Hand, Foot and Mouth Disease: Mouth Sores, Fluids, Daycare Rules
In hand, foot and mouth disease the rash looks alarming, but dehydration is the real danger: painful mouth sores make toddlers refuse to drink. Count wet nappies, keep cold fluids coming, and the illness usually clears in 7 to 10 days. Here is how to get fluids in, what to feed, and when the child can go back to daycare.
Quick facts
- Cause: a group of enteroviruses, most often coxsackievirus
- Who gets it: mostly under 5s, in daycare and school outbreaks, especially in summer and the monsoon
- Signs: fever, sore mouth, then small spots or blisters on palms, soles, bottom and sometimes knees
- Watch: wet nappies and urine; fewer than usual means act now
- Urdu: there’s no widely used Urdu name; parents usually just say “hand foot mouth”
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Hand, foot and mouth disease: when to worry about dehydration
Sores in the mouth sting every time the child swallows. So they stop. Simple as that. A toddler who has barely drunk for half a day can dry out faster than parents expect.
Check urine. A baby should have about 4 to 6 wet nappies a day; an older child should pass pale urine several times. Darker urine, dry lips, and fewer nappies are early warnings. No urine for 6 to 8 hours is a doctor-now sign.
No urine for 6 to 8 hours, no tears when crying, sunken eyes or a sunken soft spot, or the child refuses all fluids. The child is drowsy, floppy, very irritable or hard to wake. Twitching, jerky movements, unsteady walking or a fit. Breathing fast or with effort. A stiff neck or a bad headache. Fever of 39 °C or more with the child unwell, fever for more than 3 days, or any fever under 3 months. Spots that are large, spreading, or look infected. Call 1122 in Pakistan, 112 or 108 in India for emergencies.
How to get fluids in a child with mouth sores
- Cold beats warm. Chilled water, cold milk, lassi that isn’t sour, or ORS kept in the fridge sting far less than warm drinks.
- Tiny and often. One or two teaspoons or small sips every few minutes. Set a timer if you need to. Small amounts add up.
- Use a cup, spoon or straw. Whatever the child accepts. A syringe (no needle) squirted into the side of the cheek works for babies.
- Keep breastfeeding. Offer more often. Under 6 months, breast milk or formula only, no water or other drinks.
- ORS if intake is falling or there’s diarrhoea. The WHO home mix is 1 litre of clean water, 6 level teaspoons sugar, half a level teaspoon salt. A pharmacy sachet is easier. Our loose motions by age guide has how much by age.
- Frozen ORS or homemade ice lollies from diluted juice count as fluid, and the cold numbs the mouth.
- Pain relief before meals. Paracetamol or ibuprofen, by the child’s weight from the pack or a pharmacist, about half an hour before feeds can make eating possible. No aspirin under 16.
The half-hour drink routine
Every 30 minutes while the child is awake, offer something cold: a few sips of ORS, a spoon of yoghurt, a lick of a frozen lolly. Tick it on paper. Parents are often surprised how much this adds up to over a day, and the tick list tells the doctor exactly what went in.
What to feed during HFMD
Soft, cool and bland wins. Every time. Yoghurt, custard, kheer served cold, mashed banana, soft khichdi at room temperature, chilled soup, soaked bread in milk, and ice cream are all fine as a treat when little else is going down.
Avoid salty, spicy, sour and crunchy food until the sores heal: chips, pickles, citrus, tomatoes, fried snacks. For children over 1, a very soft finger food like steamed potato is often accepted. Our guide to mouth ulcers covers mouth soreness in general; skip any adult rinses or gels there for young children unless a pharmacist says they suit that age.
HFMD by age
- Under 6 months: uncommon. Any fever under 3 months means a doctor now. Keep feeding breast milk or formula only
- 6 to 12 months: count wet nappies carefully. Doctor if feeding drops by half
- 1 to 3 years: the peak age. Cold drinks and soft food
- 3 to 6 years: milder. Can usually explain the pain and sip on request
- Over 6 and adults: often mild or no symptoms, but can pass it on
Can hand, foot and mouth only be on the feet?
Yes. The name promises three places, but many children show only some of them: mouth sores alone, spots only on the feet, or a rash mostly on the bottom and legs. Spots on the palms and soles are often flat red dots or small grey blisters, and they may be sore more than itchy. Some children have spots on the tongue, the gums, and the back of the throat.
Myth: it’s the same as foot and mouth disease in cattle
It isn’t. Foot and mouth disease in cows and goats is a different virus altogether, children don’t catch HFMD from animals, animals don’t catch it from children, and the only thing the two illnesses really share is an unlucky, confusing name that sends worried parents searching in the wrong direction. Different bug.
Two things parents find odd. Weeks after the illness, some children’s fingernails or toenails peel or fall off. It looks worrying but is harmless, and new nails grow back normally. And a child can have HFMD more than once, because several different viruses cause it.
With HFMD, the rash is for show. The water bottle is where the real work happens.
Daycare rules and hand hygiene
The virus spreads through spit, nose drips, blister fluid and, for weeks afterwards, stool, which means the child is catching while unwell and can still pass it on to siblings, cousins and classmates well after the spots have gone and everyone at home has stopped thinking about it. Hands matter.
- Keep the child home while they have a fever or are too unwell to join in, and while blisters are still weeping. Many daycares ask for a few days off; follow your school’s rules
- Wash hands with soap for 20 seconds after nappy changes, wiping noses and before food. Hand sanitiser alone isn’t reliable against this virus
- Wash cups, spoons and toys in hot soapy water. Don’t share towels
- Don’t pop blisters; let them dry
Many homes rub a little glycerine or a honey paste on mouth sores. Honey is never for a baby under 1 year because of botulism. For older children it’s a food, not a medicine, and it may sting the sores. Cold yoghurt does the soothing job better. Parents who want more on childhood illnesses can browse Bachon Ki Sehat.
Hand foot and mouth disease: questions parents ask
How to treat hand foot and mouth disease at home?
There is no medicine that kills the virus. Keep the child drinking cold fluids little and often, offer soft cool food, give fever or pain medicine by weight from the pack or a pharmacist, and watch urine output.
How long does hand foot and mouth disease last?
Usually 7 to 10 days. The mouth is sorest in the first 3 to 4 days.
Is hand foot and mouth disease contagious?
Yes, most in the first week. The virus can stay in stool for several weeks, so keep up hand washing after nappies.
When can a child go back to school after HFMD?
Once the fever has gone and the child feels well enough, and blisters have dried. Check your school or daycare’s own rule.
What should a child with hand foot and mouth eat?
Cold, soft, bland food: yoghurt, custard, cold kheer, banana, cool khichdi. Avoid salty, sour, spicy and crunchy food until the mouth heals.
How can you tell a child is dehydrated with HFMD?
Fewer wet nappies, dark urine, dry lips and mouth, no tears, sunken eyes or soft spot, and unusual sleepiness. No urine for 6 to 8 hours means see a doctor now.
Can adults get hand foot and mouth disease?
Yes, but it is usually milder. Adults can also carry and pass it on without symptoms.
Does aloe vera help hand foot and mouth disease?
There is no good reason to use it. Don’t put aloe gel in a child’s mouth; cold food and fluids ease the sores better.
Why do nails peel weeks after HFMD?
Nail peeling or shedding 3 to 8 weeks later is a known, harmless after-effect. The new nails grow back normally.
Can a child get HFMD twice?
Yes, because several different viruses cause it. Immunity to one doesn’t protect against the others.
Is there a vaccine for hand foot and mouth disease?
Not in routine use in Pakistan or India. Hand washing and keeping sick children home are the main protection.