Hand, Foot and Mouth Disease (HFMD) is a common viral infection that mainly affects young children, particularly those under 5 years old, although older children, teenagers and adults can also become infected. It is caused by viruses from the enterovirus group, including coxsackieviruses and enterovirus A71 (EV-A71).
Most cases of HFMD are mild and self-limiting, with children recovering without serious complications. However, a small proportion of cases can develop neurological or cardiopulmonary complications, so parents and caregivers should know the warning signs that require prompt medical attention.
The classic symptoms are:
FEVER + MOUTH SORES + RASH OR BLISTERS ON THE HANDS AND FEET
However, symptoms can vary considerably from one child to another.
1. FEVER
A fever is often one of the earliest signs of HFMD.
A child may suddenly:
- Feel unusually warm
- Develop a raised temperature
- Become tired or less active
- Become irritable
- Sleep more than usual
- Have a reduced appetite
HFMD commonly begins with a short period of fever, often accompanied by feeling generally unwell and reduced appetite.
A fever by itself does not mean that a child has HFMD because many childhood infections can cause fever.
However, when fever is followed by painful mouth ulcers and a characteristic rash on the hands or feet, HFMD becomes more likely.
2. SORE THROAT
A child may complain of a sore or uncomfortable throat before the typical mouth sores appear.
You may notice:
- Difficulty swallowing
- Refusing certain foods
- Drinking less
- Crying during meals
- Complaining that the throat hurts
- Becoming irritable when eating
Sore throat can occur during the early stage of HFMD.
For younger children who cannot explain what they are feeling, refusing food or drinks may be one of the first clues.
3. RED SPOTS INSIDE THE MOUTH
One of the characteristic signs of HFMD is the appearance of small red spots or lesions inside the mouth.
They may occur on:
- The tongue
- Gums
- Inside the cheeks
- The roof of the mouth
- Other areas of the oral cavity
These lesions may subsequently develop into painful blisters or ulcers.
4. PAINFUL MOUTH ULCERS
As HFMD progresses, the red spots in the mouth may become painful sores or ulcers.
This can be one of the most noticeable symptoms.
A child may:
- Cry while eating
- Refuse solid food
- Drink less than usual
- Avoid acidic or spicy foods
- Drool more than normal
- Put their hands in their mouth
- Become unusually irritable
The sores can make swallowing uncomfortable, which can lead to reduced fluid intake.
This is particularly important because young children can become dehydrated quickly if they refuse to drink.
5. LOSS OF APPETITE
A child with HFMD may suddenly lose interest in food.
You may notice:
- Refusing breakfast or dinner
- Eating only a few bites
- Refusing solid foods
- Crying when offered food
- Preferring liquids
- Eating much less than usual
Painful mouth sores are a common reason for this.
Loss of appetite is usually temporary, but maintaining adequate fluid intake is important.
6. DROOLING MORE THAN USUAL
Some children may drool more because the mouth is painful.
A child may:
- Keep saliva in the mouth
- Drool onto clothing
- Refuse to swallow
- Become upset when swallowing
This may be particularly noticeable in younger children who cannot explain that their mouth hurts.
If drooling is accompanied by difficulty breathing or an inability to swallow, seek urgent medical attention.
7. RED SPOTS ON THE HANDS
Another classic feature of HFMD is a rash involving the hands.
You may notice small:
- Red spots
- Raised spots
- Blisters
The rash can appear on the palms, fingers or other parts of the hands.
The appearance can vary between children.
8. BLISTERS ON THE HANDS
Some of the red spots may develop into small blisters.
The blisters can contain clear fluid and may appear on:
- Palms
- Fingers
- Backs of the hands
HFMD is named after its characteristic involvement of the hands, feet and mouth, although not every child will have all three areas affected.
9. RASH ON THE FEET
The feet are another characteristic location.
You may see:
- Red spots
- Small raised bumps
- Blisters
- Multiple lesions around the toes
- Lesions on the soles
The soles of the feet are particularly characteristic of HFMD.
10. BLISTERS ON THE FEET
Some children develop small fluid-filled blisters on the feet.
They may be visible:
- On the soles
- Around the toes
- Along the sides of the feet
The rash is often not intensely itchy, which can help distinguish typical HFMD from some other childhood rashes.
However, the appearance of a rash alone is not enough to diagnose HFMD.
11. RASH ON THE BUTTOCKS
HFMD can also cause a rash on the buttocks.
This may appear as:
- Red spots
- Small raised lesions
- Blisters
The buttocks are a recognized additional location for the HFMD rash.
