Reviewed by: Alyson Insull, Pediatric Nurse Practitioner
Your kid wakes up cranky, running a fever, and by lunch they’ve got blisters on their hands, feet, and (oh joy) mouth. Is it chickenpox? Allergies? Something they picked up from that one snotty playdate?
Welcome to the wonderful world of hand-foot-and-mouth disease—a viral illness that sounds like a farm report but feels more like a parenting curveball.
The good news? It’s common, usually mild, and totally manageable. The bad news? It can look scary, feel miserable, and spike your search history with “weird blisters toddler won’t eat”.
This guide breaks it all down: what causes it, how long it lasts, what to do when your kid refuses food, and when to call in the experts (like Poppins!). Let’s go.
What Is Hand-Foot-and-Mouth Disease in Kids?
Hand-foot-and-mouth disease (HFMD) is a contagious viral illness that affects children—especially those under age five. It’s typically caused by Coxsackievirus A16, though more severe forms may stem from Coxsackievirus A6 or other enteroviruses.
What Causes Hand-Foot-and-Mouth?
The virus spreads through saliva, nasal mucus, blister fluid, and poop (yep—kids are nothing if not efficient vectors). It’s most common in late summer and early fall but can pop up year-round in daycare and school settings.
“Most cases are caused by Coxsackie A16,” explains Aly Insull, pediatric nurse practitioner at Poppins. “That version tends to have a classic presentation: a few blisters on the hands and feet, mouth sores, plus a mild fever.”
Is Hand-Foot-and-Mouth Contagious?
Very. Kids are contagious before the rash even appears and remain so for several days—sometimes longer if they still have mouth sores or aren’t feeling well.
Why Kids (Especially Toddlers) Get It Most
Studies show that 95% of HFMD cases occur in children under 5 years old. That’s because children under 5 have immature immune systems and are constantly touching things, licking stuff, and coughing into each other’s snack bags.
Older kids and adults can catch HFMD too, but it’s less common and usually milder.
What Does Hand-Foot-and-Mouth Look Like?
HFMD has an incubation period that typically lasts 3 to 5 days (but can last as long as 14 days) before symptoms appear. Once symptoms appear, they often start with a fever and sore throat. Within a day or two, a rash of flat red spots or small blisters appears—typically on the hands, feet, mouth, and sometimes the buttocks.
Rash, Mouth Sores, and Fever: The Big Three
These are the hallmark symptoms of HFMD. Most kids will have some combination of all three—though the exact mix and severity can vary by child and by viral strain.
Here's what to watch for:
- Tiny red spots or fluid-filled blisters on the hands and feet.
- Painful mouth sores on the tongue, inner cheeks, or gums.
- Fever (usually under 102°F but can go higher).
- Loss of appetite and drooling (because mouth ulcers hurt).
- General irritability or fatigue.
Where the Rash Shows Up—And What It Feels Like
On light skin tones, the rash appears pink or red. On deeper skin, it may look grayish, purplish, or darker than surrounding areas. Some kids say the rash is itchy or burns, especially if blisters pop.
“The mouth sores are often the most painful part,” says Insull. “That’s what makes kids stop eating and drinking.”
What’s Normal vs. What’s Not
A mild rash and low-grade fever are typical. But widespread blisters, a rash on the trunk or face, or prolonged high fever could suggest a more severe form like Coxsackie A6.
How Long Does Hand-Foot-and-Mouth Last?
When you’re in the thick of HFMD—fever, rash, tears, refusal to eat—it feels endless. But most cases are short-lived and self-limiting, meaning they resolve on their own with time, fluids, and comfort care. That said, some symptoms (like rash or nail changes) can stick around longer than you'd expect and still be totally normal.
Here’s a breakdown of how long symptoms typically last and what to watch for as your child heals.
Typical Symptom Timeline
While every child’s immune response is a little different, this is the usual course for HFMD symptoms:
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Most kids are back to baseline within a week, though the skin and nails may take longer to return to normal.
Why It Can Look Worse Before It Gets Better
HFMD rash has a way of looking dramatic right when you thought it was getting better. Blisters may darken, crust, or scab as they dry out, and peeling around the fingers, toes, or nails is common.
