November 4, 2026, 5:08 pm | Read time: 6 minutes
Small blisters, painful sores in the mouth, and unusually heavy drooling. What initially sounds like a scene from a horror movie are possible signs of hand-foot-and-mouth disease. The highly contagious infection primarily affects children but can also occur in adults.
Parents with young children know the problem: As soon as the kids start daycare, it feels like one cold follows another. However, behind fever, sore throat, and loss of appetite could also be hand-foot-and-mouth disease. The contagious viral infection mainly affects children under ten and is usually harmless. However, the painful blisters in the mouth can be particularly unpleasant, sometimes causing children to avoid eating or drinking.
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Symptoms of Hand-Foot-and-Mouth Disease
The name already indicates the body parts most commonly affected: the mouth, hands, and feet. However, before the typical rash appears, other symptoms often manifest.
The disease usually begins with fever, loss of appetite, and sore throat. About one to two days later, small red spots appear in the mouth, especially on the tongue, gums, and oral mucosa. These can develop into blisters and painful sores.
This can be particularly unpleasant for children. Some may even avoid swallowing their saliva due to the pain. Parents might notice that their child is drooling excessively.
Another one to two days later, the rash often follows. The red spots primarily appear on the palms and soles but can also occur on the buttocks, knees, elbows, or genital area. Small blisters may form. The rash usually does not itch. However, in unusual cases, severe itching can occur.1
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What Is Behind the Disease?
Hand-foot-and-mouth disease is caused by various viruses from the group known as enteroviruses. Coxsackie A viruses are particularly often responsible.
The pathogens are transmitted from person to person. Infection can occur through saliva, nasal and throat secretions, or the fluid from skin blisters. Parents can also come into contact with the viruses during diaper changes, as they are excreted in the stool.2
Contaminated objects such as toys, doorknobs, or cutlery can also play a role. Anyone who touches such surfaces and then touches their face can become infected.
Infected individuals are particularly contagious during the first week of illness. However, even after symptoms have disappeared, the viruses can still be excreted in the stool for several weeks. Transmission is therefore still possible, though less likely. Typically, three to ten days pass between infection and the onset of symptoms.
How Does the Disease Progress?
In most cases, hand-foot-and-mouth disease is mild. Symptoms usually subside on their own within five to seven days. It may take a little longer for the rash to heal completely.
Many people do not notice the infection at all. According to the Robert Koch Institute, more than 80 percent of infections are asymptomatic. This is particularly common in adults. They can still spread the pathogens.3
Those who have already had hand-foot-and-mouth disease are not permanently protected from reinfection. Since different virus types can be responsible, it is possible to become infected multiple times.
Can Fingernails Fall Out After the Disease?
A rare consequence of hand-foot-and-mouth disease may initially alarm many parents: A few weeks after the infection, individual fingernails or toenails may detach.
This can occur, especially after unusual courses of the disease. The good news: The affected nails usually grow back.
Very rarely, the infection can also cause more severe complications, including inflammation of the brain or meninges. Such cases are exceptions.
What Does the Treatment Look Like?
There is no specific therapy for hand-foot-and-mouth disease. Antibiotics are also ineffective, as the disease is caused by viruses, not bacteria.
Since the infection usually resolves on its own, treatment mainly focuses on alleviating symptoms. Suitable medications like acetaminophen can help with pain and fever. For children, the medication must be age-appropriate and correctly dosed.
Important: Children should not be given acetylsalicylic acid (ASA), such as aspirin, during a viral infection. The active ingredient can, in rare cases, trigger the life-threatening Reye’s syndrome in them. It is also crucial that affected children drink enough fluids. The painful sores in the mouth can lead them to refuse not only food but also drinks.4
Cool drinks and soft foods may be more comfortable. Sour, spicy, or hard foods can further irritate the sores.
When Should You Seek Medical Advice?
Even though hand-foot-and-mouth disease is usually harmless, parents should take certain warning signs seriously. It can be particularly problematic if children can hardly take in fluids due to the pain.
Parents should seek medical advice promptly if:
- the affected child is younger than six months,
- the child is hardly drinking or shows signs of dehydration, such as a dry mouth or unusual drowsiness,
- the fever lasts longer than three days,
- the symptoms have not improved after ten days,
- the symptoms are unusually severe,
- the child has a weakened immune system.
Immediate medical help is necessary in the case of seizures, unconsciousness, or other severe neurological symptoms. Severe headaches combined with neck stiffness are also serious warning signs.
When Can Children Return to Daycare?
For working parents, the question of how long their child must stay home arises quickly. According to the Robert Koch Institute, a general exclusion of children with hand-foot-and-mouth disease from daycare and schools is not planned. In mild cases, children can generally attend a community facility as long as they do not have a fever and feel healthy.
After recovery and once the blisters have dried, a return is usually possible without a doctor’s note.
However, special rules may apply in the case of larger outbreaks. The responsible health department may then, for example, order that affected children temporarily not attend the facility.
Childhood Illnesses Parents Should Know
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Is Hand-Foot-and-Mouth Disease Dangerous During Pregnancy?
Pregnant women can also become infected with the viruses. In most cases, the infection is mild or even asymptomatic for them.
However, special caution is advised around the time of birth. If the mother is infected at this time, she can transmit the viruses to her newborn.
Most affected newborns also only experience mild illness. In very rare cases, however, the infection can spread throughout the body and affect vital organs. The risk of a severe course is highest in the first two weeks of life.
Pregnant women who develop corresponding symptoms shortly before birth should inform their treating physician.5
How Can You Prevent Infection?
A vaccine against hand-foot-and-mouth disease is currently not available in Germany. Therefore, simple hygiene measures that can reduce the risk of infection are all the more important.
These include:
- regular and thorough handwashing with soap, especially after using the toilet and changing diapers,
- thorough cleaning of frequently touched objects and surfaces like toys and doorknobs,
- avoiding close physical contact with acutely ill individuals,
- not sharing utensils, drinking cups, or towels.
Since the viruses can still be excreted in the stool after symptoms have subsided, parents should continue to practice careful hygiene, especially when changing diapers.