If you notice spots on your child’s hand, foot or mouth, it could be more than a common rash. If they’ve been around other children with the highly contagious hand, foot and mouth disease (HFMD), it’s possible they can get it, too.

What Causes Hand, Foot and Mouth Disease?

Coxsackievirus, which belongs to a group of viruses called nonpolio enteroviruses, is the most common virus that causes hand, foot and mouth disease. This includes the coxsackievirus A16 strain.

Most people get hand, foot and mouth disease through the mouth. However, you can also get it through contact with stool (poop) and fluid from the blisters that appear.

“It’s primarily spread through respiratory droplets, nasal secretions and coughing, but it can also be found on surfaces like playground equipment, doors and tabletops, and in day cares,” says Lindsay Allain Newburn, DO, a pediatrician at Northwestern Medicine.

Symptoms of Hand, Foot and Mouth Disease

Hand, foot and mouth disease starts like many other illnesses. The early signs can look like strep throat or a cold, but HFMD is different because it leads to painful mouth sores and a rash on the hands and feet.

To help you understand the progression of HFMD, here’s a closer look at the symptoms and when they usually appear.

Days 1 and 2: Flu-like symptoms begin

The initial symptoms of HFMD usually include:

• Fever and pain
• Runny nose
• Sore throat
• Loss of appetite

“Many of these symptoms occur with other illnesses, so most people don’t catch on until they see the skin lesions,” says Dr. Newburn. “This stage is called the prodrome, which is an early sign of the illness.”

Days 3 to 6: Mouth sores and rash appear

Within a couple of days of the initial symptoms, your child may develop:

• Painful mouth sores on the tongue, cheeks or gums. These can make eating and drinking difficult and lead to dehydration if your child is not taking in enough fluids. You may notice excessive drooling or your child may refuse to eat.
• A mildly itchy skin rash made up of tiny raised red or pink bumps, which may begin to turn into blisters. The rash can appear anywhere on the body, especially the hands (including the palms), feet (including the soles) and diaper area.

New lesions can continue to develop for a few days in this stage. Sometimes they appear in clusters.

Days 7 to 10: Recovery phase

Most children start feeling better in this phase. The lesions turn into blisters (if they haven’t already), then dry out and crust over.

“Children can have hundreds of lesions, but they rarely scar. The skin will eventually renew. And the number of lesions isn’t linked to the severity of the virus,” says Dr. Newburn. “The crusting process can linger, but your child is no longer contagious once blisters dry.”

Symptoms usually clear within 10 days. But it can take more time for children younger than 2 to clear the virus. Also, infants younger than 6 months who get hand, foot and mouth disease don’t always get lesions.

“Recovery time depends on the child,” she says. “And the virus can live in stool for weeks after the rash disappears.”

How to Help Ease Symptoms of Hand, Foot and Mouth Disease

To help ease your child’s mouth pain and encourage hydration:

• Offer cold foods like ice pops, smoothies and yogurt.
• Give acetaminophen to soothe pain, following package instructions for your child’s age and weight.
• Keep offering fluids, including water, milk or oral rehydration solutions.

You can use calamine lotion on the rash to soothe it, but the only way to get rid of the rash is by letting it go through its cycle.

Avoid the following:

• Oral numbing gels: They can interfere with swallowing in young children.
• Aspirin: Never give it to children.
• Exfoliation products on the blisters or rash: They can irritate the skin and slow healing.

“And don’t pop the lesions. They will heal on their own,” says Dr. Newburn.

How to Tell Hand, Foot and Mouth Disease Apart From Other Rashes

The rash is one of the most distinctive signs of HFMD and can help set it apart from other conditions that cause spots or bumps. HFMD typically appears as small red spots or blisters on the hands, feet and inside the mouth. Here’s how it differs from other common rashes:

• Chickenpox: Caused by the varicella virus, chickenpox lesions spread across the entire body, often starting on the chest and back. They tend to itch more than HFMD blisters and progress from spots to fluid-filled blisters before crusting over.
• Measles: The rash begins as flat red spots on the face and then spreads downward to the body, arms and legs. Measles is usually accompanied by high fever, cough and runny nose.
• Bug bites like mosquito bites: These typically appear as isolated, itchy bumps rather than clusters of blisters, and they don’t occur inside the mouth.
• Contact dermatitis: This rash is caused by skin irritation from allergens or chemicals. It’s usually confined to the area of contact and may look dry or scaly rather than blistered.
• Eczema: This chronic condition causes dry, itchy patches of skin, often in the creases of the elbows and knees. Unlike HFMD, eczema doesn’t cause painful mouth sores.

When to Seek Help

Any time you see a new rash, have your child evaluated by their pediatrician.

Seek immediate medical attention if your child has:

• A high fever that lasts more than three days
• Signs of dehydration like dry mouth, no tears when crying or less urine
• Stiff neck, headache or unusual sleepiness
• Difficulty breathing
• Changes in mental status or responsiveness

“Like any virus, you can have rare complications, such as viral meningitis. But for most people, HFMD is a minor illness,” says Dr. Newburn. “HFMD is pesky but does not usually lead to complications.”

When Can My Child Return to School or Day Care?

Typically, a preschool-age child can go back to preschool or day care once mouth sores improve, drooling stops and the blisters crust over. That’s about a week after you first notice symptoms.

Why HFMD Is More Common in Children Under 5

Young children have developing immune systems and can come into close contact with a child who is infected at day care or playgrounds. They also touch their eyes, noses and mouths more often than adults, making it easier for the virus to spread.

“Kids visit more areas with a high concentration of germs that are not wiped down, like under tables at restaurants. They go places adults don’t,” says Dr. Newburn. “As part of social development, children share toys, but adults use their own pen and computer.”

Can Adults Get HFMD?

It’s possible for adults to get HFMD. But when they do, their symptoms are typically milder. Adults can have a fever, sore throat or mild rash. Some adults may not develop symptoms but still be contagious.

“It’s rare for adults to see skin lesions with hand, foot and mouth disease,” says Dr. Newburn.

Can You Get Hand, Foot and Mouth Disease Again?

Viruses — including the coxsackievirus — are constantly evolving, so it’s possible to get HFMD again. However, it can be less severe the second time you get it.

“It’s expected that your child will encounter hand, foot and mouth disease at some point. It’s an important virus for your body to learn,” says Dr. Newburn.

Can HFMD Be Prevented?

There’s no vaccine for HFMD, but as with protecting yourself from any virus, good hygiene helps.

• Wash your hands often with soap and water.
• Wipe down toys, surfaces and other commonly touched objects.
• Avoid contact with hand, foot and mouth blisters.
• Don’t share cups, utensils or towels with a person who’s infected.

“Handwashing is not always realistic on the go. In those cases, use hand sanitizer, which is effective at preventing the spread of germs,” says Dr. Newburn.

There isn’t a specific season when hand, foot and mouth disease is more likely to occur. It can occur any time of year.

“If your child does get it, remember to keep them hydrated, manage pain and practice good hygiene to prevent spreading the virus,” says Dr. Newburn.