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Hand, foot and mouth disease: symptoms, relief and going back to school

Hand, foot and mouth disease is a viral infection, most common in children under 5, that causes fever, painful mouth sores and spots on the palms and soles. It is usually mild and clears up on its own in 7 to 10 days. The most important thing is to keep your child drinking despite the sore mouth.

Can we help by telehealth? Yes, we can help by telehealth.

Is this an emergency?

This is not an emergency service. Call 911 or go to the nearest emergency room if you have:

  • Not drinking, or barely peeing
  • Signs of dehydration: dry mouth, crying without tears, unusual sleepiness
  • Severe headache with a stiff neck
  • A seizure
  • Very listless or hard to wake
  • A baby under 6 months with symptoms

Help lines:

Warning signs: when to go to the ER

Book a visit

Symptoms of hand, foot and mouth disease

Symptoms usually start 3 to 5 days after exposure:

  • Fever and cold-like symptoms.
  • Sore throat.
  • Painful mouth sores: small red spots on the tongue and inside the mouth that turn into blisters.
  • Flat or slightly raised red spots on the palms and soles, sometimes with small blisters; they can also appear on the buttocks, legs and arms. They usually do not itch.
  • Less interest in eating or drinking because swallowing hurts.

How does it spread?

The virus spreads through droplets from coughing, sneezing or talking; by touching objects and surfaces with the virus on them; through fluid from the blisters; and through stool. That is why it passes easily in daycare and school, especially among children still in diapers. Anyone can catch it, adults included.

Home relief: fluids first

Treatment means easing symptoms while the body fights off the virus:

  • Offer fluids often, in small sips, even if your child is eating little.
  • Acetaminophen or ibuprofen help with fever and pain. Dose by weight and use the device that comes with the medicine.
  • Never give aspirin to a child unless their doctor says so.
  • There is no antibiotic or vaccine for this illness; antibiotics do not work on viruses.

When can a video visit help?

Hand, foot and mouth disease can often be assessed by video in children 6 months or older who look well. In an online doctor visit, the doctor can see the sores and spots on camera, check whether your child is drinking enough, help with weight-based dosing and tell you whether an in-person visit is needed. If appropriate, the doctor can prescribe medication. We do not prescribe controlled substances.

The doctor is a general practice physician and is not a pediatrician. A parent with patria potestad or a legal guardian must be on camera for the whole visit. A visit costs US$79. See the child doctor visit and how to prepare your child.

When do you need an in-person visit or the ER?

Get medical care if your child cannot drink enough or shows signs of dehydration, has a fever lasting more than 3 days, has a weakened immune system, has severe symptoms or no improvement after 10 days, or is very young, especially under 6 months. We do not see babies under 6 months.

Complications are rare, but go to the ER if your child has a severe headache with a stiff neck, a seizure, is very listless or is not peeing. See diarrhea and vomiting in children for dehydration signs.

Warning signs by age

We do not see babies under 6 months. A baby under 3 months with a temperature of 100.4 °F (38 °C) or higher needs the ER right away. For children 6 months and older, go to the ER or call 911 if:

  • Babies 6 to 12 months: a weak, high-pitched or nonstop cry, a bulging soft spot, fewer than 6 wet diapers a day with listlessness, or cannot keep fluids down.
  • Children 1 to 5: drooling or unable to swallow, peeing only once or twice a day, sunken eyes or cold hands.
  • Children 6 to 17: a severe headache with a stiff neck, or dizziness on standing from drinking too little.
  • At any age: a seizure, very hard to wake, working hard to breathe, or a fever with purple spots that do not fade when pressed.

Going back to school or daycare in Puerto Rico

According to the CDC, your child can return to school or daycare once they have no fever, feel well enough to take part, and are not drooling uncontrollably from mouth sores. Check your school or daycare's own rules too.

No special medical certificate is needed for this, and we do not issue one without a real visit. If the school asks for a note covering the absence, read school health forms in Puerto Rico.

Preventing the spread

There is no vaccine, so hygiene is the best protection:

  • Wash hands often with soap and water, especially after diaper changes or using the bathroom.
  • Clean and disinfect toys and frequently touched surfaces.
  • Avoid kissing, hugging, or sharing cups and utensils with the sick person.

Video visit: US$79 · Pay by card · See the price and what is included

Before you book

  • You must be physically in Puerto Rico during the visit (visitors and tourists are welcome).
  • We see patients from 6 months old. Patients under 21: a parent or legal guardian must be on camera for the whole visit.
  • Real-time video only; we do not do phone-call visits.
  • We do not prescribe controlled substances.

What we don't do by telehealth

Frequently asked questions

How long does hand, foot and mouth disease last?
Most children have mild symptoms that last 7 to 10 days. If symptoms do not improve after 10 days, or a fever lasts more than 3 days, get a medical evaluation.
When can my child go back to school or daycare?
Once they have no fever, feel well enough to take part, and are not drooling uncontrollably from mouth sores, according to the CDC. Check your school or daycare's rules too.
What can I give my child who will not eat because of mouth sores?
Fluids matter most: small, frequent sips, even if they eat little. For pain, acetaminophen or ibuprofen dosed by weight. If your child is barely drinking or not peeing, get care.
Can adults catch it?
Yes. It is most common in children under 5, but anyone can catch it. Pregnant women who have been exposed should talk to their doctor.

Sources

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