If your child suddenly has painful blisters in their mouth, doesn't want to eat, and shortly after develops a rash on their hands or feet, many parents think of Hand-Foot-and-Mouth Disease. Especially after a notice from daycare, the questions quickly arise: How contagious is it? Does my child need to stay home? And when can they return to daycare?

The good news: Although Hand-Foot-and-Mouth Disease is very contagious, it usually runs a mild course in most children and resolves on its own within a few days.

What is Hand-Foot-and-Mouth Disease?

Hand-Foot-and-Mouth Disease is a viral infection that primarily affects children under five years old. It is usually caused by Coxsackie viruses or other enteroviruses.

Outbreaks are particularly common in summer and autumn. Since the viruses spread easily, there are regular small outbreaks in daycares and kindergartens.

What are the typical symptoms?

The symptoms often start non-specifically and develop over a few days.

Typical symptoms include:

  • mild to moderate fever
  • sore throat or difficulty swallowing
  • painful blisters or small ulcers in the mouth
  • rash or blisters on hands and soles of the feet
  • sometimes blisters on the buttocks, legs, or diaper area
  • reduced appetite and increased drooling
  • tiredness or increased clinginess

Not every child develops all symptoms. Some mainly have mouth discomfort, while others have the typical skin rash.

Why do many children stop eating?

For many children, the painful changes in the mouth are more problematic than the blisters on their hands or feet.

This can cause:

  • eating to be painful,
  • drinking to be uncomfortable,
  • increased drooling,
  • children to refuse meals.

Therefore, it is important to ensure they get enough fluids.

How long does the illness last?

In most cases:

  • the fever subsides after one to two days,
  • the mouth blisters heal within a week,
  • the skin rash disappears after about seven to ten days.

Sometimes, fingernails or toenails may partially peel off a few weeks later. This can happen after Hand-Foot-and-Mouth Disease and usually grows back completely.

What can help your child at home?

Since the illness is caused by viruses, there is no specific treatment.

Helpful measures often include:

  • offering small amounts of fluids regularly
  • cool drinks or foods if they are soothing
  • soft foods like yogurt, porridge, or mashed potatoes
  • rest and plenty of sleep
  • age-appropriate pain or fever medication as recommended by a pediatrician

Spicy, sour, or very hot foods can increase mouth pain and are often poorly tolerated.

When should you take your child to the doctor?

It's advisable to consult a pediatrician if:

  • your child is drinking very little or not at all,
  • there are significantly fewer wet diapers,
  • high fever persists for several days,
  • your child appears unusually lethargic or is difficult to wake,
  • there is severe pain,
  • skin changes look unusual or become inflamed,
  • you're unsure if it is indeed Hand-Foot-Mouth disease.

Especially for young children, maintaining hydration is more important than the number of blisters.

When can my child return to daycare?

This question concerns many families.

In general:

A child can usually return to daycare when:

  • they are fever-free,
  • they feel well overall,
  • they are drinking enough and can participate in daily activities.

The blisters do not need to be completely gone for this.

Important to know: The viruses can still be shed in the stool for several weeks. Completely preventing further infections is therefore hardly possible. Good hand hygiene remains important.

Some daycares have their own rules. It's worth checking if in doubt.

How contagious is Hand-Foot-Mouth disease?

The disease is particularly contagious in the first few days.

Transmission occurs mainly through:

  • saliva,
  • nasal secretions,
  • the contents of the blisters,
  • and stool.

Regular handwashing—especially after diaper changes or using the toilet—helps reduce the risk of infection.

Key points to remember

Hand-Foot-Mouth disease is usually harmless, although the painful mouth blisters can be very distressing for children. The key concern is not the rash but whether your child is drinking enough and overall stable. Once they are fever-free and feeling well again, returning to daycare is often possible.