Hand Foot Mouth Disease in Children: Symptoms, Treatment and When to Worry

Hand, foot and mouth disease (HFMD) is a common viral illness in children under 10, caused primarily by Coxsackievirus A16 and Enterovirus 71 (EV71). It spreads rapidly in schools, crèches, and play groups — through direct contact with blister fluid, faeces, nasal secretions, and respiratory droplets. In Hyderabad, outbreaks typically occur in the monsoon and post-monsoon months when humidity favours viral transmission.

Typical Presentation

Incubation: 3–7 days after exposure. The illness begins with 1–2 days of fever (38–39°C), sore throat, reduced appetite, and malaise. Then the characteristic rash appears:

• Mouth ulcers: Painful red spots that blister then ulcerate, on the tongue, inside the cheeks, and on the gums. These are the most distressing aspect — the child refuses to eat or drink because swallowing is painful
• Hand rash: Small, red spots or blisters on the palms, fingers, and dorsum of the hands — typically non-itchy
• Foot rash: Similar lesions on the soles and sides of the feet
• Buttocks: Rash may also appear on the buttocks and groin

Management at Home

No specific antiviral treatment exists — management is supportive. Hydration is the priority: the mouth ulcers make swallowing painful, and children easily become dehydrated. Cold foods (cold milk, yoghurt, ice cream, chilled water) are easier to swallow and soothe the ulcers. Paracetamol for fever and pain relief. Ibuprofen in children over 6 months — anti-inflammatory property helps with mouth pain. Mouthwashes: diluted salt water in older children.

Most children recover fully in 7–10 days. The illness is self-limiting. School exclusion until the child is fever-free and blisters have dried (typically 7–10 days) — to prevent spread.

When to Seek Emergency Care

• Signs of dehydration: no wet nappy in 8 hours, sunken eyes, dry mouth, lethargic
• Very high fever above 39.5°C not responding to paracetamol
• Neck stiffness, severe headache, seizures — may indicate viral meningitis (rare EV71 complication)
• Weakness of limbs — encephalitis or acute flaccid paralysis (rare but serious EV71 complication)

For HFMD assessment: Dr. Sushma B at Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.