Hand, Foot, and Mouth Disease… if you’re reading this, I’m praying you aren’t experiencing the torture that is HFMD!

I’m writing this from experience, as my 15-month-old and my 2.5-year-old (32 months) children are both just now well from this disease; Hand, Foot, & Mouth is no joke. My son also had it when he was 27 months. So, as you can see, I’ve had many reasons to research in to this disease. Scroll to the bottom for my personal experience with hand, foot, and mouth disease – including pictures, a timeline, and a description of how it affected my children, and our cousin Ava – who had the disease at 8-months-old and 11-months-old!

The Disease
What is Hand, Foot, and Mouth Disease?

Basically, it’s a viral infection caused by enterovirus. In America, it’s most often been traced back to the coxsackievirus (a part of the enterovirus family). Hand, foot, & mouth disease is most common in the US in the warmer months (May through October). It mostly affects children under 5 years of age, though cases have been reported in older children and adults. It can cause fever, rash, lethargy, sleeping disruptions, and tummy aches.

The coxsackievirus lives in the digestive tract and can cause illness aside from HFMD, such as herpangina, pink-eye, meningitis, encephalitis, and even a cold.

My Experience

My 1-year-old (15 months) has hand, foot, and mouth disease – what should I expect?

• Timeline of hand, foot, and mouth disease in my 15-month-old:
  • Exposure Day (Saturday): Exposed to HFMD
  • 3 days after exposure:
    • Skipped her 2^nd nap
    • Low grade fever 99.3 (early afternoon)
    • Fussy (early afternoon)
    • 5-6 red spots in diaper area (not raised, not big, not painful)
    • 
    • 1 red spot on thigh (not raised, not big, not painful)
  • 4 days after exposure:
    • Unhappy from the moment she woke up
    • 1 red spot on chin
    • Very fussy
    • Mouth obviously hurting (putting fingers in it)
    • Low-grade fever, 99.5, all day long
    • Administering acetaminophen & ibuprofen for pain & fever
    • Administering magic mouthwash for blisters (2x/day)
    • This night, she woke up every 45 minutes and cried for 5-10 minutes before I was able to soothe her back to sleep with cold water & singing!
  • 5 days after exposure:
    • No fever
    • Moderate-to-Severe mouth pain
    • Rash on arms (8-10 light spots)
    • 
    • Rash on diaper area/bottom (raised, painful, red, grouped together)

    • 

    • Rash on mouth is 4-6 spots and starting to blister, painful
    • Rash in throat (can’t see much) on tongue, cheeks, throat, roof of mouth… maybe 5 small blisters
    • Rash on bottoms of feet – painful to walk without socks
    • Less severe rash on hands, legs, and belly
    • Drooling
    • Loss of appetite (ate about ½ what she normally eats)
    • Still administering acetaminophen & ibuprofen for pain
    • Still administering magic mouthwash for blisters (2x/day)
    • This night, she was able to sleep in her own bed but woke up about every 3 hours and whimpered for <30 seconds each time. Slept about 13 hours.
  • 6 days after exposure:
    • No fever
    • Bottoms of feet & toes, sides of toes, and in between toes have blisters, causing pain when walking. This is the worst of her rash.

      Hand, Foot, & Mouth Disease Foot Blisters, Early Stage

    • Mouth/Chin blisters are worse, due to drool.

      

    • Diaper rash is mostly the same but a little less harsh looking

    • 

    • Much happier disposition, but still fussy off and on
    • Ate more, but still not back to 100%
    • Went to sleep much easier
  • 7 days after exposure:
    • 100% better as far as how she feels & acts
    • Rash is still here but is getting progressively better; doesn’t seem to cause any pain
      • Diaper area, hands, feet, chin
    • Blisters still on some spots
  • 11 days after exposure:
    • 100% better
    • Rash is gone everywhere except faintly in diaper area
    • Diaper rash is minimal
    • 
    • No pain
• 18 Days after exposure
  • The only remnants are her feet peeling from the blisters and the rash on her legs looks like scarring but it will go away fully.
  • We didn’t have fingernail or toenail loss
• What worked for her, as far as remedies for HFMD:
  • Popsicles (home-made yogurt ones were the favorite)
  • Ice-cold water
  • Cold milk
  • Cold yogurt
  • Aquafor on chin blisters
  • Magic mouthwash on throat blisters before bed
  • Extra naps
  • Tylenol & Motrin alternated every 3 hours
  • Oatmeal baths

My 2-year-old (27 months) has hand, foot, and mouth disease – what should I expect?

