Hand-foot-and-mouth disease is a mild, but highly contagious viral infection common in young children. Hand-foot-and-mouth disease is characterized by sores in the mouth and a rash on the hands and feet. It spreads from person to person, usually through unwashed hands or contaminated surfaces. The most common cause of hand-foot-and-mouth disease is coxsackievirus infection.

Hand-foot-and-mouth disease isn't related to foot-and-mouth disease (sometimes called hoof-and-mouth disease), which is an infectious viral disease found in farm animals. You can't contract hand-foot-and-mouth disease from pets or other animals, and you can't transmit it to them.

There's no specific treatment for hand-foot-and-mouth disease. You can reduce your risk of infection by practicing good hygiene, such as washing your hands often and thoroughly.

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Hand-foot-and-mouth disease on the hand

The signs and symptoms of hand-foot-and-mouth disease include:

• Fever
• Sore throat
• Painful red blister-like lesions on the tongue, mouth, palms of the hands or soles of the feet
• Headache
• Fatigue
• Irritability in infants and toddlers
• Loss of appetite

The usual period from initial infection to the onset of signs and symptoms (incubation period) is three to seven days. Fever is often the first sign of hand-foot-and-mouth disease, followed by a sore throat and sometimes a poor appetite and the feeling of being sick (malaise). One or two days after fever begins, painful sores may develop in the mouth or throat. Rash on the hands and feet can follow within one or two days, and may also appear on the buttocks. Hand-foot-and-mouth disease may cause all of the above signs and symptoms or just a few of them.

The most common cause of hand-foot-and-mouth disease is infection due to the coxsackievirus A16. The coxsackievirus belongs to a group of viruses called enteroviruses. Other enteroviruses sometimes cause hand-foot-and-mouth disease. Most cases of hand-foot-and-mouth disease aren't serious.

Oral ingestion is the main source of coxsackievirus infection and hand-foot-and-mouth disease. The illness spreads by person-to-person contact with nose and throat discharges, saliva, fluid from blisters, or the stool of someone with the infection. Hand-foot-and-mouth disease is most common in children in child care settings, where diaper changing and potty training are constant, and little hands often are in and out of the mouth frequently.

Hand-foot-and-mouth disease primarily affects children younger than 10. Children in child care centers are especially susceptible to outbreaks of hand-foot-and-mouth disease because the infection spreads by person-to-person contact with nose and throat discharges, saliva, fluid from blisters, or the stool of someone with the infection. The virus can also spread through a mist of fluid sprayed into the air when someone coughs or sneezes.

Although less common, hand-foot-and-mouth disease can also occur in adolescents and adults. Because they've most often developed immunity, adults and older children are less likely than younger children are to be susceptible to illness from coxsackievirus infection.

The coxsackievirus may spread for weeks after signs and symptoms have disappeared. Some people excreting the virus, especially most adults, may have no signs or symptoms of hand-foot-and-mouth disease.

The risk of contracting hand-foot-and-mouth disease is greater in the summer and fall.

Your doctor will likely be able to distinguish hand-foot-and-mouth disease from other types of viral infections by evaluating:

• The age of the affected person
• The pattern of signs and symptoms
• The appearance of rash or sores

A throat swab or stool specimen may be taken and sent to the laboratory to determine which virus caused the illness. However, your doctor probably won't need this type of testing to diagnose hand-foot-and-mouth disease.

The most common complication of hand-foot-and-mouth disease is dehydration. The illness can cause sores in the mouth and throat making swallowing painful and difficult. Watch closely to make sure your child consumes adequate amounts of fluids during the course of the illness. If dehydration is severe, intravenous (IV) fluids may be necessary.

Hand-foot-and-mouth disease is usually a minor illness causing only a few days of fever and relatively mild signs and symptoms. However, a rare and sometimes serious form of the coxsackievirus can involve the brain and cause other complications:

• Viral meningitis. This is an infection and inflammation of the membranes (meninges) and cerebrospinal fluid surrounding the brain and spinal cord. Viral meningitis is usually mild and often clears on its own.
• Encephalitis. This severe and potentially life-threatening disease involves brain inflammation caused by a virus. Encephalitis is rare.

There's no specific treatment for hand-foot-and-mouth disease, and antibiotics aren't effective because it's a viral infection. The illness simply must run its course. To help lessen discomfort, doctors often recommend:

• Rest
• Plenty of fluids — milk-based fluids may be easier to tolerate than acidic liquids, such as juice or soda
• Over-the-counter pain relievers, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others), if needed

Signs and symptoms of hand-foot-and-mouth disease usually clear up in seven to 10 days.

Certain precautions can help to reduce the chances of infection with hand-foot-and-mouth disease:

• Wash hands carefully. Be sure to wash your hands frequently and thoroughly, especially after using the toilet or changing a diaper, and before preparing food and eating. When soap and water aren't available, use hand wipes or gels treated with germ-killing alcohol.
• Disinfect common areas. Get in the habit of cleaning high-traffic areas and surfaces first with soap and water, then with a diluted solution of chlorine bleach, approximately 1/4 cup of bleach to 1 gallon of water. Child care centers should follow a strict schedule of cleaning and disinfecting all common areas, including shared items such as toys, as the virus can live on these objects for days. Clean your baby's pacifiers often.
• Teach good hygiene. Be a positive role model by showing your children how to practice good hygiene and how to keep themselves clean. Explain to them why it's best not to put their fingers, hands or any other objects in their mouths.

• Isolate contagious people. Because hand-foot-and-mouth disease is highly contagious, people with the illness should limit their exposure to others while they have active signs and symptoms. Hand-foot-and-mouth disease is most contagious during the first week of illness. However, the coxsackievirus may spread for weeks after signs and symptoms have disappeared.

  Keep children with hand-foot-and-mouth disease out of child care or school until fever is gone and mouth sores have healed. If you have the illness, stay home from work.

Certain foods and beverages that can cause burning or stinging may irritate blisters on the tongue or in the mouth or throat caused by hand-foot-and-mouth disease. Try these tips to help make blister soreness less bothersome and eating and drinking more tolerable:

• Suck on popsicles or ice chips
• Eat ice cream or sherbet
• Drink cold beverages, such as milk or ice water
• Avoid acidic foods and beverages, such as citrus fruits, fruit drinks and soda
• Avoid salty or spicy foods
• Choose foods that are soft and don't require a lot of chewing
• Rinse your mouth with warm water after meals

If your child is able to rinse without swallowing, rinsing the inside of his or her mouth with warm salt water may be soothing. Mix 1/2 teaspoon of salt with 1 cup of warm water. Have your child rinse with this solution several times a day, or as often as needed to help reduce the pain and inflammation of mouth and throat sores caused by hand-foot-and-mouth disease.