Hand foot mouth disease rash on buttocks

Hand, foot, and mouth disease (HFM) is a common viral infection that causes painful red blisters in the mouth and throat, and on the hands, feet, and diaper area. The coxsackievirus causes most HFM infections.

HFM is contagious and easily spreads through contact with unwashed hands, feces (poop), saliva (spit), mucus from the nose, or fluid from the blisters. Kids under age 7 are most at risk for HFM. Infections are common in childcare centers, preschools, schools, summer camps, and other places where kids are close together.

Besides the blisters, kids often have a fever for a few days and can get dehydrated because it hurts to swallow liquids. Symptoms usually clear up within a week to 10 days, and kids recover completely.

There's no cure for HFM and no vaccine to prevent it, but your doctor can recommend home care to make your child more comfortable during recovery.

What Are the Signs & Symptoms of Hand, Foot, and Mouth Disease?

The blisters caused by HFM are red with a small bubble of fluid on top. They often peel, leaving an ulcer, which is a sore with a reddish base. The soles of the feet and the palms of the hands may have a rash that can look like flat red spots or red blisters.

Occasionally, there might be a pink, non-itchy rash on other parts of the body, such as the buttocks and thighs. However, some kids will have no problems other than sores in the back of the throat (called herpangina).

It can be hard for parents to tell if a child (especially a very young one) has HFM if sores are only inside the mouth or throat. Very young kids might not be able to communicate that they have a sore throat. But if a child stops eating or drinking, or wants to eat or drink less often, it's a sign that something is wrong.

A child with HFM also might:

• have a fever, muscle aches, or other flu-like symptoms
• become irritable, fussy, or sleep more than usual
• begin drooling (due to painful swallowing)
• only want to drink cold fluids
• have belly pain, vomiting, or diarrhea

How Is HFM Treated?

You can give acetaminophen or ibuprofen if your child is achy or irritable. Never give aspirin to children or teens, as it may cause a rare but serious illness called Reye syndrome.

Cold foods like ice cream, smoothies, and popsicles also help by numbing the area, and will be a welcome treat for kids who have trouble swallowing (and even those who don't!). Avoid hot drinks, sodas, and acidic food (citrus juice, tomato sauce, etc.) because they can make the pain worse.

Kids with blisters on their hands or feet should keep the areas clean and uncovered. Wash the skin with lukewarm soap and water, and pat dry. If a blister pops, dab on a bit of antibiotic ointment to help prevent infection and cover it with a small bandage.

Make sure your child drinks plenty of fluids to stay hydrated.

When Should I Call the Doctor?

Call your doctor if your child remains very irritable, can't be comforted, is sluggish, or seems to be getting worse. Also call if you see signs of dehydration, like a dry or sticky mouth, sunken eyes, and peeing less than usual or fewer wet diapers.

Can Hand, Foot, and Mouth Disease (HFM) Be Prevented?

To prevent the spread of HFM, keep kids home from school and childcare while they have a fever or open blisters on the skin and in the mouth.

Hand washing is the best protection. Remind everyone in your family to wash their hands well and often, especially after using the toilet or changing a diaper, and before preparing or eating food. Shared surfaces and toys in childcare centers should be cleaned often with a disinfectant because many viruses can live on objects for a few days.

Common questions our doctors are asked

Is HFMD dangerous for pregnant women?

HFMD is not known to pose a risk to pregnant women or their unborn babies.

My child still has blisters. Can she return to school?

If the fluid in the blisters has dried, then it is safe for your child to go back to school.

Hand-Foot-Mouth Disease (HFMD) is a common childhood illness caused by a virus.  It easily spreads from person to person (contagious) when someone comes in contact with the body fluids of an infected person. This can happen by:

• Touching something that has been sneezed, coughed or drooled on
• Breathing in air droplets of the infected person when talking (less than 3 feet)
• Touching something that has been soiled with stool (bowel movement or feces)
• Touching body fluid from a draining sore

It is most common in young children under age 5 years, but teenagers or adults may also get the virus.  Most outbreaks occur in the summer and fall.  Symptoms of HFMD usually go away without treatment in 5 to 7 days.  

Signs and Symptoms

The early symptoms of HFMD are much like a common cold.