This was our first experience with the disease and we didn’t even know it existed. It was awful but fortunately lasted less than 7 days.

• Timeline of hand, foot, and mouth disease in my 2-year-old:
  • Exposure day: December 27
  • 2 days after exposure:
    • Vomited once, but otherwise fine
  • 3 days after exposure:
    • Vomited in the middle of the night & had fever of 101 consistently overnight, ever after Motrin.
    • After a 2^nd dose of Motrin in the AM his fever was still climbing and was 103 degrees.
    • Red cheeks
    • Appt = “probable hand, foot, and mouth disease”
    • Lethargic & Sad seeming
    • 100-degree fever at bedtime + Motrin
    • WON’T EAT
  • 4 days after exposure:
    • Woke at midnight with 101-degree temperature again. Fever stayed consistent even after administering Tylenol & Motrin, over 3 hours.
    • Woke at 7:30 am complaining of sore throat and “I hurt!”
    • ALL DAY he complained of sore throat, laid around, and slept on the floor.
    • Vomited twice
    • Fever remained around 100-degrees all day, with round-the-clock fever reducers
    • Administered magic mouthwash 2x
    • WON’T EAT
  • 5 days after exposure:
    • Less complaining
    • Finally slept all night
    • Administered Motrin 2x for mouth pain
    • WON’T EAT
  • 6 days after exposure:
    • Administered Motrin for tummy
    • Finally ate
  • 7 days after exposure:
    • 100% better!
    • Rash completely gone!
    • No pain!

My 2.5-year-old (32 months) has hand, foot, and mouth disease – what should I expect?

Hudson had HFMD 6 months ago, so I suspected that he would not get a very bad case, if he even contracted the illness at all. He did end up with it, but it never fully developed. No rash.

• Timeline of hand, foot, and mouth disease in my 2.5-year-old:
  • 5 days after exposure:
    • Was fine all day, but refused dinner (very abnormal!)
  • 4 days after exposure:
    • Fussy
    • Lower appetite
    • No real symptoms – thought we were home free!
  • 5 days after exposure:
    • 101 fever in the AM
    • Regular nap
    • Lounged around, watching TV (not typical)
    • Alternated Tylenol & Motrin, fever was still fairly consistent, around 101 degrees F
    • Tummy Ache
    • Says he’s not feeling good
    • Complains of sore throat (I see some red spots on the back, no blisters)
    • No rash
    • Woke up 3 times at night with complaints of sore throat, not feeling good, or tummy ache
    • Fever at 4pm of 101 degrees F
  • 6 days after exposure:
    • 1 spot on chin, causing pain
    • Loss of appetite (ate about ½ of what he normally does)
    • No more fever
    • Acting alright, but slightly fussy
    • Complains of tummy ache and foot pain
  • 7 days after exposure:
    • Slept great last night, about 13 hours
    • Not eating a lot because he still has the throat sores
    • Acting happy
    • No pain
    • 1 spot under chin is painful and bleeds sometimes (only has 2 on face)
    • 
    • Has spots on feet and hands (maybe 3-5 each) but no real blisters
    • 
  • 8 days after exposure:
    • Very tired
    • 
    • Rash nearly gone
    • Otherwise Happy
  • 9 days after exposure:
    • 100% Well!
    • No pain!
    • No rash!
    • No blisters!

Our Cousin, Ava’s Experience

8-month-old baby has hand, foot, and mouth disease – what should I expect?

