Hand, Foot and Mouth Disease
Hand foot and mouth daycare outbreaks are so common that many parents call the illness a rite of passage. It is a viral infection that causes small blisters in the mouth and on the hands and feet. It is usually mild, but it spreads easily. In NSW, children stay home until all their blisters have dried.
If you have just spotted red dots on your toddler's palms, or received a note that there is a case in the room, this guide explains what to expect. It follows NSW Health advice throughout. More topics, from exclusion periods to allergies, are in our childcare health and safety guides.
General information only. See your GP for a diagnosis, or call healthdirect on 1800 022 222 for advice.
What HFMD is
Hand, foot and mouth disease, or HFMD, is a common, highly contagious infection caused by a group of viruses called enteroviruses, including coxsackieviruses. It mostly affects children under ten, and outbreaks at daycare are common because young children share toys, touch everything and are still learning to wash their hands.
It is usually a mild illness that gets better on its own.
Your GP can diagnose it from the symptoms. Tests are not usually needed.
It has nothing to do with the foot and mouth disease that affects cattle and sheep.
Because several different viruses cause it, children can catch it more than once.
HFMD in brief
- Cause
- Enteroviruses
- Most affected
- Under 10s
- Usually
- Mild, clears alone
Hands, feet, mouthSymptoms and the typical course
HFMD usually starts with small red dots that turn into blisters and then shallow ulcers. They appear inside the cheeks, on the gums and the sides of the tongue, and on the palms and soles. Babies may also get them in the nappy area. Some children have a low fever, sore throat and tiredness, and go off their food for a day or two.
- Days 1 to 5
Picking it up
Blisters usually appear three to five days after contact with someone who has it.
- First days
Feeling off
Some children have a mild fever, sore throat or tiredness, and may not want to eat.
- Blister stage
Spots and sores
Red dots become blisters and mouth ulcers. Sore mouths can make drinking painful.
- Days 7 to 10
Drying up
Blisters usually last seven to ten days, then dry and fade.
This is a typical pattern, and some children have only a few spots while others are covered.
Why childcare outbreaks happen
HFMD spreads from person to person in several ways, which is why hand foot and mouth daycare outbreaks move so quickly through groups of young children. The virus passes from faeces to mouth on unwashed hands, through coughs and sneezes, by touching blister fluid, and from toys and surfaces. It can stay in a child's faeces for several weeks after they recover.
Toddlers put toys in their mouths and share them straight away, so one sick child can expose a whole room in a morning.
Nappy changes and toileting are high-risk moments, which is why handwashing afterwards matters so much.
Children can pass the virus on before anyone has noticed a single blister, so outbreaks often start quietly.
HFMD is not a notifiable disease, but NSW Health asks parents to tell the centre so other families can watch for symptoms.
Exclusion: when they can return
NSW Health advises that children with hand, foot and mouth disease stay away from childcare until their blisters have dried up, any rash has gone and any fever has settled. For most children that means about a week, sometimes a little longer. A doctor's certificate is not needed to return.
Dried means crusted over and no longer weeping, not simply fewer blisters.
During the exclusion, NSW Health also suggests avoiding swimming lessons, playgrounds and indoor play centres.
Tell us when your child is diagnosed, so we can let families in the room know, without naming your child.
Not sure the blisters count as dry yet? Ring (02) 7238 8668 before drop-off.
Managing it at home
There is no specific treatment for HFMD, and it usually clears on its own. Home care is about keeping your child comfortable and drinking. Paracetamol can ease fever and discomfort. Never give children aspirin. Let blisters dry naturally, and do not burst them, because the fluid inside is infectious.
Offer cool drinks, icy poles and soft foods if the mouth is sore. Salty or acidic foods may sting.
Small, frequent sips are easier than big drinks.
Loose, comfortable clothing and bare feet at home help blisters dry.
Wash hands after every nappy change and before meals, for the whole family.
Comfort kit
- Cool drinks, icy poles
- Soft, bland foods
- Paracetamol if needed
- Rest and quiet play
Sips and restSee a doctor urgently if your child has
- A fever of 38°C or above for 72 hours or more
- Jerking or unusual movements
- Rapid breathing
- Extreme tiredness, drowsiness or irritability
- Difficulty walking, or keeps refusing fluids
Adults can catch it too
Adults can catch hand, foot and mouth disease, although many are exposed without getting sick. Adults who do get symptoms can have the same mouth ulcers and sore spots on the hands and feet as children. Careful handwashing after nappy changes and wiping noses is the best protection for parents and carers.
According to NSW Health, many pregnant women are exposed without symptoms, and there is no clear evidence of risk to unborn babies. If you are pregnant and worried, talk to your doctor or midwife.
Newborns can catch it from their mother or siblings and, rarely, become very unwell, so take extra care around new babies.
Avoid sharing cups, cutlery, towels and toothbrushes while someone in the house has it.
Preventing spread
There is no vaccine for HFMD, so good hygiene is the main protection. At home and at care, that means washing and drying hands well, not sharing cups or towels, cleaning toys and surfaces that may be contaminated, covering coughs and sneezes, and keeping sick children home until their blisters have dried.
Wash hands with soap and water after the toilet, before eating, after wiping noses and after nappy changes.
Do not share shoes and socks, as blisters on feet can spread the virus.
Wash soiled clothing, and clean toys that go in mouths.
Read the full NSW Health hand, foot and mouth disease fact sheet, or our guide to exclusion periods in NSW.
HFMD, answered
How long is my child contagious?+
Children are most contagious while they have symptoms and blisters, and can spread it before blisters appear. The virus can also stay in their faeces for several weeks after they recover, so careful handwashing after nappy changes and toileting matters even once they are back at care.
Can they return with blisters?+
Not while blisters are still fresh or weeping. NSW Health advises children stay home until their blisters have dried up, any rash has gone and any fever has settled. Once blisters are crusted and dry and your child is well, they can come back, usually without a doctor's certificate.
Is it related to foot and mouth in animals? No+
No, the two are completely unrelated. Hand, foot and mouth disease in children is caused by human enteroviruses, while foot and mouth disease affects cattle, sheep and pigs and is caused by a different virus. Children cannot catch the animal disease from HFMD, or the reverse.
Spotted blisters this morning? Let the team at our St Ives centre know.
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