How long does hand, foot and mouth disease last?

Fever typically lasts 1–3 days. Mouth sores and skin blisters improve within 7–10 days. Children often feel better before all lesions disappear, but isolation should continue while there is still fever and open blisters.

When can my child return to daycare after HFMD?

After the fever has been gone for at least 24 hours without fever medication AND all blisters are dry and crusted (no fluid). On average, 7 days after symptoms begin. Notify the daycare to alert other parents.

Can adults get hand, foot and mouth disease?

Yes. Adults can contract HFMD, especially caregivers of young children. In adults the illness tends to be milder or even asymptomatic. Pregnant women should take extra precautions and consult their OB if exposed.

What can I give to relieve mouth sores from HFMD?

Paracetamol or ibuprofen help with pain and fever. Offer cold, soft, non-acidic foods (yogurt, ice cream, mashed banana). Avoid citrus fruits, hot foods, and salty foods. Ice pops are a great ally! If the child refuses liquids for more than 6 hours, see a doctor.

My child's nails fell off after HFMD — is that normal?

Yes! Onychomadesis (temporary nail shedding) affects up to 30% of cases, typically 4–8 weeks after infection. It is caused by a temporary pause in nail growth during the illness. Nails grow back normally — no need to worry, but do mention it to your pediatrician.

Hand, Foot and Mouth Disease in Children: Complete Guide

The daycare sent a HFMD alert and your child arrived home with a fever, refusing to eat, and painful sores in their mouth — the classic scenario that frightens every parent. The good news: in the vast majority of cases, hand, foot and mouth disease is self-limiting and resolves in 7 to 10 days. What matters is knowing what to do, what to avoid, and most importantly when to call the pediatrician.

What is Hand, Foot and Mouth Disease?

Hand, foot and mouth disease (HFMD) is an acute viral infection caused mainly by Coxsackievirus A16 and Enterovirus 71 (EV71). It is extremely common in children under 5 and frequently causes outbreaks in daycares and schools. EV71 is the more dangerous strain and is associated with rare neurological complications.

Do not confuse it with foot-and-mouth disease — that is a livestock illness with no relation to human HFMD.

How HFMD Progresses — Day by Day

Days 1–2 (Prodrome)

• Fever 38–39 °C (100–102 °F)
• Irritability and loss of appetite
• Mild sore throat
• Already contagious before lesions appear

Days 2–3 (Mouth sores)

• Red spots → blisters → ulcers (painful sores)
• Location: tongue, gums, palate, inner cheeks
• Intense pain — child refuses to eat or drink
• This is the peak of discomfort

Days 3–5 (Skin rash)

• Blisters on palms of hands and soles of feet
• Also: buttocks, genitals, knees, elbows
• Usually not itchy (unlike chickenpox)
• New crops may appear for 2–3 days

Days 7–10 (Resolution)

• Blisters dry out and crust over
• Mouth sores heal without scarring
• Appetite gradually returns
• Return to daycare once all lesions are dry

Treatment: What to Do at Home

There is no specific antiviral treatment. The goal is to relieve symptoms and ensure adequate hydration.

Paracetamol or ibuprofen

For fever and pain. Paracetamol: 10–15 mg/kg every 4–6h. Ibuprofen: 10 mg/kg every 6–8h (from 6 months). Follow your pediatrician's guidance.

Hydration — top priority

Mouth sores make drinking painful. Offer fluids frequently in small amounts. If the child refuses liquids for more than 6 hours, see a doctor.

Cold, soft foods

Yogurt, ice cream, mashed banana, gelatin, fruit ice pops. Avoid: citrus, hot foods, salty snacks, spicy foods.

Hand hygiene

Wash hands thoroughly with soap and water frequently. Disinfect toys, pacifiers, and surfaces with alcohol or diluted bleach.

Light, loose clothing

Avoid tight clothing over blisters. Do not pop the blisters — this increases the risk of bacterial superinfection.

No antibiotics needed

HFMD is viral — antibiotics are useless. Use them only if your doctor identifies a secondary bacterial infection.

Questions about hand, foot and mouth disease?

Dr. Paula Andrade sees expat families in English in São Paulo — in-person and via telemedicine.

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Warning Signs — When to See a Doctor

Most cases resolve at home, but seek medical attention if you notice:

Child refuses liquids for more than 6 hours (dehydration risk)
Fever above 39.5 °C (103 °F) that does not respond to medication, or that returns after improving
Persistent vomiting preventing oral hydration
Excessive lethargy, difficulty waking up, or confusion
Breathing difficulty or rapid breathing
Severe headache or neck stiffness — meningitis warning signs
Seizure
Blisters becoming very red, hot, swollen, or oozing pus (bacterial infection)
Baby under 6 months with any of the above

Nail Shedding After HFMD — Is It Normal?

Onychomadesis — know what it is before you panic

Up to 30% of children who had HFMD lose one or more nails partially or completely 4 to 8 weeks after the infection. The mechanism: the virus temporarily pauses nail production at the root, creating a line of weakness that eventually separates the nail from the nail bed.

It is not dangerous and requires no treatment. Nails grow back normally within 1 to 3 months. Mention it to your pediatrician to have it noted in the medical record.

Isolation and Daycare Return

Isolation Rules

Keep the child home while there is fever OR open blisters (with fluid)
Return allowed: fever-free for ≥24h without medication AND all blisters dry and crusted
Notify the daycare — other families need to monitor their children
The virus can remain in stool for weeks after recovery — always wash hands after diaper changes