Written by Dr Nické Theron, Pediatrician.

Hand, foot and mouth disease is caused by a very contagious VIRUS that leads to a wide range of symptoms in young children (usually under 5 years). The main culprit is usually the Coxsackie virus, part of a larger group of Entero-viruses and outbreaks usually occur late in the summer or autumn.

It spreads easily in a creche or school setting as it is transmitted when your child comes into direct contact with an infected child or an infected object (such as toys or surfaces). The virus is found in the nasal secretions, saliva, fluids from blisters, stool or respiratory droplets spread by a cough from an infected person. Adults can spread the disease without showing any symptoms of being infected.

“Attitudes are contagious. Is yours worth catching?”

Bruce van Horn

Most children have mild symptoms that can last for 7-10 days, but it can have some serious complications. Firstly, a low grade fever (37.5 to 38.9°C) develops 3 – 6 days after being exposed to the virus. A sore throat, irritability and a decreased appetite may follow.

1 – 3 days later you may see painful, red, blister-like lesions on the tongue, gums and inside of the cheeks (also called herpangina) which might cause excessive drooling and pain when eating or drinking.

A red rash on the palms of the hands and the soles of the feet, that can change into blisters, complete the typical picture. This rash is not itchy and usually not painful. It can also be found on the knees, elbows, buttocks or genital area. The fluid in these blisters are contagious as it contains the virus. These blisters peel off without leaving scars.

Children usually build a good immunity against this virus after the first exposure and re-infection is not common. 


  • Dehydration (due to painful/difficult swallowing) is the most common issue to watch out for.
  • Finger and toenails may develop white lines or fall out 2 months after the illness.
  • Inflammation of the bowels can lead to vomiting, diarrhoea and abdominal pain, also leading to dehydration.
  • In severe cases there might also be inflammation of the heart, brain, spinal cord and lungs.

Nobody wishes these miserable symptoms on any of our little ones, so how can we prevent them from getting this virus?

  • With Covid19 we have all been drilled in the steps of thorough hand washing, so make sure to continue with this good habit as it really is the best way to prevent viral infections of any kind.
  • Sanitize areas that children touch often.
  • Do not share cutlery, cups or toothbrushes.
  • Teach and practice good personal hygiene (yes, I know you have told your little one not to pick his nose a 100 times today, but tell him again, practice makes perfect!)
  • Isolate infected and contagious children. A child is the most contagious in the first week of the disease and should stay home until all symptoms have resolved. The blisters are contagious until they have dried up, usually within a few days, the stools can stay contagious up to a month later. 


Unfortunately there is no specific treatment that can stop the infection. We target the specific symptoms to help your little one feel better. If you are at all worried, please see your health care provider as babies and toddlers can dehydrate quickly and might need admission for further care.

  • Make sure to offer fluids frequently (cold drinks such as milk and water soothes a sore mouth). See below for more tips on how to get them to eat or drink. Intravenous fluids may be necessary if they cannot or will not eat or drink. 
  • Give a good oral Zinc supplement as Zinc helps to heal mucous membranes in the mouth and gut, as well as skin lesions.
  • Analgesia is important to keep them comfortable. Start with Paracetamol and Ibuprofen or Mefenamic acid (Ponstel). These are all available in suppositories if swallowing is difficult. Stilpane syrup combines Codeine (opioid analgesia), Promethazine (antihistamine) and Paracetamol so it works very well in severe pain.
  • You can apply an oral gel such as Phargel to the sores in the mouth to assist in healing. Older children can gargle with lukewarm saltwater, liquid ibuprofen (Nurofen) and antiseptic mouth washes or apply Adolex C spray (contains local analgesic and anti-inflammatory properties).
  • Do not rupture the blisters on the skin as this can spread the infection. Keep blisters clean and cover with a clean non-adherent dressing. If the skin is peeling or if large areas are affected you can make a mixture with Zinc ointment and Bepanthen to apply regularly as a barrier to assist healing. Silverlab healing spray contains colloidal silver that can also aid in recovery of lesions on the skin.

“He will yet fill your mouth with laughter and your lips with shouts of joy.”

Job 8:21

Some more tips to help them eat and drink:

  • Suck on ice or popsicles.
  • Eat ice cream.
  • Avoid citrus fruits, fruit juices and sodas.
  • Avoid spicy and salty foods.

I hope you never have “first-hand” experience with this little virus, but that you will have an action plan to give to other moms when necessary!


  1. https://www.mayoclinic.org/diseases-conditions/hand-foot-and-mouth-disease/symptoms-causes/syc-20353035
  2. https://www.cdc.gov/hand-foot-mouth/about/signs-symptoms.html
  3. https://www.nicd.ac.za/diseases-a-z-index/hand-foot-and-mouth-disease/
  4. Guerra AM, Orille E, Waseem M; “Hand foot and mouth disease”; Stat Pearls; February 10, 2021

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