Infant drooling

What Child Care Providers Should Know About Hand-Foot-and-Mouth Disease

What is Hand-Food-and-Mouth Disease? 
Hand-Foot-and-Mouth Disease is a common illness caused by a virus (coxsackievirus A16). The illness can cause blisters in the mouth and on the hands, buttocks, and feet.  

Who gets Hand-Food-and-Mouth Disease and how? 
Younger children (6 years old and younger) get Hand-Foot-and-Mouth Disease more often than older children and adults. Hand-Foot-and-Mouth Disease is most common in the summer and fall. 

The virus that causes Hand-Foot-and-Mouth Disease spreads easily in children. It spreads from person to person through the air when a person coughs, sneezes, sings, or talks. It can also spread when droplets land on surfaces and then are rubbed into the eyes, nose, or mouth. 

Direct contact with mucus, saliva, or the fluid in the blisters can spread the disease. It may also spread from contact with the child’s stool (bowel movement). For example, a child may not wash their hands after using the bathroom and then may then touch a toy, which another child touches and then puts their hands in their mouth. This spreads the virus from the first child’s stool to the second child’s saliva. 

Hand-Foot-and-Mouth Disease most commonly spreads during the first week of the infection. It can also spread for weeks to months after the symptoms end. 

What are the symptoms of Hand-Food-and-Mouth Disease? 
A child with a  Hand-Foot-and-Mouth Disease infection may have: 

  • Sores in the mouth 
  • Tiny, painful blisters on the fingers, palms of hands, buttocks, or soles of feet 
  • Loss of appetite because of the painful mouth sores 
  • Mild fever 
  • Sore throat 
  • Runny nose 
  • Vomiting or diarrhea 

Symptoms usually last around 7 to 10 days. Some people who are infected do not have symptoms. 

Should a child with Hand-Food-and-Mouth Disease stay home?  
Most children with Hand-Foot-and-Mouth Disease do not need to stay home from child care. Exclusion may not prevent the spread because the virus can spread before or after children have symptoms, or a child with Hand-Foot-and-Mouth Disease may not have symptoms at all. The virus can be in the stool for weeks to months after the symptoms have ended.  

Keep children home if they do not feel well enough to participate or require more care than can be provided without impacting the care of the other children. A child with Hand-Foot-and-Mouth Disease may have a lot of drooling or may be fussy and refuse to eat because of painful mouth sores. This can make it difficult for teachers to care for the child while also caring for the rest of the class. 

Children with Hand-Foot-and-Mouth Disease will usually get better on their own within a week. Families should check with their child’s health care provider if they have questions or concerns about their child’s symptoms, especially if they are not eating or drinking. 

Tips to reduce the risk of Hand-Food-and-Mouth Disease 
Practicing healthy habits can prevent Hand-Foot-and-Mouth Disease: 

  • Practice good handwashing.  
  • Wear gloves and wash hands for diaper changes, contact with body fluids, and before eating or handling food. 
  • Wash and disinfect all objects and surfaces soiled with mucus, saliva, blister fluid, or stool. 
  • Teach children to cough into their elbow and away from people. 
  • Wipe noses with clean tissues, dispose of them properly, and then wash your hands. 
  • Don’t allow children to share food, bottles, toothbrushes, eating utensils, drinking cups, or toys that can be put in the mouth. 
  • Follow the routine schedule for cleaning, sanitizing, and disinfecting in Caring for Our Children Appendix K 

Where can I find more information? 

Updated June 2023, UCSF California Childcare Health Program