Hand, foot and mouth disease

At a glance

  • Hand, foot and mouth disease (HFMD) is a very contagious viral infection.
  • It mainly affects younger children.
  • The typical symptoms are fever, a rash on the hands and feet, and blister-like sores in the mouth.
  • The symptoms usually go away on their own within a week, with no lasting effects.
  • Until then, good hygiene is very important to protect others from infection.


Photo of a toddler with a rash around their mouth

Hand, foot and mouth disease (HFMD) is a very contagious disease that is most common in children. The name comes from the fact that it can cause painful blisters in the mouth and a rash on the hands and feet.

Many people don’t notice the at all. If it does cause symptoms like fever and a rash, they go away on their own after about one week. The disease doesn't usually have any lasting effects. It only rarely causes complications, such as meningitis.

There is no treatment for HFMD, but there is generally no need for treatment anyway because the symptoms are usually mild. Medication to relieve pain and reduce fever can help to ease the symptoms. It is important that children who have HFMD drink enough.

Only humans can be infected with HFMD. It has nothing to do with the foot and mouth disease that affects cattle, sheep and pigs.


Fever is often the first sign of HFMD. Most young people who get it might also feel unwell, have a sore throat or no appetite.

A rash in the mouth appears after one to two days, particularly at the back of the mouth, on the tongue and on the gums. It consists of small red dots that can turn into blisters and then painful open sores. Children avoid swallowing as a result, which can cause them to drool a lot.

Red, sometimes slightly raised spots then appear on the skin another one or two days later, usually on the palms of the hands and the soles of the feet. But the rash can also occur on the buttocks (bottom), around the genitals, and on the knees or elbows. It usually isn’t itchy. There is a less typical kind that is very itchy, though.

Some spots turn into blisters that crust over after a couple of days, particularly around the mouth. The rash usually goes away after about one week. It doesn't leave any scars.

Illustration: Typical rash on the hands, feet and in the mouth.

Typical rash on the hands, feet and in the mouth.

Causes and risk factors

Hand, foot and mouth disease is caused by a type of virus called enteroviruses. The viruses are very contagious and are passed from person to person. This often happens through direct contact with bodily fluids like mucus from the nose or throat, or saliva (spit) – for instance, when sneezing or coughing. They can also be passed on through kissing and close physical contact. You may become infected if you come into contact with the stool (poo) of an infected child, like when changing their diaper. But adults are only rarely affected, probably because they already had it when they were younger. Or they do actually become infected but don’t have any symptoms and so don’t notice it.

Infectious bodily fluids can also be found on objects like toys, door handles, knives and forks. You may become infected if you touch them with your hands and then rub your eyes or touch your mouth or nose.


Hand, foot and mouth disease is very common and mainly affects children under the age of ten. It is estimated that 80,000 to 140,000 people get the disease each year in Germany. There are no exact figures, though, because a lot of people don’t even notice that they have it.

Outbreaks are more common in the summer and fall, probably because warm, damp weather increases the likelihood of .


It is thought that 80% of all people who become infected with HFMD viruses don't have any symptoms, so they don’t notice that they have the disease. These kinds of symptom-free infections are most common in adults.

It usually takes a few days to a week for the first symptoms to appear after . The disease is normally mild with no lasting effects. It takes about a week for the symptoms to go away again.


Children who have severe pain in their mouth might no longer swallow their saliva (spit) as a result. The saliva then flows out of their mouth. This can increase the risk of getting blisters and crusts around the mouth, especially if they touch their face a lot.

The pain can also cause children to hardly eat anything, particularly not hard, spicy or sour foods. If your child doesn't want to drink anything either, it's important to see a doctor to make sure they get enough fluids.

Complications are very rare: Individual nails might fall off toes or fingers, but the nails will grow back. Other possible (but very rare) complications include encephalitis and meningitis, paralysis and even life-threatening lung and circulation problems.

If a pregnant woman gets hand, foot and mouth disease, it is still usually harmless. Newborn babies can be infected by the mother during and after birth. In very rare cases, the can then spread through the baby’s whole body and cause complications. But the risk of this kind of "systemic" goes down again two weeks after birth.


Hand, foot and mouth disease can generally be spotted easily because of the symptoms and the typical rash. Parents might also notice their child drooling, hardly eating anything, or only wanting to drink cold drinks, if at all.

More detailed tests like laboratory examinations are usually not needed. In rare severe cases, the can be confirmed quickly by testing a stool (poo) sample, a swab from the throat or the fluid in a blister, or cerebrospinal fluid (fluid in the brain and spinal cord) if necessary.


You are especially contagious while you have symptoms. The fluid in the blisters is particularly infectious. The viruses can still be found in the stool (poo) for several weeks after the symptoms have gone away. So it's still possible to pass them on, but it’s less likely. Because of this, experts recommend that children only stay at home during the acute phase, until the blisters have completely dried up.

Like with many other infectious diseases, the following is true: Good hand hygiene prevents infections. It is important to make sure you don’t touch the blisters and crusts. If you do, make sure you don’t touch your face afterwards, and immediately wash your hands thoroughly. Parents, brothers, sisters and other contacts don't need to take any other measures.

There is no against hand, foot and mouth disease.


There is no treatment that fights the HFMD and makes the disease go away. Antibiotics don't help. But because the usually goes away on its own without any lasting effects, no special treatments are needed.

Parents should make sure that their child still drinks enough despite the pain in their mouth, though. Pain-relieving and fever-reducing medication like acetaminophen (paracetamol) can help to ease the symptoms. But children with a viral must not take acetylsalicylic acid (the drug in medicines like “Aspirin”) because it can cause a rare but life-threatening complication called Reye’s syndrome.

Hand, foot and mouth disease can usually be left to clear up on its own at home without any problems. Complications may have to be treated in hospital, though. It is important to see a doctor soon if any of the following is true:

  • The affected child is younger than six months old.
  • The child isn't drinking enough and seems dehydrated. For instance, they are sleepy, slow to respond, and have a dry mouth. They might also have sunken eyes or a sunken fontanel ("soft spot" on the top of the head).
  • The fever has lasted for longer than three days.
  • The child has a weakened .
  • The symptoms are especially bad – for instance, very painful, or large sores in the mouth.
  • Other symptoms develop that could be a sign of complications, such as severe headaches, seizures, a stiff neck (they can't touch their chest with their chin), drowsiness or unconsciousness.
  • The symptoms still haven't got better after ten days.

It is also a good idea for adults to seek medical attention if they do develop severe symptoms or the symptoms last for a long time.

Centers for Disease Control and Prevention (CDC). Hand, Foot, and Mouth Disease (HFMD). 2021.

Liu Z, Meng Y, Xiang H et al. Association of Short-Term Exposure to Meteorological Factors and Risk of Hand, Foot, and Mouth Disease: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2020; 17(21): 8017.

Ni XF, Li X, Xu C et al. Risk factors for death from hand-foot-mouth disease: a meta-analysis. Epidemiol Infect 2020; 148: e44.

Robert Koch-Institut (RKI). RKI-Ratgeber Hand-Fuß-Mund-Krankheit (HMFK). 2017.

World Health Organization (WHO). A guide to clinical management and public health response for hand, foot and mouth disease (HFMD). Geneva: WHO; 2011.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on August 22, 2022
Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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