Hand, foot and mouth disease — what new parents need to know

Hand, foot and mouth (HFM) is one of those illnesses that sounds dramatic and looks scarier than it is. Almost every child gets it before age 5. It's almost always mild and clears up on its own in 7-10 days.

Here's what to look for, what to do at home, and when it's actually worth calling the GP. Written from years of seeing this on the postnatal ward and in nursery settings.

What it actually looks like

HFM is a viral illness caused by coxsackievirus. Classic symptoms:

• A fever for the first day or two (usually 38-39°C)
• Sore throat and reduced appetite
• Mouth ulcers on the tongue, gums, and inside the cheeks — these can be properly painful
• A red, blistery rash on the hands, feet, and sometimes the bottom — small flat spots that turn into blisters
• Sometimes irritability and tiredness

The mouth ulcers are usually the worst bit. The rash looks alarming but doesn't usually itch.

How long it lasts

The illness itself: usually 7 to 10 days. Most kids feel grim for 2-3 days and then perk up while the rash is still healing.

The rash and sometimes nail loss can happen up to 6-8 weeks after the infection — the nail loss is harmless and they grow back fine.

How contagious is it?

Very. It spreads through:

• Coughs and sneezes
• Saliva (shared toys, dummies)
• Stool (nappy changes)
• The blister fluid

Children are most contagious in the first 3-5 days, but they can shed the virus for weeks afterwards in their stool. Wash your hands obsessively after nappy changes.

Should they go to nursery / school?

NHS guidance: they don't need to be excluded as long as they're well enough to attend. But most nurseries prefer they stay home until the blisters have crusted over (usually 5-7 days).

Check with your nursery's specific policy — some are stricter than others.

What to do at home

• Paracetamol or ibuprofen for pain and fever (correct dose for their weight)
• Cold drinks and ice lollies — soothing for sore mouths. A frozen breast-milk pop is brilliant for under-1s.
• Soft cool foods — yoghurt, smoothies, mashed potato. Avoid spicy, salty, or acidic things — they sting the ulcers.
• Encourage drinking — dehydration is the only real risk with HFM
• Don't burst the blisters — they're sterile until you do

When to call 111 or the GP

Most kids with HFM never need medical attention. Call 111 if:

• They're not drinking and you're worried about dehydration (fewer than 4 wet nappies in 24 hours, no tears when crying, sunken fontanelle in babies)
• The fever is over 39°C and not coming down with paracetamol
• They become very floppy or hard to wake
• The rash spreads onto the genitals, or there's lots of redness/swelling around blisters (might be a secondary infection)
• They're under 3 months old with any HFM symptoms

Call 999 if they have a stiff neck, struggle to breathe, or have a non-blanching rash (one that doesn't fade when you press a glass to it).

Want hands-on training for spotting serious illness?

Distinguishing "normal childhood virus" from "this is serious" is the most useful skill you'll ever learn as a parent. We cover it in detail in my paediatric first aid courses — what's normal, what's worth watching, what's an emergency.

2-Hour Parent First Aid covers the basics. The 12-Hour Ofsted Paediatric course is the full version for childcare professionals.

Eva Levinson is a Postnatal Midwifery Assistant for the NHS, a Doula UK trained doula, and an Ofsted/HSE compliant first aid instructor. She runs And Chillax in Anerley, South London.