Hand, Foot and Mouth Disease in Children: Fever and Care
Hand, foot and mouth disease (HFMD) is a common viral illness in Singapore, especially among children in childcare and preschool. It usually starts with a fever, followed by mouth ulcers and a rash on the hands and feet. The fever is mild for most children. The bigger challenge is keeping a child with painful mouth ulcers drinking. Here is what to expect, how to help, and when to see a doctor.
What HFMD looks like
Hand, foot and mouth disease is a common viral illness in young children and spreads easily in childcare and preschool settings. It is not the same as foot-and-mouth disease in animals.
It usually starts with a fever and a child who seems off-colour, sometimes with a sore throat or reduced appetite. Over the next day or two, small painful ulcers appear inside the mouth, and a rash of small red spots or blisters shows up on the palms, soles, and sometimes the buttocks and legs. The mouth ulcers are often what bothers a child most.
The fever with HFMD
For most children the fever is mild and short. It often appears first and starts settling within a day or two, around the time the mouth ulcers and rash come out. A high number on its own is not the part to focus on here, the discomfort from the ulcers usually is.
You can give paracetamol or ibuprofen by weight for comfort once your child is uncomfortable or the fever is 38.5°C or above. Both also ease the pain of mouth ulcers, which can make drinking easier.
Use paracetamol, not ibuprofen, if dengue is possible, your child is vomiting or not drinking well, is under 3 months, or has had diclofenac. When not to use ibuprofen
→ Check the correct paracetamol dose by weight
Keeping a child drinking
The main thing to manage with HFMD is fluids. Mouth ulcers make drinking and eating painful, and the most common complication is dehydration from a child who has gone off fluids. Keeping them drinking matters more than getting them to eat.
- Offer cool or cold drinks in small amounts, often. Cold soothes a sore mouth.
- Cold soft foods like yoghurt, ice cream, or jelly are easier than warm or solid food.
- Time a paracetamol dose so it falls about 30 minutes before a main meal, while keeping to the usual 4 to 6 hours between doses and the daily limit.
- Avoid acidic juices, salty snacks, and spicy food, which sting raw ulcers.
- Do not worry about appetite for a few days. Fluids are what count.
→ Signs of dehydration and what to offer
When to see a doctor
Most children recover from HFMD on their own within about a week. See your GP or polyclinic if your child is drinking very little, the fever lasts more than 3 days, or you are simply unsure and want them checked. A baby under 3 months with any fever of 38.0°C or above needs urgent assessment regardless.
Call 995 now if your child has a fever and any of these:
- !A seizure lasting more than 5 minutes (give rectal diazepam if a doctor has prescribed it, and still call)
- !Struggling to breathe (skin pulling in under the ribs, nostrils flaring, or grunting), pauses in breathing, or lips turning blue or grey
- !Cannot be woken, or floppy and not responding to you
- !A rash of small red or purple spots that does not fade when you press a glass on it
- !Swelling of the lips, tongue, or face, with any difficulty breathing
- !Cold, clammy, or mottled skin, with drowsiness or restlessness
Go to the nearest 24-hour A&E or children's emergency now if:
- !Jerking or twitching movements of the arms or legs
- !Weakness of an arm or leg, or unsteady walking
- !Repeated vomiting
- !Breathing fast
- !A baby under 3 months with a temperature of 38.0°C or above
- !A first febrile seizure, even if it has stopped
- !After a seizure: confused, still drowsy after 30 minutes, or more than one seizure in a day
- !A stiff neck, or crying in pain when bending the head forward
- !Unusually drowsy or hard to wake, but can be woken
- !Dengue warning signs as the fever comes down: tummy pain, repeated vomiting, bleeding gums or nose, or very tired
- !No urine or wet nappy for 12 hours or more
- !No tears when crying, sunken eyes, or a very dry mouth
- !Cannot keep any fluids down
- !Green vomit
- !A temperature above 40°C that is not coming down, and your child seems unwell
Stopping it spreading
HFMD spreads through saliva, fluid from the blisters, and stool, and it spreads most easily in the first week. Frequent handwashing, washing toys and surfaces, and not sharing cups or utensils all help reduce the chance of it passing to others at home.
Keep your child home until the fever has settled, the blisters have dried, and they are well enough for normal activities. Childcare centres in Singapore have their own exclusion rules during outbreaks, so check with yours on when your child can return.
→ Fever with a rash: what to check first
→ How long does a fever usually last in a child?
Frequently asked questions
How high does the fever go with hand, foot and mouth disease?+
For most children the fever is mild and short, often settling within a day or two as the mouth ulcers and rash appear. A fever of 38.5°C or above can be treated with paracetamol for comfort. A fever that is very high, lasts more than 3 days, or returns after the rash has appeared is worth getting checked.
My child with HFMD will not eat or drink. What can I do?+
Painful mouth ulcers are the main reason children with HFMD stop drinking, and dehydration is the most common complication. Offer cool or cold drinks, milk, and soft cold foods like yoghurt or ice cream, which numb the mouth a little. Time a paracetamol dose so it falls about 30 minutes before a main meal, while keeping to the usual 4 to 6 hours between doses and the daily limit. Avoid acidic, salty, or spicy foods that sting.
How long is a child with HFMD contagious, and when can they return to childcare?+
HFMD spreads easily, especially in the first week. A child is generally kept home until the fever has settled and the blisters have dried up, and they are well enough to take part in normal activities. Follow the specific exclusion guidance from your childcare centre, since centres in Singapore have set rules during outbreaks.
Can my child get HFMD more than once?+
Yes. HFMD is caused by several different viruses, so a child can catch it again from a different one. Having had it once does not give full protection against future episodes.
When should HFMD make me worried enough to see a doctor urgently?+
Call 995 if your child cannot be woken, is floppy and not responding, or is struggling to breathe. Go to the nearest 24-hour A&E if your child is drinking very little with signs of dehydration, is unusually drowsy but can be woken, is breathing fast, or has jerking or twitching movements of the arms or legs. These are uncommon but need prompt assessment.