12. RASH AROUND THE GENITAL AREA
Some children may develop HFMD lesions around the genital region.
This can sometimes cause discomfort, particularly when:
- Sitting
- Walking
- Wearing tight clothing
- Going to the toilet
Not every child develops lesions in this area.
13. TIREDNESS AND LOW ENERGY
A child with HFMD may become noticeably less energetic.
You may notice:
- Less interest in playing
- More frequent naps
- Wanting to lie down
- Reduced physical activity
- Appearing generally unwell
WHO identifies lack of energy and malaise among the symptoms associated with HFMD.
14. IRRITABILITY
Young children may become unusually irritable because of:
- Fever
- Mouth pain
- Difficulty swallowing
- Poor appetite
- Tiredness
- General discomfort
A normally active child may suddenly become quieter or more clingy.
This can be particularly noticeable before the rash becomes obvious.
15. CHILDREN MAY CRY DURING MEALS
One subtle sign of HFMD is a sudden change in eating behaviour.
For example:
The child normally eats well.
Then suddenly:
They take a bite → stop → cry → refuse food.
This may happen because mouth ulcers are painful.
Parents may initially think the child is simply being fussy, but if this occurs together with fever and a developing rash, HFMD should be considered.
16. REFUSING TO DRINK
This is more concerning than simply refusing food.
A child may refuse:
- Water
- Milk
- Juice
- Oral fluids
because swallowing hurts.
This creates a risk of dehydration.
Parents should pay particular attention to how much the child is drinking and how frequently they are urinating.
17. SIGNS OF DEHYDRATION
If mouth sores are painful, a child may drink too little.
Possible signs of dehydration include:
- Dry mouth
- Very little urine
- Fewer wet diapers
- No tears when crying
- Unusual weakness
- Excessive sleepiness
- Sunken-looking eyes
- Very dark urine
A child who cannot drink enough fluids should be medically assessed.
18. HEADACHE
Older children may complain of a headache.
This may occur alongside:
- Fever
- Tiredness
- Sore throat
- General discomfort
Headache is not specific to HFMD, but it can occur during viral infections.
A severe or unusual headache, particularly when accompanied by vomiting, extreme drowsiness or neurological symptoms, requires urgent medical assessment.
19. VOMITING
Vomiting is not a defining feature of mild HFMD, but it can occur.
Occasional vomiting may accompany a viral illness.
However, repeated vomiting is a warning sign, particularly when it occurs together with:
- High fever
- Extreme sleepiness
- Abnormal behaviour
- Rapid breathing
- Muscle jerking
- Weakness
WHO clinical guidance emphasizes vomiting among warning signs that may indicate more serious HFMD requiring closer assessment.
20. UNUSUAL SLEEPINESS
This is one of the symptoms parents should take seriously.
There is a difference between:
“My child is tired and wants to sleep.”
and:
“My child is unusually sleepy, difficult to wake or not responding normally.”
Marked drowsiness or lethargy can be a warning sign of neurological involvement in severe HFMD.
If a child becomes difficult to wake or is not behaving normally, seek urgent medical care.
21. MUSCLE JERKING OR TWITCHING
In a small number of severe HFMD cases, neurological involvement can occur.
Parents may notice:
- Repeated jerking movements
- Muscle twitching
- Sudden spasms
- Abnormal movements
These are not typical signs of mild HFMD.
They require urgent medical assessment because neurological complications can occur in severe cases.
22. WEAKNESS OF THE ARMS OR LEGS
Another serious warning sign is unusual weakness.
For example:
- The child cannot walk normally
- The child stops using one arm or leg
- The child suddenly becomes unable to stand
- Movements become unusually weak
WHO guidance highlights limb weakness as a warning sign requiring medical attention.
23. DIFFICULTY WALKING
A child who normally walks and plays normally may suddenly become:
- Unsteady
- Weak
- Unable to walk properly
- Reluctant to stand
- Unable to coordinate movements normally
This is not typical of uncomplicated HFMD.
It can indicate neurological involvement and should be assessed urgently.
24. RAPID BREATHING
Fast breathing is another important warning sign.
You may notice:
- The child's chest moving very quickly
- Rapid breathing even while resting
- Increased effort when breathing
- Difficulty speaking or crying normally because of breathlessness
WHO identifies respiratory symptoms such as fast breathing or difficulty breathing as features of severe HFMD.
25. DIFFICULTY BREATHING
Difficulty breathing is an emergency warning sign.
