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Hand, foot and mouth disease

Hand Foot and Mouth is a common childhood illness, caused by a virus called Coxsackie. It is usually a mild infection that does not need specific treatment and will usually get better on its own. Antibiotics will not help. 

It commonly affects children under 5 years of age, and initial symptoms can include  

  • a high temperature 

  • sore throat 

  • reduced appetite 

  • generally feeling unwell

After a few days, mouth ulcers and a rash appear. These can be painful and make it difficult to eat or drink.

Image to show ulcers on the tongue

 

Red spots, which develop into blisters, usually appear on the hands and feet.

Image to show blisters on the fingersImage to show blisters on the toes

 

It's possible to get hand, foot and mouth disease more than once. 

If you are not sure it is hand, foot and mouth disease, look at other childhood rashes here.  

When should you worry? 

If your child has any of the following: 

  • Has a rash that does not go away with pressure (the ‘Glass Test’) 

  • Swollen lips or tongue and struggling to breathe 

  • Breathing very fast, too breathless to talk, eat or drink  

  • Working hard to breathe, drawing in of the muscles below the ribs, or noisy breathing (grunting) 

  • Breathing that stops or pauses 

  • Is pale, blue, mottled or feels unusually cold to touch  

  • Difficult to wake up, very sleepy or confused 

  • Weak, high-pitched cry or can’t be settled 

  • Has a fit (seizure)  

  • Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red features) 

You need urgent help

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following: 

  • Increasing pain and redness between the spots 

  • Symptoms do not improve after 10 days 

  • Breathing a bit faster than normal or working a bit harder to breathe 

  • Dry skin, lips or tongue 

  • Not had a wee or wet nappy in last 8 hours 

  • Poor feeding in babies (less than half of their usual amount) 

  • Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down) 

  • Is 3-6 months old with temperature 39°C or above (unless fever in the 48 hours following vaccinations and no other red or amber features) 

  • Temperature of 38°C or above for more than 5 days or shivering with fever (rigors) 

  • Temperature less than 36°C in those over 3 months 

  • Getting worse or you are worried about them 

You need to contact a doctor or nurse today

Please call your GP surgery or contact NHS 111 - Go to 111.nhs.uk or call 111.(111 online does not currently take questions about children aged under 5, so if your child is 4 or younger,  please call 111).

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features.

If none of the above features are present:

  • Most children with fever and rash can be safely managed at home 

  • Watch them closely for any change and look out for any red or amber symptoms 

  • Additional advice is also available to young families for coping with crying of well babies

  • If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you

  • If you think that this is a worsening of your child’s eczema, please look at the eczema page or contact your GP or practice nurse 

Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111

What should you do? 

Seeing your child unwell with hand foot and mouth disease can be very distressing for a parent and while there is no treatment for the virus itself there are simple things you can do to make your child more comfortable: 

  • Get them to drink plenty of fluids and try ice lollies if your child is not drinking much 

  • Try soft foods like soup, yoghurt or ice cream. Avoid hot and spicy foods as these may be painful on ulcers in the mouth 

  • Speak with your local community pharmacist for advice about treatments, such as mouth ulcer gels, sprays and mouthwashes to relieve pain

  • Paracetamol or ibuprofen for temperature or pain 

  • While there is normally no risk to pregnant people it is best to avoid close contact if possible 

You can't take antibiotics or medicines to cure hand, foot and mouth disease. It has to run its course. It usually gets better in 7 to 10 days. 

How to stop hand foot and mouth disease spreading? 

Hand, foot and mouth disease is easily passed on to other people. It's spread when people cough or sneeze and in poo. 

You're infectious from a few days before you have any symptoms, but you're most likely to give it to others in the first 5 days after symptoms start. 

To reduce the risk of spreading hand, foot and mouth disease: 

  • wash your hands often with warm soapy water and teach children to do so 

  • use tissues to trap germs when you cough or sneeze 

  • bin used tissues as quickly as possible 

  • don't share towels or household items like cups or cutlery 

  • wash soiled bedding and clothing on a hot wash 

How long will your child’s symptoms last? 

  • Hand foot and mouth disease usually lasts 7 to 10 days 

  • It is easy to spread for first 5 days (it is spread in sneezes, coughing and poo) 

  • Wash your hands often and avoid sharing towels at home 

  • You should keep your child off school or nursery while they are feeling unwell 

  • Once they are feeling better they can go back and there is no need to wait until all the blisters have healed. It is best to let the school or nursery know

Where should you seek help?

For wear and tear, minor trips and everything in between

Self-care

You can treat your child's very minor illnesses and injuries at home.

Some illnesses can be treated in your own home with support and advice from the services listed when required, using the recommended medicines and getting plenty of rest.

Sound advice

Children can recover from illness quickly but also can become more poorly quickly; it is important to seek further advice if a child's condition gets worse.

For information on common childhood illnesses go to What is wrong with my child?

Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.

Sound advice

  • Visit a pharmacy if your child is ill, but does not need to see a GP
  • Remember that if your child's condition gets worse, you should seek further medical advice immediately
  • Help your child to understand - watch this video with them about going to the pharmacy

For information on common childhood illnesses go to What is wrong with my child?

Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Programme. They work with you through your pregnancy up until your child is ready to start school.

Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns or to the Community Paediatricians or to the child and adolescent mental health services.

Contact them by phoning your Health Visitor Team or local Children’s Centre.

Sound advice

Health visitors also provide advice, support and guidance in caring for your child, including:

  • Breastfeeding, weaning and healthy eating
  • Exercise, hygiene and safety
  • Your child’s growth and development
  • Emotional health and wellbeing, including postnatal depression
  • Safety in the home
  • Stopping smoking
  • Contraception and sexual health
  • Sleep and behaviour management (including temper tantrums!)
  • Toilet training
  • Minor illnesses

For more information watch the video: What does a health visitor do?

School nurses care for children and young people, aged 5-19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and or emotional health needs.

Contacting the School Nurse

Primary and secondary schools have an allocated school nurse – telephone your child’s school to ask for the contact details of your named school nurse.

There is also a specialist nurse who works with families who choose to educate their children at home.

Sound Advice

Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.

They all have a role in preventing disease and promoting health and wellbeing, by:

  • encouraging healthier lifestyles
  • offering immunisations
  • giving information, advice and support to children, young people and their families
  • supporting children with complex health needs

Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.

GPs assess, treat and manage a whole range of health problems. They also provide health education, give vaccinations and carry out simple surgical procedures. Your GP will arrange a referral to a hospital specialist should you need it.

Sound advice

You have a choice of service:

  • Doctors or GPs can treat many illnesses that do not warrant a visit to A&E
  • Help your child to understand – watch this video with them about visiting the GP or going to a walk in centre

For information on common childhood illnesses go to What is wrong with my child?

If you’re not sure which NHS service you need, you can call 111 or use 111 online.

Please note that 111 online is for people aged 5 and over. Call 111 if you need help for a child under 5.

An adviser will ask you questions to assess your symptoms and then give you the advice you need, or direct you straightaway to the best service for you in your area.

Sound advice

Use NHS 111 if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services

For information on common childhood illnesses go to What is wrong with my child?

A&E departments provide vital care for life-threatening emergencies, such as loss of consciousness, suspected heart attacks, breathing difficulties, or severe bleeding that cannot be stopped. If you’re not sure it’s an emergency, call 111 for advice.

Sound advice

  • Many visits to A&E and calls to 999 could be resolved by any other NHS services
  • If your child's condition is not critical, choose another service to get them the best possible treatment
  • Help your child to understand – watch this video with them about going to A&E or riding in an ambulance
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