• Timeline of hand, foot, and mouth disease in my 8-month-old:
  • Not sure when/how she was exposed to the virus.
  • Day 1 of symptoms: Fever + Loss of Appetite
  • Day 2: Fever of 102 F + Loss of Appetite
    • Pediatrician says it’s a bug
  • Day 3: Vomiting all food/milk
  • Day 4: Symptoms continue
    • Trip to Cook’s Children’s for Urgent Care
    • Doctor found ulcers in back of mouth
    • Diagnosed with Herpangina (HFMD that affects the mouth only)
  • Day 5: Same symptoms = Worst Day
  • Days 6-8: Progressively getting better each day
• What worked for us:
  • Magic Mouthwash (1:1 Maalox + Benadryl dabbed on sores)

11-month-old baby has hand, foot, and mouth disease – what should I expect?

• Timeline of hand, foot, and mouth disease in my 11-month-old:
  • Exposure Day (Thursday, when Grandma took her to the hospital to visit a sick friend… obviously bad idea… but that’s a different story 😉 ha)
  • 2 days after exposure: a little fussy, low-grade fever, chewing on hand… chalked it up to teething.
  • 3 days after exposure:
    • Fussy
    • Warm
    • Little bit of rash on arm
    • Wouldn’t nap longer than 30 minutes
    • A few spots in diaper area and on chin
    • Didn’t sleep well at night
  • 4 days after exposure:
    • Blisters on hands & feet
    • Very fussy
    • Doctors appointment = Hand, Foot, & Mouth Disease
    • Major diaper rash
    • Tiny dots on entire body, but worse on hands/feet/mouth/diaper
    • Sore throat kept her up all night
    • THIS WAS THE WORST DAY FOR HER
  • 5-12 days after exposure:
    • Feeling more energetic each day
    • Rash progressively got better

LONG STORY SHORT – I HOPE YOU NEVER HAVE TO EXPERIENCE HAND, FOOT, AND MOUTH DISEASE.

Symptoms
What are the typical symptoms associated with hand, foot, and mouth disease?

Hudson lesser symptoms both times he contracted this illness. His symptoms stopped after fever, sore throat, and lethargy; this reigned true for both times he had HFMD. Everleigh, however, had a much more severe case. Aside from dehydration, vomiting, hand-skin peeling, and fingernail loss – she had all the symptoms.

• Loss of fingernails
  • From what I read, this is very uncommon and occurs as part of the body’s way of getting rid of the virus.
• Shedding or peeling of the skin on the hands and feet
  • Again, this is less common and is the body’s way of shedding the virus.
• Fever (days 1 & 2 of the virus)
  • Low-grade, 99.1
  • High, 104
  • Can occur with no fever present
• Rash of the hands, feet, and mouth (typically begins 3-6 days after exposure)
  • In more severe cases it can also show up in the diaper area, belly, back, thighs, arms, and even scalp.
  • The rash starts as small red dots and can transform in to a raise, bright red, clump of irregular-shaped spots.
  • Rash around the mouth commonly lasts longer, due to excess saliva constantly irritating it.
  • Can turn in to blisters, which cause a painful, burning sensation.
  • Blisters on the bottoms of the feet can cause pain when walking.
• Diaper Rash
• Blisters in mouth
  • Known as herpangina.
  • Starts as small red dots in the back of the throat that typically turn in to blisters.
  • Can be so far in to the throat that you cannot see them; you may know they are there due to your baby’s loss of appetite, desire for cold liquids, drooling, or crying & holding their mouth area.
• Sore throat
  • Due to the blisters in the throat
• Drooling
  • Because of the blisters in the throat it is painful to swallow and therefore your baby may be drooling more, instead of swallowing. This also irritates the blisters around the mouth.
• Dehydration
  • Due to pain when swallowing liquids; child chooses to forgo.
• Loss of appetite
  • Primarily due to pain when swallowing foods; child chooses to forgo.
• Sleeplessness
  • HFMD often comes with flu-like symptoms such as joint pain, headache, etc., all of which may cause your baby to not be able to get comfortable enough to sleep.
• Lethargy
  • Due to flu-like symptoms that often come with HFMD, your baby may mope around and sleep more often, or be tired more often but unable to get comfortable enough to sleep.
• Tummy Ache and/or Vomiting
• Muscle Pains

Transmission & Exposure
How is hand, foot, and mouth transmitted? How did my baby catch hand, foot, and mouth?

