What parents need to know about hand, foot and mouth disease — and how to tell it apart from monkeypox

·5-min read
Three kids in overalls play games at preschool. Hand, foot and mouth disease primarily affects young children under the age of 5.
Hand, foot and mouth disease primarily affects children under age 5. (Getty Images)

Between COVID-19, monkeypox and polio, it’s understandable that some parents may be feeling a bit overwhelmed by reports of so many contagious diseases circulating at once. Adding to the mix is hand, foot and mouth disease (HFMD) — a contagious viral infection that’s common in young children but can affect adults as well.

Here’s what parents need to know about hand, foot and mouth disease, including how to tell it apart from monkeypox.

How is hand, foot and mouth disease transmitted?

HFMD, which is typically caused by coxsackieviruses in the U.S., is “quite contagious,” Dr. Jake Scott, infectious diseases physician at Stanford Medicine, tells Yahoo Life. The disease spreads “easily from person to person through close contact with body fluids — saliva, nasal secretions, stool, fluid from blisters — and through respiratory droplets,” Dr. Jill Weatherhead, assistant professor of infectious diseases and tropical medicine at Baylor College of Medicine, tells Yahoo Life.

For example, touching toys that have the virus on them and then touching your eyes, nose and mouth can spread the disease, along with close contact, such as hugging, kissing or sharing utensils and cups, with an infected person, according to the Centers for Disease Control and Prevention (CDC).

What are the symptoms to look out for?

HFMD usually starts with a sore throat or sore mouth, notes Scott. “In younger, nonverbal children, it often manifests as a refusal to eat or drink,” he says. “Low-grade fevers that last a day or two sometimes occur. The classic sign is the development of mouth sores, most commonly on the tongue and on the inside lining of the cheek. These start out as small, flat red spots which progress to blisters and then ulcers.”

About 75% of those infected with HFMD develop a rash on the palms of their hands and soles of their feet and occasionally on the buttocks, upper thighs and arms, says Scott. “The rash may appear as red spots that are flat or slightly raised or blisters, similar to chickenpox, and may or may not be painful. It is usually not itchy,” he says.

Scott adds that people are most contagious during the first week of the illness.

“Outbreaks of hand, foot and mouth disease are common, so being aware of cases in schools, day cares and other child care settings will allow child care providers to be alert to signs and symptoms of disease,” says Weatherhead. The CDC points out that HFMD happens more frequently in the summer and fall but can occur year-round.

How can you tell it apart from monkeypox?

In some cases, it can be hard for parents to tell HFMD and monkeypox apart, at least at first. “The initial stages of the rash — flat red spots — can be similar, but they progress differently,” says Scott.

Monkeypox lesions generally develop more slowly — over two to four weeks — and “the blisters evolve into pus-filled lesions with a central depression on top and then crust over and fall off,” explains Scott.

HFMD rashes, on the other hand, tend to look like flat red spots on the hands and feet along with blisters in the mouth, notes Weatherhead. These generally resolve within seven to 10 days. “Also, the current monkeypox outbreak is primarily occurring among men who have sex with men, and the rashes generally first appear at the site of exposure, typically in the anal and genital regions,” Scott says. “Another distinguishing feature of monkeypox is the development of swollen lymph nodes, which may occur with monkeypox but is less common with HFMD.”

Are certain groups more vulnerable to hand, foot and mouth disease?

HFMD mostly occurs in infants and children, particularly those under 5 years old. But Scott notes that the disease can spread to other family members, including adults.

How is hand, foot and mouth disease treated?

There is no specific antiviral treatment available for HFMD. Instead, treatment consists of supportive care — namely, managing the child’s fever and giving pain-relieving medications to help with painful mouth sores, as well as making sure they stay hydrated. “The painful oral lesions can make it difficult to drink, which could lead to dehydration,” says Weatherhead. “Encouraging oral hydration is important.”

The disease “nearly always” resolves on its own within a week or so, says Scott.

What can parents do to prevent it?

When it comes to preventing HFMD, it’s all about good hygiene. “Washing hands with soap and water is key,” says Scott. Cleaning and disinfecting surfaces, particularly in child care settings such as day care centers, is also important, points out Weatherhead.

“As a parent of young children, I know this is difficult to control, but it’s also helpful if kids can try not to touch their eyes, nose and mouth with unwashed hands,” says Scott.

Since HFMD is considered mild, children can return to child care and school once they’re no longer ill, according to the CDC. “Avoiding contact with those who are sick is important, of course, but keeping kids home from school is generally only recommended if the child has a fever, is not able to participate in class, has open blisters or has uncontrolled drooling that requires attention from a provider.”

If you’re not sure whether it’s OK to send your child back to school or day care after an HFMD infection, check in with a pediatrician.

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