“You might think it’s getting worse when the rash looks more intense on day five,” says Insull. “But that’s just part of the healing process—it doesn’t mean the virus is coming back or spreading.”
This phase is often when parents reach out in a panic—rest assured, peeling skin and dry spots are normal and not contagious.
Post-Viral Peeling and Nail Changes (Yes, Really)
Here’s the weirdest (but harmless) twist in the HFMD story: nail shedding. In some kids, fingernails or toenails start to peel or fall off 3–6 weeks after the illness. It’s a post-viral effect called onychomadesis, and it’s totally benign.
- Fingernails usually grow back within 3–6 months.
- Toenails may take up to 9–12 months.
- New nails grow in normally—even if the old ones look alarming while detaching.
“Parents often think nail loss means a new infection or something they did wrong—but it’s just the tail end of HFMD,” Insull reassures. “No treatment needed—just clip sharp edges and keep skin moisturized.”
Bottom line: HFMD symptoms usually peak fast and fade gradually—but some after-effects (like skin peeling or nail changes) hang around longer than you’d expect. As long as your child is hydrated, active, and improving overall, you’re in the clear.
How to Treat Hand-Foot-and-Mouth at Home
There’s no magic pill for HFMD—but with a little know-how, you can ease your child’s symptoms and keep them comfortable until the virus runs its course. Most kids recover at home within 7 to 10 days, and the goal is to manage symptoms like fever, mouth pain, and rash without overcomplicating care.
This section walks you through evidence-backed treatments for each major symptom, plus what to skip (because not every home remedy belongs on your kid’s face).
Fever and Pain Relief Tips by Age
Fever and general discomfort are often the first symptoms of HFMD, and they’re usually what make your child feel the worst—especially in the first 48 hours.
Here’s how to safely treat fever and body aches based on your child’s age:
- Under 6 months: Always check with your pediatric provider before giving any medication. Infants this young need extra caution.
- 6 months to 12 years: Use acetaminophen (Tylenol) or ibuprofen (Motrin) as needed for pain or fever over 100.4°F.
- Follow the dosage instructions carefully based on your child’s weight.
- Ibuprofen may be preferred if inflammation is more severe (e.g., painful mouth ulcers).
- Avoid aspirin: It’s not safe for children and can cause a rare but serious condition called Reye’s syndrome.
“Don’t feel like you have to treat every mild fever,” says Insull. “But if your child’s uncomfortable or not sleeping well, fever-reducing medications can make a huge difference in how they feel—and how much they’ll drink.”
Mouth Sore Management (From Popsicles to Magic Mouthwash)
Painful mouth sores are often the hardest part of HFMD for kids—and the main reason they stop eating and drinking. Luckily, there are simple, pediatrician-approved ways to reduce pain and help your child stay hydrated.
Start with cooling and soothing options:
- Offer cold fluids like water, diluted apple juice, slushies, or breastmilk popsicles.
- Stick to soft, bland foods like yogurt, mashed potatoes, or oatmeal.
- Avoid anything salty, spicy, citrusy, or carbonated—those can sting open sores.
If your child is still in significant pain even after using Tylenol or Motrin, your provider may suggest a “magic mouthwash” mixture:
- For ages 1–6: Mix equal parts Children’s Benadryl and Maalox (or Mylanta). Apply a few drops to a cotton swab and dab gently on the mouth sores. Use up to 4 times daily.
- For kids over 6: Use 5 mL of the same mixture as a mouth rinse. Have your child swish it around and spit it out—do not swallow.
“We reserve magic mouthwash for kids who aren’t eating despite pain meds,” says Insull. “Start simple—cool drinks and Tylenol usually go a long way.”
Best and Worst Foods for Soothing Sore Mouths
Feeding a child with mouth ulcers can feel like a losing battle—but the right foods can soothe, not sting. Here’s what to offer—and what to avoid.
Keep in mind: hydration comes first, nutrition second. It’s okay if your child only eats popsicles and yogurt for a few days.
“We tell parents: if all your kid wants is smoothies, let them have smoothies,” says Insull. “The priority is fluids and comfort—not a perfectly balanced plate.”
