A Boston Parent’s Guide to Hand, Foot, and Mouth Disease: Symptoms and Care Tips
Hand, foot, and mouth disease (HFMD) is one of the most common viral illnesses affecting young children, and outbreaks are especially frequent during the warmer months in the Boston, Massachusetts area.
Even though HFMD is usually mild, it can feel alarming for parents when fevers, rashes, and painful mouth sores appear suddenly. At Essential Pediatrics in Boston, we understand how stressful these symptoms can be, and we’re here to guide you through every step of your child’s recovery.
This comprehensive resource gives Boston families clear, reliable information on how HFMD spreads, what symptoms to watch for, how to keep your child comfortable at home, and when it’s safe for them to return to daycare or school.
1. What causes hand, foot, and mouth disease?
Hand, foot, and mouth disease is caused by a virus called the coxsackie virus or enterovirus. Typically, it is seen more frequently in the summer and fall seasons, often affecting young children under the age of 5. However, anyone, including adults, can contract this virus.
2. How is hand, foot, and mouth disease spread?
The virus is spread in 2 ways: the respiratory route and the fecal-oral route.
The respiratory route
Large respiratory droplets can be spread from one individual to another through talking, sneezing, and coughing. These droplets can infect a healthy individual if they enter the eyes, nose, or mouth or are rubbed into these sites from the hands.
The particles do not stay in the air and do not usually travel more than 3 feet. Direct contact with the respiratory secretions on objects contaminated by an affected individual can also lead to the spread of the virus. This is especially relevant in Boston-area daycares and schools, where shared surfaces can increase exposure.
The fecal-oral route
Contact with stool from a child who has the illness can also spread the virus. Most commonly, this occurs when the infected child contaminates their hands with stool particles and then transfers these particles to an object, such as a toy, used by healthy individuals who then touch their mouth, eyes, or nose. This transmission pattern is one of the most common reasons HFMD circulates among young children in Massachusetts childcare centers.
3. What are the typical signs and symptoms of hand, foot, and mouth disease?
Signs and symptoms typically start about 3 to 6 days after being exposed and infected with the virus and may include:
- Cold symptoms, such as a cough and a runny nose
- Fevers
- Sore throat
- Rash: Characteristically, the rash consists of tiny, red, roughly circular lesions that are sometimes flat and sometimes raised, and often associated with small blisters. The rash can be located anywhere on the body, but often affects the feet (including the bottom of the feet and top of the toes), fingers/hands/palms, buttocks, and around the mouth. The lesions can also occur inside the mouth, including the tongue, the roof and back of the mouth, the inner cheeks, and the gums. The lesions can form a small scab and eventually fade away.
SOURCE: HealthyChildren.org
SOURCE: DukeHealth.org
- Peeling of the hands and feet: Some children may experience peeling of their fingers and toes after 1-2 weeks, which is not painful or harmful.
- Loss of fingernails/toenails: This is not common but can occur several weeks after the illness started. Do not worry, this is not painful, and the nails will regrow.
4. How is hand, foot, and mouth disease diagnosed?
Pediatricians can diagnose hand, foot, and mouth disease based on your child’s symptoms and the characteristic rash. Laboratory testing is usually not needed. This is a common diagnosis for Boston-area families during peak HFMD seasons.
5. How long do hand, foot, and mouth disease symptoms last?
On average, the symptoms last about 7 to 10 days and typically reach their peak in the first few days of the illness, then gradually improve. The rash often forms small scabs before it completely heals. The rash does not scar.
6. How is hand, foot, and mouth disease treated?
While there is no treatment for hand, foot, and mouth disease, it is possible to make your child more comfortable during this time.
- Pain relievers: The sores in the mouth can be especially uncomfortable and make it so that your child does not want to eat or drink much. Medications such as acetaminophen (Tylenol) or ibuprofen (Motrin/Advil) can help encourage them to eat and drink.