A child may:
- Struggle to breathe
- Breathe very rapidly
- Use extra muscles around the chest or neck
- Appear distressed
- Become pale or bluish
Severe HFMD can rarely involve cardiopulmonary complications.
DO NOT WAIT FOR THE SYMPTOM TO DISAPPEAR.
Seek emergency medical care.
26. SEIZURES OR CONVULSIONS
Seizures are not a normal feature of uncomplicated HFMD.
They may indicate serious neurological involvement such as encephalitis or other central nervous system complications.
A child who develops a seizure requires immediate emergency medical assessment.
27. HIGH OR PERSISTENT FEVER
Most uncomplicated HFMD cases have a relatively brief fever, but a very high, persistent or worsening fever deserves medical assessment.
WHO clinical guidance emphasizes paying attention to fever duration and warning signs because severe cases can deteriorate rapidly.
A child with fever plus vomiting, unusual sleepiness, limb weakness, abnormal movements or breathing difficulty should be assessed urgently.
28. SYMPTOMS MAY APPEAR IN STAGES
HFMD often follows a recognizable progression.
A child might experience:
EARLY STAGE
Fever + sore throat + poor appetite + tiredness
↓
1–2 DAYS LATER
Painful mouth sores
↓
FOLLOWING DAYS
Red spots or blisters on hands and feet
This general sequence has been described by WHO, although not every child follows exactly the same pattern.
29. NOT EVERY CHILD HAS ALL THE CLASSIC SIGNS
This is an important point.
A child may have:
Fever + mouth ulcers
but no obvious rash.
Another child may have:
Rash + mild fever
but few mouth symptoms.
Some infected people may have very mild symptoms or no noticeable symptoms.
Therefore, absence of one classic symptom does not completely exclude HFMD.
30. HFMD CAN ALSO AFFECT ADULTS
Although HFMD is most common in young children, teenagers and adults can also become infected.
Adults may experience:
- Fever
- Sore throat
- Mouth sores
- Hand and foot rash
- Fatigue
- Body discomfort
Some adults may have relatively mild symptoms.
HOW HFMD SPREADS
HFMD is highly contagious.
The viruses can spread through contact with:
- Saliva
- Nasal or respiratory secretions
- Fluid from blisters
- Stool
- Contaminated objects and surfaces
Close personal contact can therefore facilitate transmission, particularly in childcare centres, nurseries and households.
WHEN IS A CHILD MOST CONTAGIOUS?
People with HFMD are generally most contagious during the first week of illness, although the virus can continue to be shed for longer periods.
This is why good hygiene and avoiding close contact while sick are important.
HFMD IS NOT THE SAME AS FOOT-AND-MOUTH DISEASE IN ANIMALS
Despite the similar name, human Hand, Foot and Mouth Disease is different from foot-and-mouth disease, which affects animals.
HFMD in humans is caused by enteroviruses.
It is not a disease that children catch from livestock.
WHEN SHOULD YOU TAKE YOUR CHILD TO A DOCTOR?
Medical assessment is appropriate if your child develops:
🌡️ FEVER
Particularly high, persistent or worsening fever.
👄 PAINFUL MOUTH SORES
Especially if the child refuses fluids.
🖐️ HAND AND FOOT RASH
Particularly when associated with fever and mouth ulcers.
🤮 REPEATED VOMITING
Especially together with lethargy or other warning signs.
😴 UNUSUAL SLEEPINESS
Particularly if the child is difficult to wake.
💪 LIMB WEAKNESS
Especially if the child suddenly has difficulty walking or moving.
🫁 FAST OR DIFFICULT BREATHING
This requires urgent assessment.
These warning signs are emphasized in WHO clinical guidance for HFMD.
🚨 SERIOUS WARNING SIGNS OF HFMD
Parents should seek urgent medical attention if a child with suspected HFMD develops:
PERSISTENT OR VERY HIGH FEVER
REPEATED VOMITING
UNUSUAL SLEEPINESS OR LETHARGY
MUSCLE JERKING OR SPASMS
SEIZURES
LIMB WEAKNESS
RAPID BREATHING
DIFFICULTY BREATHING
These symptoms can indicate neurological or cardiopulmonary complications.
WHY EARLY RECOGNITION MATTERS
Most HFMD cases are mild, but severe cases can deteriorate rapidly after initially subtle symptoms. WHO's clinical guidance specifically emphasizes early recognition of warning signs and timely intervention because a small proportion of children can develop neurological involvement followed by potentially serious cardiopulmonary complications.
