and sneezes: Use tissues or the inside of the elbow to prevent spreading respiratory droplets

Environmental cleaning:

• Disinfect frequently touched surfaces, including toys, doorknobs, tables, and countertops
• Use EPA-approved disinfectants or a bleach solution (1 tablespoon of bleach per 1 quart of water)
• Clean and disinfect items that may have come in contact with saliva or feces
• Wash clothing, bedding, and towels in hot water

Avoiding close contact:

• Keep infected children home from school or childcare until fever is gone and mouth sores have healed
• Avoid kissing, hugging, sharing cups, utensils, or personal items with infected individuals
• Limit contact with individuals showing symptoms of HFMD
• Practice good hygiene during diaper changes, disposing of diapers properly and washing hands immediately

In childcare and school settings:

• Implement strict handwashing policies for children and staff
• Regularly sanitize toys, especially those that children put in their mouths
• Maintain clean diaper-changing areas with proper sanitation protocols
• Educate staff and parents about HFMD symptoms and prevention
• Establish clear policies about when children can return after illness

It’s important to note that even with careful prevention measures, HFMD can still occur because infected individuals may be contagious before symptoms appear and can continue to shed the virus for weeks after recovery. However, these preventive strategies significantly reduce transmission rates.

Frequently Asked Questions About Hand, Foot, and Mouth Disease

How long does hand, foot, and mouth disease last?

Hand, foot, and mouth disease typically lasts 7 to 10 days. The fever usually resolves within 2 to 3 days, while mouth sores and the rash on hands and feet may take a full week or slightly longer to heal completely. Most children feel significantly better within a week of symptom onset.

Can adults get hand, foot, and mouth disease?

Yes, adults can get hand, foot, and mouth disease, although it’s less common than in children. Adults with HFMD may experience more severe symptoms, including more intense body aches and fatigue. Many adults have immunity from previous exposure during childhood, which is why the disease is less frequent in adult populations.

When should I see a doctor for hand, foot, and mouth disease?

You should consult a healthcare provider if your child is younger than 6 months, has a high fever that doesn’t respond to fever-reducing measures, shows signs of dehydration (dry mouth, decreased urination, no tears when crying), has severe mouth pain preventing fluid intake, or if symptoms worsen or don’t improve after 10 days. Seek immediate medical attention for severe headache, neck stiffness, difficulty breathing, or seizures.

Is hand, foot, and mouth disease the same as foot-and-mouth disease in animals?

No, these are completely different diseases caused by different viruses. Hand, foot, and mouth disease in humans is caused by enteroviruses (primarily coxsackievirus), while foot-and-mouth disease affects livestock and is caused by a different virus entirely. The two diseases are not related, and humans cannot get foot-and-mouth disease from animals.

How contagious is hand, foot, and mouth disease?

Hand, foot, and mouth disease is highly contagious, especially during the first week of illness. The virus spreads through respiratory droplets, direct contact with blister fluid, contaminated surfaces, and the fecal-oral route. Infected individuals can shed the virus in their stool for several weeks after symptoms resolve, contributing to continued transmission even after visible symptoms disappear.

What does hand, foot, and mouth disease look like in the beginning?

In the early stages, hand, foot, and mouth disease typically begins with fever, reduced appetite, sore throat, and general malaise. Within 1-2 days, small red spots appear in the mouth that develop into painful sores. Shortly after, a rash of flat red spots or small blisters appears on the palms of hands, soles of feet, and sometimes the buttocks. The initial symptoms can resemble a common cold before the characteristic rash develops.

Can you get hand, foot, and mouth disease more than once?

Yes, it is possible to get hand, foot, and mouth disease multiple times. Because several different viruses can cause HFMD, having the disease once provides immunity only to that specific virus strain. A person could be infected by a different enterovirus strain later, leading to another episode of HFMD, though repeat infections are generally less common.

What are the stages of hand, foot, and mouth disease?

HFMD progresses through several stages: Stage 1 (Days 1-2): Incubation period with fever, sore throat, and malaise; Stage 2 (Days 2-3): Mouth sores develop and become painful; Stage 3 (Days 3-5): Rash and blisters appear on hands, feet, and sometimes buttocks; Stage 4 (Days 5-7): Symptoms peak, with maximum discomfort from sores and rash; Stage 5 (Days 7-10): Recovery phase as lesions heal, blisters dry up, and symptoms gradually resolve.

References:

• Centers for Disease Control and Prevention – Hand, Foot, and Mouth Disease
• Mayo Clinic – Hand-foot-and-mouth disease
• NHS – Hand, foot and mouth disease
• World Health Organization – Hand, Foot and Mouth Disease
• Johns Hopkins Medicine – Hand, Foot and Mouth Disease