Hand, foot and mouth disease in children usually gets better on its own in about a week. What makes the illness turn serious is not the rash on the skin — it is a child whose mouth hurts so much that they refuse to drink, and who then becomes dehydrated. And there is a group of neurological signs that mean hospital immediately.
Recognising hand, foot and mouth disease
It is most common in children under 5 and is caused by a group of enteroviruses. It usually opens with fever and a sore throat, and only then do the two characteristic signs become clear:
- Ulcers inside the mouth: small, painful sores on the tongue, the gums and the inside of the cheeks. This is exactly why the child is fretful, drools a lot and refuses food and drink.
- A rash or blisters on the palms, the soles and around the mouth; many children also have them on the buttocks, knees or elbows. The rash is usually not itchy.
- A child too young to speak shows it by being fretful, refusing the breast, spitting food out and drooling more than usual.
A few other illnesses look similar. Being able to tell them apart saves you worrying about the wrong thing:
| Easily mistaken for | What is visibly different |
|---|---|
| Chickenpox | Blisters scattered over the whole body and the scalp, very itchy, coming out in successive waves — not confined to the hands, feet and mouth. |
| Ordinary mouth ulcers | Only ulcers in the mouth, no rash on the hands or feet, usually no fever. |
| Dengue | A flat red rash rather than blisters; the child has headache and body aches, and may bleed from the gums or nose. |
What to do at home straight away
The only aim for the first few days: keep the child drinking. There is no medicine that kills this particular virus, so everything done at home is supportive care.
- Give drinks a little at a time and many times a day, rather than making them drink a lot in one go. Cool things go down more easily.
- Favour cool, soft, bland things: milk, yoghurt, thin congee left to cool, cooled soup, ice cream, smoothies that are not sour.
- Avoid salty, sour, spicy and hot things — orange juice, lemon juice and salty fried food make the ulcers hurt more, so the child drinks even less.
- Use a straw or a small spoon if it hurts the child to suck from a bottle or at the breast.
- Write down the number of wet nappies or trips to the toilet in the day and how much the child managed to drink — a doctor needs this first, and it also shows you whether the child is improving or getting worse.
- For fever and pain: paracetamol (acetaminophen) is the usual choice for children, but the dose is calculated by weight and prescribed by a doctor or pharmacist — do not estimate from age or from another child.
And this is the part that most often gets done wrong — the things NOT to do:
- Do not give a child aspirin — in a child with a viral infection, aspirin is linked to a serious complication affecting the liver and brain.
- Do not buy antibiotics yourself: this is a viral illness, antibiotics cannot kill it but still have side effects.
- Do not pierce or break the blisters — the fluid in them carries the virus, and the broken skin is easily infected.
- Do not put leaves, traditional preparations or products of unknown type on the blisters and ulcers.
- Do not use numbing gels or mouth preparations in a young child without a doctor's instruction.
- Do not use honey to soothe mouth pain in a child under 1 year — honey is not safe at that age.
- Do not force the child to finish a meal. Eating little for a few days while still drinking enough is acceptable; refusing to drink is the thing that has to be dealt with.
- There is no need to avoid bathing, avoid draughts or wrap the child up — a hot, stifled child is more uncomfortable; give a quick warm bath and pat dry gently.
Keeping the rest of the household from catching it
- Keep the child off nursery or school while there is still fever or while the mouth ulcers still hurt.
- Wash hands with soap and water after every nappy change and after helping the child use the toilet — alcohol hand gel is less effective against this group of viruses.
- Do not share spoons, cups, face cloths or towels; wipe down toys and the surfaces the child touches. The virus stays in the stool for weeks after the child is well again, so keep up the handwashing habit even once they are back at school.
- Adults can catch it with very mild or no symptoms and still pass it to other children. A pregnant woman living with a child who has it should ask her obstetrician.
When you need to go in
Take the child to emergency care NOW, or call 115 (the emergency number in Vietnam), if any of the following appear: sudden startle jerks during sleep or just after being put down; trembling hands and feet, unsteady walking or standing, weakness in the arms or legs; a lot of vomiting; fast breathing, laboured breathing with the chest drawing in, or difficulty breathing; lethargy, hard to wake, drowsiness; seizure; blue or dusky skin, or mottled purplish skin; unable to drink anything, or signs of dehydration (a dry nappy for hours, dry lips, crying without tears, sunken eyes, a sunken soft spot in a baby still breastfeeding). The group of neurological signs — the startle jerks above all — is the most important warning.
A doctor needs to see the child within 24–72 hours, rather than waiting for it to resolve on its own, if:
- A high fever is not coming down despite fever medicine used as instructed, or the fever lasts more than 2 days.
- The child is drinking markedly less than usual, or passing noticeably less urine.
- The mouth ulcers are spreading, or the blisters have pus, are swollen and red, or hurt more — signs of an added infection.
- The child is under 6 months, has an underlying condition, or is taking medicines that suppress the immune system.
- The rash and ulcers have not improved after about a week, or you are not sure this is hand, foot and mouth disease.
To be clear about our part: GreenCare does not provide home care for young children — that belongs with paediatricians. What we can do is advise remotely by video call so you can decide whether to go in now or wait for an appointment. If any of the signs in the box above are present, go to hospital first and call afterwards.
According to the US CDC, there is no specific treatment for hand, foot and mouth disease and most children recover on their own; what is needed is keeping them hydrated, relieving pain as instructed by a health worker, and watching closely for signs of severe illness. This page summarises CDC public guidance and does not replace being examined. Citing CDC here does not imply that CDC endorses Y Te Xanh or our services.
Need personalised advice for your loved one? Call our hotline 094 368 81 15 (24/7) — calling to ask a question or to book costs nothing. GreenCare has doctors who come to examine, nurses who carry out doctor's orders (injections, infusions, dressing changes), remote consultation by video call, and a review of the medicines you are taking; an in-depth remote consultation, or any one after the first, is a paid service. For children we take examination and acute care only — not long-term care at home, and not newborns or expectant mothers. We confirm we have staff in your area and provide transparent pricing before we begin.