This means parents should not panic when they see the typical HFMD rash—but they should closely monitor the child's overall condition.
HOW IS HFMD DIAGNOSED?
HFMD is usually diagnosed based on:
- The child's symptoms
- Physical examination
- The appearance and location of the rash
- The presence of mouth sores
- The clinical history
In many typical cases, extensive laboratory testing is not necessary.
However, healthcare professionals may order additional tests when:
- The diagnosis is uncertain
- Symptoms are unusually severe
- There are neurological symptoms
- There are complications
- Another serious infection needs to be ruled out
IS THERE A SPECIFIC CURE FOR HFMD?
Most HFMD cases recover naturally.
WHO notes that management is largely supportive, and there is no specific antiviral treatment routinely used for HFMD.
Supportive care generally focuses on:
- Adequate fluid intake
- Rest
- Managing fever and discomfort appropriately
- Monitoring for dehydration
- Monitoring for warning signs
Medication should be given to children according to appropriate medical advice and dosing instructions.
HOW LONG DOES HFMD USUALLY LAST?
Most uncomplicated cases are self-limiting, with children generally recovering within about a week or so, although the exact duration can vary. WHO has reported that many mild cases recover within approximately 7–10 days.
The mouth sores and skin lesions gradually resolve.
However, the child should still be monitored carefully while symptomatic.
HOW CAN PARENTS HELP PREVENT THE SPREAD?
Good hygiene is extremely important.
🧼 WASH HANDS FREQUENTLY
Especially:
- After changing diapers
- After using the toilet
- After helping a child use the toilet
- Before preparing food
- Before eating
- After wiping a child's nose
🧸 CLEAN TOYS AND SURFACES
Regularly clean and disinfect frequently touched objects.
🤧 COVER COUGHS AND SNEEZES
Teach children to cover their mouth and nose appropriately.
🏠 KEEP SICK CHILDREN AT HOME
Follow local health guidance regarding when a child should return to school or childcare.
🚫 AVOID SHARING PERSONAL ITEMS
Do not share:
- Cups
- Eating utensils
- Towels
- Toothbrushes
- Other personal items
WHO recommends frequent handwashing, cleaning and disinfecting surfaces and avoiding close contact with infected people.
A SIMPLE HFMD WARNING-SIGN CHECKLIST
COMMON SIGNS
🌡️ FEVER
👄 PAINFUL MOUTH SORES
🖐️ RED SPOTS OR BLISTERS ON THE HANDS
🦶 RED SPOTS OR BLISTERS ON THE FEET
🍑 RASH ON THE BUTTOCKS
😴 TIREDNESS
🍽️ LOSS OF APPETITE
👄 SORE THROAT
These are characteristic features of HFMD.
🚨 SERIOUS WARNING SIGNS
Pay close attention if a child develops:
VERY HIGH OR PERSISTENT FEVER
REPEATED VOMITING
UNUSUAL SLEEPINESS
MUSCLE JERKING OR SPASMS
SEIZURES
LIMB WEAKNESS
RAPID BREATHING
DIFFICULTY BREATHING
These symptoms require prompt or emergency medical assessment.
FINAL TAKEAWAY
Hand, Foot and Mouth Disease is a common childhood viral infection and most cases are mild.
The classic symptoms include:
FEVER
PAINFUL MOUTH SORES
RED SPOTS OR BLISTERS ON THE HANDS
RED SPOTS OR BLISTERS ON THE FEET
LOSS OF APPETITE
SORE THROAT
TIREDNESS
However, parents should remember that HFMD can rarely become serious.
DO NOT IGNORE UNUSUAL SLEEPINESS, REPEATED VOMITING, MUSCLE JERKING, LIMB WEAKNESS, SEIZURES OR DIFFICULTY BREATHING.
These may indicate neurological or cardiopulmonary complications and require urgent medical assessment.
The most important thing is not to panic when a child develops the typical rash. Instead:
RECOGNIZE THE SYMPTOMS → KEEP THE CHILD HYDRATED → MONITOR CLOSELY → SEEK MEDICAL CARE IF WARNING SIGNS APPEAR.
Medical disclaimer: This article is for general health education and cannot diagnose HFMD. Many childhood illnesses can cause fever, rashes or mouth ulcers. If you suspect your child has HFMD—especially if the child is very young, unable to drink, unusually sleepy, repeatedly vomiting, developing abnormal movements, becoming weak or having difficulty breathing—seek professional medical assessment promptly.
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