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Hand, Foot, and Mouth Disease (Coxsackie Virus)

Hand, Foot, and Mouth Disease is a self-limited viral infection caused by the coxsackie A-16 virus.


Fever is often the first symptom and may be high (103-105 degrees).

The hallmark of the disease is mouth and throat pain. Painful mouth and throat ulcers on a bright red base develop 2-4 days into the illness. The ulcers are most commonly seen at the back of the throat, but may also occur on the gums, tongue, or inside of the cheeks and lips. 95% of children with this virus will develop mouth ulcers.

Some children will develop a rash on their palms and soles, and/or between their fingers and toes. This rash looks like tiny blisters underneath the skin. Children may also develop a more generalized pink rash on the rest of their body.

This illness is most commonly seen in the late spring, summer, and early fall.

Hand, foot, and mouth disease is most common in children between the ages of 6 months and 4 years, but can occur at any age.

Expected Course

  • The fever will typically last 2-5 days.
  • The mouth ulcers usually appear by day 2-3 of the illness, and resolve in 7 days.
  • The rash on the hands and feet is typically seen later in the illness, and can last up to 10 days. The hands and feet may peel as the rash is resolving.
  • Dehydration is the main concern, as many children refuse liquids due to mouth and throat pain.

Home Care Instructions

  • Pain Relief- give Tylenol or Motrin for fever greater than 101 degrees or mouth and throat pain.
  • Encourage favorite fluids to prevent dehydration.
  • Offer cold drinks, Popsicles or Sherbet.
  • Avoid citrus, carbonated beverages, and salty or spicy foods.

For infants and toddlers offer a sippy cup if sucking on a bottle seems more painful.

Liquid Antacids: Older children may get some relief from mouth pain by swishing and spitting 1-2 tsp of an antacid solution (Maalox or Mylanta) up to 4 times a day.

Contagiousness and return to school

This virus is quite contagious and most children will get this virus during the first 4 years of life.

The incubation period is 3-6 days after exposure.

Children are contagious 2 days before to 2 days after the mouth sores develop.

Children can return to school or daycare once their fever has resolved. Children do not need to be excluded from school or daycare due to the mouth sores.

If a child develops the rash on the palms and soles or elsewhere on the body, it signifies an immune response, and the child is no longer contagious.

Call the office if:

  • Your child has not urinated for more than 8 hours.
  • Fever lasts more than 72 hours.
  • Your child is refusing to drink.
  • Mouth pain is severe. Some children will need prescription pain relief stonger than Motrin or Tylenol in order to drink fluids.