It is typical for children in daycare to catch this disease because it is passed through feces, saliva, and bodily secretions. The hand, foot, & mouth virus can live on surfaces outside the body for weeks. This makes it very easy to pass to other children. Think about it… an infected child (who may not even be showing symptoms yet) can sneeze on a table, and another child can touch that table and then rub their eyes… now they’re both infected.

• Nasal & Mouth Secretions (sneezing, mucus, boogers!)
• Feces (messy diaper changes or blowouts)
• Blister Fluid (spreads easily since the blisters are often on hands + feet)
• Air (mostly sneezes)
• Direct contact (with bodily fluid, stool, or blister fluid)
• Contaminated surfaces (touching a surface that has been contaminated with the virus)

Once a child or baby has been exposed to the hand, foot, and mouth disease he or she will likely begin to show symptoms between 3-7 days later; this is the incubation period of the virus.

My children 1st caught the disease from the local Chuck-E-Cheese’s. This time, they caught it from their cousin who caught it from a visit to the hospital.

Virus Life
How long does the hand, foot, and mouth virus live?

• The HFMD can live on surfaces for weeks (bring on the Lysol!)
• The blisters cause by HFMD are filled with the active virus and they last ~6 days (the rash lasts longer, but the blisters are what holds the virus).
• The HFMD may live in your saliva for ~7 days (from exposure).
• The HFMD lives in stool for 6 weeks (wash hands after diaper changes!!)
• The HFMD lives in your respiratory system for less than 1 week.

Contagious
Is hand, foot, and mouth disease contagious? How long?

Though some pediatricians will tell you that your child is no longer contagious once they are fever-free for 24 hours, research studies say differently:

• The first week is the most contagious (even though the fever only lasts 24-72 hours). The reason is because the virus only lives in your respiratory system for the first week, and that’s the easiest way to spread it (coughing, sneezing, spitting, drooling… all things that baby’s do a lot of!)
• The blisters are filled with the active virus, so until all blisters are gone you can easily spread the disease (the blisters last 4 days, typically, with the rash lasting a bit longer).
• The HFMD lives in your stool for months, so good hygiene is the only way to keep from spreading the disease. Always wash your hands after diaper changes!

When to Call the Doctor
My baby has hand, foot, and mouth disease – when should I call the doctor?

Use your mommy instincts, but what were told by our pediatricians (and our research!) was that you need to go to the doctor when you can answer YES to one of these questions:

• If your baby is under 6 months, is her fever over 100.4 degrees?
• If your baby is over 6 months, is her fever higher than 102.9 degrees?
• Is your baby producing little or no urine in 6 hours?
• Has your baby stopped fluid intake?
• Is your baby showing signs of dehydration?
• Is your baby vomiting to the point of dehydration?
• Has your baby’s fever lasted 72 hours or longer?
• Is your baby’s fever unable to be brought down with fever reducers?
• Have the symptoms lasted longer than 7 days?
• Did the symptoms seem to get better and then start getting worse again?

Diagnosis
How is hand, foot, and mouth disease diagnosed? A Physical Exam.

Your pediatrician will usually diagnose hand, foot, and mouth disease by examining your child for rash, blisters inside the mouth/throat, and fever. They can usually give the diagnosis based on your description of the symptoms. However, a test can be done by swabbing the throat blisters; this takes a while, though, and the virus will likely have passed before the results are even in.

But again, follow your mommy instincts and if you’re not sure of the diagnosis or aren’t comfortable with the diagnosis you were given then it’s probably worth a pediatric visit, if only to give you peace of mind.

Relief Techniques: The Feel Betters
How can I soothe my baby’s hand, foot, and mouth disease? What are some natural remedies for hand, foot, and mouth disease? Are there any medicines for hand, foot, and mouth disease?

There are no medicines, no treatments, no antivirals, and no vaccines for hand, foot, and mouth disease (not yet, anyway). All you can really do is treat the symptoms and watch out for severe problems, like dehydration.

