The Infamous Hand,Foot and Mouth Disease

Most of the parents out there, especially those with toddlers, have experienced or are experiencing the effects of hand, foot, and mouth disease. For the most part, it is a self-limiting virus, but it can cause distress to the entire household. Children have to be out of school or daycare for several days, parents have to take off work or find a caregiver for their ill child, and it can be a struggle to keep children eating and drinking during this time. So what causes this illness and what can you do at home to try and prevent it or treat it?

Hand, foot, and mouth disease (HFMD) is caused by two different viruses, enterovirus and coxsackievirus, more specifically the enterovirus 71 and coxsackie A16 viral strains. Coxsackie virus A16 is the most common cause of HFMD in the United States, but the enterovirus causes more epidemics and outbreaks of HFMD. It can be found year-round, but is more prevalent during summer and fall. Any age group, including adults, can be infected, but it is most common in toddlers and infants. For most people, you will only be infected by HFMD once because you will develop immunity to that virus after the infection. However, since there are two different viruses that can cause HFMD, it is possible to get the disease twice. Usually, the symptoms are more benign the older you are when infected.


A diagnosis is made by examining the child. The classic presentation is a rash of small dots on the skin, most commonly around the hands, feet, and buttock, fever, and bright red dots inside the mouth.  HFMD can be diagnosed by testing the stool or saliva for the virus, but it takes weeks to run the test, so this is reserved mostly for research purposes. For example, several years ago there was a new rash that looked like HFMD but it was all over the body instead of just the hands and feet. Tests were performed on these children and it was confirmed that it was still the virus, but the strain had altered itself slightly to cause a different distribution of the rash.


The virus is excreted and transmitted from the nose, throat, and stool of infected people starting about three days before symptoms start up until four days typically after the rash appears. These viruses can stay on doorknobs or toys for hours or days, and if you touch an object that has the virus on it unknowingly and then touch your nose or eyes, you can become infected. Cleaning toys and surfaces and washing your hands, preferably with soap and water, will help protect you from getting infected.


A study in China from 2008 showed that caretakers and toddlers that washed their hands regularly and used good hygiene had a 95% chance of not being infected with HFMD during a large outbreak. It is also helpful to avoid children with HFMD while the rash is present, and this is why schools require kids to be out of school for the first four days. If you are ever concerned about a rash or if your child is acting like their mouth hurts and has a fever, it may be beneficial to have them examined for Hand, Foot, and Mouth Disease.

Jennifer Adair M.D.

Jennifer Adair, M.D., was born and raised in Mobile. She graduated from Davidson High School in 2002 and received her Bachelor of Science in Chemistry at The University of Alabama in 2006. She completed her medical training at the University of South Alabama College of Medicine, and pediatric residency at the University of Nevada College of Medicine – Las Vegas and the University of South Alabama. She joined Children’s Medical Group in July 2013 and currently practices at their Airport office. Jennifer and her husband, Cory, reside in Mobile with their dogs, Fitz and Barkley.