How to Care for the Rash (Spoiler: Keep It Simple)
The rash from HFMD might look dramatic—red spots, fluid-filled blisters, or peeling—but it usually doesn’t need much treatment. In fact, over-treating the rash can make it worse.
Here’s how to care for the skin without making it angry:
- Keep rash areas clean and dry—gently wash with water once or twice daily and pat dry.
- Let your child wear loose, breathable clothing to reduce friction and sweat buildup.
- Do not pop blisters—it increases the risk of infection.
- Avoid topical antibiotics or steroid creams, unless your provider suspects a secondary skin infection (like impetigo).
If your child is scratching, cool compresses or dabbing with calamine lotion (on intact skin only) may help. But most of the time, the rash just needs time and gentle care.
“The rash often looks worse before it gets better—especially when it starts peeling,” says Insull. “That’s normal and not a sign of something new or dangerous.”
Bottom line: You don’t need a pharmacy aisle of products—just comfort-focused care and a few smart swaps. Treat the pain, keep things cool, and let your child rest. HFMD isn’t fun, but it’s usually short-lived—and you’ve got this.
What to Do If Your Child Won’t Eat or Drink
Dehydration in kids with HFMD is the most common reason for urgent care visits, especially in babies and toddlers who can’t tell you what they need.
The good news? With the right tools and some creative approaches, most kids can stay hydrated enough to recover at home.
Signs of Dehydration to Watch Closely
Hydration matters more than calories during the worst of HFMD. Keep a close eye for these warning signs of dehydration in children:
- Dry, cracked lips or a sticky mouth.
- No tears when crying.
- For babies, fewer than 6 wet diapers per day; for toddlers, no urination in 8+ hours.
- Sunken eyes or a sunken soft spot (in infants).
- Extreme tiredness, irritability, or unusual sleepiness.
- Cool or mottled hands and feet.
“The biggest red flag is a child who’s too uncomfortable to drink at all,” says Insull. “Even tiny sips count—but if your child hasn’t peed in 8 hours or seems unusually lethargic, that’s a sign to check in with your provider.”
These symptoms mean your child may be moving beyond mild dehydration—and it’s time to act fast or call in backup.
Tips for Hydration Without Tears
Every ounce counts. If your child is refusing their usual bottle, cup, or breast, try these pediatrician-approved hydration tips:
- Offer frequent small sips every 5–10 minutes—even if it’s just a teaspoon at a time.
- Try cold liquids like ice water, Pedialyte popsicles, or diluted juice.
- Offer drinks with a spoon, medicine syringe, or dropper.
- Breastfeed or offer pumped milk as often as your baby will tolerate it.
- Stick to non-acidic, non-carbonated drinks (no orange juice or soda).
- Prioritize fluids over solids—it’s okay if they skip meals for a day or two.
When to Use a Syringe Instead of a Bottle
Mouth sores make sucking painful—so babies and toddlers may refuse bottles, breast, or straws. If that’s the case, switch to:
- A small medicine syringe (without the needle, of course).
- A soft-tipped dropper.
- A spoon (yes, it’s slow, but it works).
It might take 10–15 minutes to get a few ounces in this way, but even that can prevent dehydration and avoid an ER trip.
“Sometimes the best approach is the slow one,” says Insull. “Parents are often surprised how much hydration you can get in with a spoon or syringe if you stay calm and consistent.”
Bottom line: If your child refuses food, don’t panic—but hydration is non-negotiable. Use whatever method works, keep fluids cool and gentle, and watch for signs that their body needs help.
When to Call the Doctor (or Poppins)
Reach out to your pediatric provider or the Poppins care team if:
- Fever lasts more than 3 days.
- Rash spreads beyond hands, feet, and mouth.
- Child is not drinking or shows signs of dehydration.
- Blisters look infected (pus, redness, warmth).
- Your child is lethargic or not acting like themselves.
“If your child seems worse instead of better, or just not right—trust your gut and check in,” says Insull. “We’re here 24/7 to help.”
How to Prevent Hand-Foot-and-Mouth from Spreading
HFMD disease spreads fast—especially in homes with multiple kids or shared toys, snacks, and sticky fingers. One study found that among households with a child with HFMD, in 77% of cases the disease was passed to another family member in the home. So yes—super contagious.