• Treating the RASH that comes with hand, foot, and mouth disease:
  • Research shows that keeping the rash dry and uncovered allows it to heal the quickest.
  • To soothe the rash, try an oatmeal bath.
    • Aveeno Baby Oatmeal Bath
    • Make your own oatmeal bath
  • Aquafor around the mouth for the mouth blisters helps tremendously when your child is constantly drooling; this keeps the drool from sitting on the rash and further irritating it.
• Treating the BLISTERS ON THE FEET that come with hand, foot, and mouth disease:
  • Research shows that keeping the rash dry and uncovered allows it to heal the quickest, but this is sometimes too painful.
    • Aquafor on the rash + socks
    • Yogurt on the rash + socks
      • Keep in mind that their feet will itch and burn 24-48 hours before the rash appears, so if your child is holding their feet or being restless and thrashing their legs around, this is probably the case and yogurt works WONDERS!!! Cold yogurt!
    • Arnica Gel is a natural remedy that helps with the pain. I don’t use this on open sores, though.
• Treating the MOUTH SORES that come with hand, foot, and mouth disease:
  • Depending on your baby’s age, use magic mouthwash:
    • (Older children) Use a 1:1 ratio of Maalox & Benadryl to create magic mouthwash and dab it on with a Q-tip to the blisters in your child’s mouth.
    • (younger children) Magic mouthwash can be used to numb the blisters. This is made up of 1 part Maalox to 1 part Benadryl. For my 15-month-old, we did 2.5 mL of each and I used a syringe to “spray” it in to her mouth, attempting to get all the blistered spots. She ingested this amount.
  • Eat popsicles
  • Drink ice cold water or milk
  • Eat cold yogurt
• Treating the DIAPER RASH that come with hand, foot, and mouth disease:
  • Research shows that keeping it dry and uncovered allows it to heal quicker (however my daughter found it to be painful to sit without a diaper on while she had severe rash).
  • Apply aquafor at night to keep the urine or stool off the rash overnight.
• Treating the FEVER that come with hand, foot, and mouth disease:
  • Tylenol & Motrin: determine your proper dosage by weight through your pediatrician
  • Luke-warm baths
  • Cold compresses
  • Cold liquids or popsicles
• Preventing the DEHYDRATION that come with hand, foot, and mouth disease:
  • If you suspect dehydration, you need to go to the Emergency Room because your baby may need fluids. This is a serious issue.
  • If you are wanting to prevent dehydration, try ice-cold liquids or warm liquids, depending on what your baby prefers. Mine both preferred ice-cold milk. You can also give popsicles – they serve two purposes, as they also numb the mouth sores.
• Treating the body aches and pains
  • ARNICA:
    • We used a natural remedy for hand, foot, mouth disease at one point: Arnica. It comes from your natural food store and is in dissolvable tablets. It’s for pain relief and it worked great with my toddler – he was finally able to sleep! We did 2 tablets as necessary throughout the day (2-3 times).
    • Arnica gel can also be used on a toddler’s arms and legs to help with body aches that usually come along with hand, foot, and mouth disease.
• Helping the virus go away quicker
  • There are some natural remedies to get rid of hand, foot, and mouth disease a little quicker. These are things that boost the immune system. We used Elderberry Syrup and it did seem to speed things along a little.

Prevention Techniques
How can I prevent my baby from getting hand, foot, and mouth disease?

• Wash your hands & your child’s hands after diaper changes
  • I’m serious about washing your hands after diaper changes… this disease has been found to be present in stool for up to 4 MONTHS.
• Wash your hands & your child’s hands before meals or snacks
• Clean & disinfect frequently touched surfaces, especially after having other children over
• Teach your children not to drink or eat after others; yes, even family.

In short, hand, foot, and mouth disease can only be prevented by good hygiene. Washing your hands and your child’s hands after diaper changes and before meals is key; try making this habit for yourself and for you children.

Good News:
They’re working on a vaccine!

Bad News:
It’s for HFMD caused by Enterovirus 71, not Coxsackieviruses… which is what is common in America.