- Hydration: To prevent dehydration, offer your child water or Pedialyte frequently and monitor how often your child urinates as a measure of hydration.
- Avoid acidic foods and drinks: Items such as orange juice, lemonade, and sodas can irritate an already sore mouth.
- Cold/soft foods: Items such as Pedialyte popsicles and ice chips, as well as soft foods like smoothies and yogurt, can feel soothing for those with mouth pain.
- Gargling saltwater: For children 6 years of age or older who can gargle, this may help reduce their mouth pain.
These strategies are commonly recommended at Essential Pediatrics for Boston parents seeking comfort measures.
7. My child has had hand, foot, and mouth disease before. Can they get this again?
Yes, however, this is not common. Individuals who have had it once may have some immunity to the specific strain of the virus that infected them. However, hand, foot, and mouth disease is caused by a group of viruses, so it’s possible to be infected with a different strain.
8. How long does my child need to stay home from school and/or daycare?
In general, a child can return to daycare and/or school once the following criteria have been met:
- Fever-free for 24 hours without fever-reducing medications
- Feeling well enough to participate in school
- Able to drink fluids without significant mouth pain
- Blisters are drying up without any open lesions
Because Boston-area daycare centers and schools may have their own guidelines, check with your child’s provider or school nurse.
9. How long is hand, foot, and mouth disease contagious?
Hand, foot, and mouth disease is most contagious in the first week of the illness. The virus can be shed in respiratory secretions for up to 3 weeks and in the stool for up to 3 months.
10. As a caregiver in a Boston household, are there any precautions I should take while caring for my child to decrease the risk that I or my other children may get hand, foot, and mouth disease?
- Wash Hands - a lot! Good hand hygiene is your best defense.
- Wash with soap and warm water for at least 20 seconds after:
- Changing diapers or helping your child use the bathroom
- Blowing noses, coughing, or sneezing
- Preparing food or feeding children
- Coming home from daycare or public places
- Use hand sanitizer (with at least 60% alcohol) if soap and water aren’t available.
- Clean and Disinfect Frequently Touched Surfaces
- HFMD viruses can live on surfaces for days.
- Wipe down toys, doorknobs, light switches, tables, and shared devices daily with a disinfectant that lists “enterovirus” or “Coxsackievirus” on the label.
- Launder bedding, clothing, and towels in hot water if a child is infected.
- Avoid Sharing
- Teach your children not to share:
- Cups, utensils, straws, pacifiers, or toothbrushes
- Towels and blankets
- Food or snacks from the same container
- Teach Respiratory Etiquette
- Encourage covering coughs and sneezes with a tissue or elbow
- Dispose of tissues immediately and wash your hands afterward
- Support Your Child’s Immunity
- Ensure good hydration, balanced nutrition, and adequate rest.
- Teach older children about the importance of proper handwashing and the importance of avoiding touching their eyes, nose, and mouth.
- What are the warning signs that I should call the pediatrician?
- High fevers lasting more than 3 days
- Your child refuses to drink, even with pain-reducing medications
- Signs of dehydration (no urine output for more than 6 hours, dry mouth)
- Blisters appear to be infected (oozing, spreading redness)
- Your child appears unusually irritable or sleepy
Boston families are encouraged to contact Essential Pediatrics any time these symptoms appear.
We’re Here to Help
If your child is showing symptoms of hand, foot, and mouth disease or you need guidance on daycare or school return, the team at Essential Pediatrics in Boston, MA, is here to help. We offer concierge pediatrics for families throughout Boston, Newton, Cambridge, Somerville, Brookline, and surrounding communities.
Reach out and schedule your consultation. Our team is here to help!
Note to Haley:
Is it possible to use the picture from healthychildren.org of the mouth sore in this website:
https://www.healthychildren.org/English/health-issues/conditions/infections/Pages/Hand-Foot-and-Mouth-Disease.aspx
And then rash on the hands from this site?
https://www.dukehealth.org/blog/hand-foot-and-mouth-disease-children-adults-faq
