HFMD 101: The Fast Facts

Hand‑Foot‑and‑Mouth disease (HFMD) is a mild but highly contagious viral rash caused most often by coxsackievirus A16 or enterovirus 71 (CDC). It strikes children under 5, shows up as blisters on the palms, soles, and mouth, and usually clears in 7–10 days without complications.

Contagion Timeline at a Glance

Phase	Day Range	What’s Happening	Contagious Level
Incubation	3 – 6 days	Virus multiplies silently	—
Prodrome	Day 0	Low‑grade fever, sore throat	High
Full rash	Days 1 – 4	Mouth ulcers, hand/foot blisters	Highest (first week) (CDC)
Recovery	Days 5 – 10	Scabs heal, appetite returns	Moderate—virus still in stool
Shedding	Up to 4 weeks	Virus exits in poop	Low but present

Return‑to‑school rule: Fever‑free 24 hrs and mouth sores improving, even if spots remain on skin (Seattle Children’s Hospital).

Symptom Checklist (0 – 10 Days)

System	Common Signs
Skin	Flat red spots → gray blisters on palms, soles, buttocks
Mouth	Painful ulcers on tongue, gums, cheeks
General	Fever 100–102 °F, poor appetite, crankiness
GI	Occasional loose stools or nausea

If your child develops neck stiffness, constant vomiting, or a rash that spreads beyond classic zones, call your doctor—rare enterovirus strains can trigger meningitis (CDC).

Home‑Care Toolkit

Tool	Dose / How Often	Why It Helps
Acetaminophen	15 mg/kg q4–6 hrs	Lowers fever, mouth‑ulcer pain
Cold foods	Ice pops, smoothies	Numbs mouth sores, boosts fluids
Magic mouthwash (Rx)	Swish 30 sec before meals	Coats ulcers for pain‑free eating
Hydrogel hand spray	3× daily on blisters	Soothes itch, speeds drying
ORS	30–60 ml after each loose stool	Prevents dehydration

Skip ibuprofen if mouth intake is poor; empty stomach plus NSAIDs = higher ulcer pain. Never pop blisters—fluid is loaded with virus.

Comfort Menu (24‑Hour Plan)

Meal	HFMD‑Friendly Choice	Avoid
Breakfast	Greek yogurt + honey (if > 12 mo)	Citrus juice
Snack	Frozen banana bites	Salty chips
Lunch	Lukewarm oatmeal	Spicy soup
Snack	Watermelon cubes (cold)	Tomatoes
Dinner	Scrambled eggs, mashed potatoes	Acidic marinara

Cleaning & Isolation Hacks

1. Bleach it: 1 Tbsp bleach : 1 gal water on toys & counters—alcohol wipes don’t kill enterovirus.
2. Toy quarantine: Seal stuffed animals for 3 days; virus dies without a host.
3. Separate towels: Use color‑coded hand towels for sick kids.
4. Hand‑wash drills: 20‑second soap scrub after diaper changes—virus sheds in stool for weeks (CDC).

Myth‑Busting Corner

Myth	Reality
“Antibiotics clear the rash.”	HFMD is viral; antibiotics do nothing.
“Once spots are scabbed, we’re safe.”	Virus can still shed in poop for 4 weeks.
“Adult caregivers won’t catch it.”	Grown‑ups can get mild or no symptoms but still spread virus.

OTC vs Prescription Decision Tree

1. Is your child refusing fluids for 8+ hrs?
   Yes ➜ Call clinic for ondansetron melt and IV‑fluid check.
2. Mouth pain ≥ 4/10 despite acetaminophen?
   Yes ➜ Ask about lidocaine/maalox swish (magic mouthwash).
3. Itch disrupts sleep?
   Yes ➜ Discuss hydroxyzine nighttime dose.

Book a quick rash assessment if you need any of the above.

Preventing Household Spread

Action	Effectiveness
Hand‑washing after diaper duty	⭐⭐⭐⭐⭐
Disinfect phone screens daily	⭐⭐⭐⭐
No shared cups, even siblings	⭐⭐⭐⭐
Teach “dab‑sneeze” into elbow	⭐⭐⭐

Parents: wash hands before touching your face—adults often forget this step and become silent carriers.

Return‑to‑Play Guidelines

Activity	When It’s Safe
Day‑care / school	Fever‑free 24 hrs + eating normally
Swim lessons	After blisters scab (≈ 7 days) to protect others
Contact sports	Same as swim—avoid popped blisters snagging
Grandparent visits	Wait until mouth sores healed; seniors weaker immunity

Sample 3‑Day Recovery Log

Time	Temp °F	Fluids oz	Blisters Count	Pain (0‑3)	Notes
Day 1 AM	101.3	4	15	3	Started acetaminophen
Day 1 PM	100.2	10	25	2	Added ORS
Day 2 AM	99.4	12	28 (drying)	1	Eating yogurt
Day 3 AM	98.7	16	30 (scabbed)	0	Fever‑free 24 hrs

Bring this chart to follow‑up; trends guide clearance decisions.

When to Head to the ER

• < 6 wet diapers in 24 hrs or sunken fontanelle
• Fever > 103 °F unresponsive to meds
• Blisters spreading to eyes or genitals
• Weak cry, little movement, or confusion
• Rapid breathing or mottled skin

External Resources Worth Bookmarking

• HFMD Parent FAQ – CDC (signs, spread, cleaning tips).
• Seattle Children’s HFMD Care Sheet (return‑to‑school guidance).

Both open in new tabs for easy midnight reference.

Quick‑Fire Parent Q&A

Q: Can I breastfeed if I have HFMD?
A: Yes—virus hasn’t been found in breast milk; antibodies may help baby.

Q: Do gloves help when applying cream?
A: Disposable gloves reduce virus on your hands; toss after one use.

Q: Are epsom‑salt foot soaks OK?
A: Yes, lukewarm soaks ease foot pain; pat dry—no picking scabs.

One‑Minute Recap

1. Most contagious first week—isolate but don’t panic.
2. Manage pain: acetaminophen + cold foods.
3. Push fluids; watch diaper counts.
4. Bleach‑based cleaning beats alcohol wipes.
5. Blisters healed? Fever gone? Back to school!

Ready for Professional Eyes?

Book a quick rash assessment—our pediatric team confirms HFMD, checks hydration, and emails school‑return notes the same day.