• Fever
• Headache
• Sore throat
• Runny nose

A day or two after the fever, you might see:

• Small painful sores (ulcers) on the throat and tonsils
• A rash of very small blisters or red spots on the palms of the hands, soles of the feet, and diaper area. These usually are not itchy.
• Tenderness or pain when touching the palms of the hands and soles of the feet
• Poor appetite due to painful swallowing

After the rash has healed, the skin may peel; but this is harmless.

Treatment

Since HFMD is a virus, antibiotics will not help.

The following may help your child feel better:

• For children older than 6 months, give acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) to help with the headache, fever, and sore throat. Do NOT give ibuprofen to children younger than 6 months.  Read the label to know the right dose for the age of your child.
• For children younger than 6 years, do not give over-the-counter (OTC) cold remedies without asking your child’s doctor.
• Do NOT give aspirin or products that contain aspirin. Aspirin has been linked to a disease called Reye’s syndrome, which can be fatal.
• If your child is over one year old, give lots of liquids, such as water, milk, apple juice, and popsicles. Avoid fruit juices that are high in acid, like cranberry juice, orange juice or lemonade.  They may irritate the mouth sores (Picture 1). 
• If your child is under one year old, continue to give either breastmilk, formula, or both. You can also give Pedialyte®.
• Offer soft foods that are easy to swallow, like applesauce, mashed potatoes, oatmeal, or eggs. Your child may not want to eat much if it hurts
  to swallow.

To soothe a sore throat:

• For children over age 1, give warm fluids such as chicken broth or apple juice. Or, place 1/2 teaspoon of a liquid antacid that does not have aspirin, in the front of the mouth after meals.
• For children over 4 years, use throat lozenges or sprays. None should contain benzocaine, which can be harmful to children.  Or, rinse the mouth after meals with 1 teaspoon of a liquid antacid that does not contain aspirin.
• For children over 6 years who are able to gargle without swallowing, use a mixture of 1/4 to 1/2 teaspoon of salt to one 8 ounce glass of warm water. Swish and gargle the mixture 2 to 3 times a day, as needed.  Do not let your child swallow the salt water; have him spit it out. 

When to Call the Doctor

Call the doctor if your child has:

• Neck pain or chest pain
• Pus, drainage, swelling, or a large area of redness around any sores
• Trouble swallowing
• Signs of dehydration
  • Dry or sticky mouth,
  • An infant’s “soft spot” pulling in
  • No tears, sunken eyes
  • No wet diaper for 4 to 6 hours (infants and toddlers)
  • Very dark urine, or
  • No urination in 6 to 8 hours (older children)
• Younger than 3 months and has a rectal temperature of 100.4˚ F or higher
• Older than 3 months and has a rectal or armpit (axillary) temperature more than 102˚ F that does not come down with medicine
• 4 years or older, has an oral temperature more than 102˚ F for more than 3 days that does not come down with medicine
• Seizures, is overly tired, not able to focus, or has a hard time communicating or waking up
• Does not get better in a few days

Prevention

There is no vaccine to prevent HFMD.  The virus spreads easiest during the first week the person is sick.  It can stay in the body for weeks after your child feels better and still be a problem to others.  To prevent spreading HFMD:

• Teach your child not to touch the rash, avoid putting his fingers or toys in his mouth, and not rub his eyes.
• Teach your child to sneeze or cough into a tissue or his or her shirt sleeve.
• Wash your hands with soap and water often. Wash after touching the rash, going to the bathroom, before handling food, before eating, and after changing a diaper.  Also, teach your child to wash his or her hands often.
• Disinfect bathrooms, toys, and other objects that your child touches with soap and water, or other household disinfectant. The virus can live on these things for days.
• Do not share drinking cups, eating utensils, napkins, or personal items like towels and brushes.
• Avoid hugging and kissing a child who is infected.

When to return to school or daycare

Tell the daycare or the school that your child has Hand-Foot-Mouth Disease.  It is important for the school personnel to know so staff and parents can be told to watch for symptoms.

Your child should stay home from school or childcare until he or she has no fever for 24 hours and the mouth sores and open blisters have healed.

Can hand foot and mouth only be on the bum?

Can hand foot and mouth look like diaper rash?

Can hand foot and mouth rash spread to other parts of the body?

What is the last stage of hand foot and mouth?