While you can’t control every cough or cuddle, you can take a few smart steps to stop HFMD from running through your household like a daycare domino effect.
Here’s how to reduce the spread and keep the rest of the crew healthy.
Why Handwashing Is Your First Line of Defense
Frequent, thorough handwashing is the single most effective way to prevent transmission. Teach kids to wash their hands:
- After diaper changes or bathroom use.
- Before eating meals or snacks.
- After sneezing, coughing, or wiping their nose.
- After touching their face or any rash areas.
Use soap and warm water, and scrub for at least 20 seconds. Hand sanitizer can help in a pinch, but it doesn’t replace good old-fashioned soap—especially when it comes to removing virus particles from messy hands.
Parents and caregivers should also be washing their hands regularly, especially after applying creams, wiping noses, or handling laundry.
“Hand-foot-and-mouth is incredibly contagious, especially in younger kids who are still learning hygiene habits. I always tell parents: handwashing isn’t optional—it’s essential. And don’t forget to clean the things your child touches after they sneeze or drool on them. That’s often where the virus lingers the longest.”
What to Disinfect (and How Often)
HFMD can survive on surfaces for hours—or even days. Daily disinfecting of high-touch objects can dramatically lower the risk of it spreading to siblings or caregivers.
Disinfect these items at least once a day, or more if visibly dirty:
- Toys (especially shared or mouthed ones).
- Doorknobs and cabinet handles.
- Light switches.
- Remote controls and tablets.
- High chair trays and booster seats.
- Bathroom faucet handles and toilet flushers.
- Pacifiers, bottle nipples, and teething toys.
- Any surface your child coughs, drools, or sneezes on.
Use a disinfectant that’s effective against viruses (like a diluted bleach solution or EPA-approved cleaner). Soft toys and blankets should be laundered on hot settings.
Bonus tip: If your child shares a room, consider keeping their bedding separate and changing pillowcases and sheets more frequently during the illness.
Don’t Forget the Invisible Touchpoints
Viruses love to hitch a ride on everyday actions. Remind kids (and adults) to avoid:
- Touching their face, eyes, nose, or mouth unnecessarily.
- Sharing cups, utensils, food, towels, or toothbrushes.
- Snuggling too closely during the peak contagious period.
It’s not about making your child feel like a biohazard—it’s about giving their siblings a fighting chance.
Bottom line: You can’t put your child in a bubble, but a few thoughtful changes to your routine can keep HFMD from bouncing around your household like a ping-pong ball. Prioritize handwashing, disinfect what you can, and give yourself extra grace—because stopping a toddler from licking the couch leg is a full-time job in itself.
How Poppins Helps Families Manage Hand-Foot-and-Mouth
When your child has a scary rash and refuses everything but air and ice cubes, you need fast answers—not vague internet rabbit holes.
Poppins provides 24/7 access to licensed pediatric providers who can guide you through:
- Diagnosis and what to expect.
- Safe medication use by age.
- Symptom-specific relief tips.
- Hydration strategies.
- Magic mouthwash instructions as needed.
- Ongoing follow-up and escalation support.
“We don’t just hand out one-size-fits-all advice,” says Insull. “We create a plan based on your child’s age, symptoms, and needs—and then check back in to make sure it’s working.”
FAQs: Common Parent Questions About HFMD
We get it—when your child is sick, Google becomes your best friend and your worst enemy. These are the most frequently asked questions from parents dealing with HFMD, answered with clarity, detail, and real pediatric insight so you can stop scrolling and start feeling confident.
Can My Child Get Hand-Foot-and-Mouth More Than Once?
Yes—children can get HFMD multiple times, especially if they’re exposed to different viral strains. The most common strain is Coxsackievirus A16, but Coxsackievirus A6 and enterovirus 71 can also cause similar (or more severe) symptoms.
Some kids have a mild case early on, then get a more intense round later in childhood. Reinfection is more likely in daycare or preschool settings where viruses circulate often.
More details: See What Is Hand-Foot-and-Mouth Disease in Kids? for a breakdown of causes and types.
Is Hand-Foot-and-Mouth Contagious—and For How Long?
