Symptoms Of Hand Foot Mouth Disease

Question of the Week

A child with hand, foot, and mouth disease.
Small red bumps on your child's hands and feet are a good tip off that they might have HFMD. Getty Images

Question: My 8-month-old niece has a rash that consists of little pimply spots that appear on her butt, the palms of her hands, the soles of her feet, and the lower part of both legs. The rash doesn't seem to be itchy. She's very crabby and has a slight fever. What could this be?

Milagro, USA

Answer: 

While many conditions can cause a rash in young children, the pattern of her rash is suggestive of hand, foot, and mouth disease (HFMD).

Symptoms of Hand, Foot, and Mouth Disease

Typical symptoms of hand, foot, and mouth disease include:

  • red spots or blisters on the palms of their hands and on their fingers
  • red spots or blisters on the soles of their feet and on their toes
  • ulcers in a child's mouth (especially their tongue, gums, and inside of the cheeks)

Other symptoms can include a fever, rash on the child's buttocks and legs, and mild pain from the mouth ulcers.

Are They Hand, Foot, Mouth Disease Symptoms?

While it is often easy to diagnose a child with classic symptoms of hand, foot, and mouth disease, there are other childhood infections that cause similar symptoms and not all cases of HFMD are so classic.

For example, some kids with HFMD:

  • may not have fever
  • may only have mouth ulcers (herpangina) and may not have blisters on their hands and feet
  • may only have a few mouth ulcers
  • may have peeling on their fingers and toes and may even lose their fingernails and toenails a few weeks after the other symptoms have gone away

    And some kids don't have any symptoms at all, but may still be contagious.

    HFMD Look-A-Likes

    And other conditions can cause mouth ulcers or a rash on a child's hand's and feet.

    Herpes simplex virus type 1 can cause mouth ulcers and fever in children, but doesn't cause hand or feet blisters.

    Ehrlichiosis and Rocky Mountain Spotted Fever can both cause rashes that involve a child's palms and soles, but since they are followed by a tick bite, they likely won't easily be confused with HFMD.

    Other rashes that involve the palms and soles, like Reiter Syndrome and Secondary Syphilis, are uncommon in the age group that gets HFMD and typically have a lot of other symptoms.

    And still other conditions cause skin peeling, like scarlet fever and Kawasaki disease.

    What To Know About Hand, Foot, and Mouth Disease Symptoms

    Other things to know about the symptoms of Hand, Foot, and Mouth Disease include that:

    • Kids don't necessarily need to be kept out of daycare when they have HFMD, unless they are drooling a lot or have a fever.
    • HFMD is not the same thing as foot-and-mouth disease, which occurs in cattle, pigs, and sheep.
    • Hand, Foot, and Mouth Disease is usually caused by the coxsackievirus A16 virus and goes away without treatment, although symptomatic treatments to control pain can be helpful. Important complications to look for include dehydration, especially if your child has painful mouth ulcers and is not eating and drinking well.
    • Enterovirus 71 and coxsackievirus A6 can also cause HFMD.
    • While most people get natural immunity to HFMD when they infected as kids, some older kids and parents can get HFMD if they aren't immune.

    Talk to your pediatrician if you think that your child has hand, foot, and mouth disease.

    Sources:

    AAP Red Book 2015. Committee on Infectious Diseases 2012–2015

    Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed.

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