Yes, HFMD is highly contagious and spreads through saliva, mucus, fluid from blisters, and stool. Children are most contagious in the first 2–3 days, even before the rash appears, and may continue to spread the virus for days after symptoms improve—especially through diaper changes.
Good hygiene (handwashing, disinfecting surfaces) is key to preventing outbreaks at home or in daycare.
More details: Visit Is It Contagious? and How to Prevent Hand-Foot-and-Mouth from Spreading.
How Can I Tell If It’s Definitely HFMD and Not Something Else?
The classic sign of HFMD is the trio of symptoms: small blisters on the hands and feet, mouth sores, and a low to moderate fever. If the rash spreads beyond those areas (like to the trunk or face) or looks different—flat, itchy, or widespread—it may be caused by a different strain like Coxsackie A6.
If there’s no rash at all, or your child has severe fatigue, neck stiffness, or vomiting, another illness may be to blame.
More details: Check out What Does Hand-Foot-and-Mouth Look Like? and When to Call the Doctor (or Poppins).
Should I Be Worried If My Child Isn’t Eating?
It’s very common for children with HFMD to refuse food or drink, especially if mouth sores are painful. The main concern is hydration—not nutrition. Focus on offering cool, soothing liquids (like water, milk, electrolyte drinks) and skip acidic or spicy foods.
If your child hasn’t urinated in 8+ hours, has dry lips, or seems unusually sleepy, they may be dehydrated and need medical attention.
More details: See What to Do If Your Child Won’t Eat or Drink and Mouth Sore Management.
Will My Child’s Fingernails or Toenails Really Fall Off?
Yes—and it’s just as weird as it sounds. Some children experience nail shedding 3–6 weeks after recovering from HFMD, a phenomenon called onychomadesis. It’s harmless, not contagious, and the nails grow back normally over the next few months.
More details: Visit How Long Does Hand-Foot-and-Mouth Last? for post-viral changes to expect.
Is It Safe to Breastfeed If My Baby Has HFMD?
Absolutely. Breastfeeding is safe during HFMD and can even help support your baby’s immune system. Just be sure to wash hands thoroughly before and after feeding, and avoid using lanolin-based nipple creams, which can clog sweat glands and potentially worsen facial rashes.
If the baby has mouth sores and refuses to latch, offer pumped milk by spoon or syringe until they’re more comfortable.
More details: Refer to What to Do If Your Child Won’t Eat or Drink and Mouth Sore Management.
How Do I Know If My Child Is Getting Worse?
Here are some red flags to watch out for that may indicate your child needs medical attention:
- Fever lasting more than 72 hours.
- Signs of dehydration.
- Rash that spreads quickly or looks infected.
- Lethargy, trouble waking, or unresponsiveness.
- Severe mouth pain that prevents any fluid intake.
Trust your instincts—if something feels off, don’t wait to seek support.
More details: See When to Call the Doctor (or Poppins) for a full list of warning signs.
When Can My Child Go Back to School or Daycare?
Children with HFMD can return to school or daycare when they are:
- Fever-free for at least 24 hours without medication.
- No longer drooling excessively due to mouth sores.
- Well enough to participate in normal activities.
Even if some rash is still visible, they’re usually no longer contagious by this point.
Final Thoughts: You’ve Got This—and We’ve Got You
HFMD is one of those classic childhood viruses that feels worse than it is. But that doesn’t mean it’s easy to handle—especially when you’re juggling a feverish toddler who won’t eat and a calendar full of things you now need to cancel.
Thankfully, with the right guidance and support, you can keep your child comfortable and ride out the symptoms with confidence.
And if you're ever unsure? That’s what Poppins is for.
With Poppins, you get 24/7 access to pediatric experts who will help you make a plan, track symptoms, and check back in to make sure your little one is on the mend.
Sign up for Poppins today—because peace of mind shouldn’t come with a waitlist.
About Alyson Insull
Alyson Insull
Pediatric Nurse Practitioner
Throughout her 15 years at Duke Children's and Boston Children's Hospitals, Aly has created healing connections with young patients. Her expertise in orthopedics, telemedicine and complex care, along with her DAISY Award, reflect her commitment to building trust with families.
