Hand, Foot, and Mouth Disease and Herpangina

Medically reviewed by Dr. CJ Henley, DMD, general dentist, Jacksonville, FL · Last reviewed October 2026

Hand, foot, and mouth disease usually announces itself with a fever and a cranky toddler who suddenly won't eat or drink. A day or two later you find the reason: small, painful sores in the mouth, and often red spots on the palms and soles. It's common, it's contagious, and it almost always clears up on its own in about a week. The hard part is the mouth, so that's what this page focuses on.

What does hand, foot, and mouth disease look like?

The mouth sores usually come first. They begin as small red spots, often on the tongue and inside the cheeks, then turn into little blisters that break and leave shallow, yellow-gray sores with a red rim. There may be a handful or quite a few. They hurt, which is why kids drool, refuse food, or will only take cold drinks.

The skin rash shows up around the same time. It's flat or slightly raised red spots, sometimes with small blisters on a red base, mostly on the palms and the soles of the feet. It can also appear on the buttocks, legs, and arms, and in the diaper area. Unlike chickenpox, it usually doesn't itch. Not every child gets all three parts. Some only have mouth sores, and some only have the rash.

Where the mouth sores show up

Where the sores sit is one of the most useful clues for telling apart three illnesses that all give young kids a fever and a sore mouth. Hand, foot, and mouth sores can be anywhere inside, but they favor the tongue, the inner cheeks, and the back of the mouth. Herpangina stays at the very back. A first herpes infection is different again: the gums get puffy, bright red, and bleed easily, and the sores sit toward the front of the mouth and on the lips.

What is herpangina?

Herpangina is a close cousin of hand, foot, and mouth disease. It comes from the same group of viruses (mostly coxsackie A viruses) and hits the same age group, usually in summer and fall. The difference is that it stays in the throat. A child gets a sudden fever and a sore throat, and a look inside shows a crop of small blisters and gray-white ulcers with red rims on the soft palate, the uvula, and the tonsil area. There's no rash on the hands and feet.

Despite the name, herpangina is not herpes. The name comes from an old Greek word for "creeping," not from the herpes simplex virus, and it has nothing to do with cold sores.

How long does herpangina last? Most kids feel better within about a week, and the fever often breaks in the first few days. It's contagious the same way hand, foot, and mouth is: most in the first week, with virus still shed in stool for weeks after. Herpangina in adults happens too, though it's less common, and grown-ups often describe it as the worst sore throat they've had. Everything on this page about fluids, pain relief, and when to call the doctor applies to herpangina as well.

Herpangina vs. hand, foot, and mouth, and other look-alikes

A fever plus mouth sores in a young child usually comes down to one of these. Telling them apart matters most for herpes, because antiviral medicine can help if it's started early. Our page on cold sores and first herpes infections covers that side in more detail.

A few other illnesses can look similar at first:

• Strep throat. Fever and a very sore throat, often with red, swollen tonsils, white patches, and tiny red dots on the palate, but not the shallow ulcers of herpangina. It needs a quick swab test and antibiotics, so a pediatrician should check any child with a bad sore throat and fever.
• Chickenpox. Very itchy blisters that start on the chest, back, and face and spread everywhere, sometimes with a few in the mouth. The hand, foot, and mouth rash sticks mostly to the hands, feet, and buttocks and usually doesn't itch.
• Canker sores. One or a few sores with no fever, no rash, and no illness around them. See our canker sore guide, or our overview of mouth ulcers for other causes.
• Oral thrush in babies. White, milky patches that don't rinse away, without blisters or fever. See oral thrush.

What causes hand, foot, and mouth disease?

It's caused by a group of viruses called enteroviruses. In the US, the usual culprit is coxsackievirus A16. Coxsackievirus A6 has become more common over the past 15 years and tends to cause a more widespread rash and more adult cases. A third virus, enterovirus 71, is behind larger outbreaks in East and Southeast Asia and is more likely to cause rare nerve and brain complications. You'll sometimes hear the whole illness called "coxsackie virus" for short.

It has nothing to do with foot-and-mouth disease in cattle, sheep, and pigs. That's a different virus, and you can't catch hand, foot, and mouth from animals or pets.

Risk factors are mostly about exposure: being under 5, going to daycare or preschool, having a sibling who brought it home, and caring for young children (parents, teachers, and pediatric staff).

Is hand, foot, and mouth contagious? How it spreads

Yes, very. It moves fast through daycares and households. The virus spreads through:

• Coughs, sneezes, and saliva, including kissing and sharing cups or spoons
• Fluid from the blisters
• Stool, especially during diaper changes
• Toys, doorknobs, and other surfaces, followed by hands to mouth

How long is hand, foot, and mouth contagious? People are most contagious during the first week of being sick. The catch is that the virus can stay in the stool for several weeks after the sores heal, and some people spread it without ever having symptoms. That's why handwashing after diaper changes matters long after your child looks well.

Is hand, foot, and mouth contagious to adults? Yes. Most adults have already met some of these viruses and don't get sick, but parents of sick toddlers come down with it often enough. More on that below.

Hand, foot, and mouth disease symptoms

Symptoms start about 3 to 6 days after exposure. The usual order goes like this:

• First: fever (usually not very high), sore throat, tiredness, and a poor appetite. Kids are often fussy before anything shows.
• A day or two later: hand, foot, and mouth disease mouth sores. Red spots on the tongue, gums, inner cheeks, and back of the mouth turn into blisters and then painful ulcers.
• Around the same time: the rash on the palms, soles, buttocks, and sometimes legs, arms, or genital area.

The signs that the mouth hurts are often more obvious than the sores themselves: drooling, refusing the bottle or a favorite snack, crying when drinking, or only wanting cold things. In babies and toddlers, that's the part to watch closely, because a child who won't drink can get dehydrated.

The coxsackievirus A6 strain can cause bigger blisters, a rash on the face, arms, legs, and trunk, and a flare in areas of eczema. It looks dramatic, but most kids still recover without problems.

How long does hand, foot, and mouth last?

Most people are better in 7 to 10 days. The mouth is usually worst in the first 3 or 4 days, then eating gets easier as the sores heal. The rash fades without scarring.

Peeling skin and nail loss afterward

One after-effect surprises a lot of parents. A few weeks after the illness, some kids' fingernails or toenails loosen and fall off, or develop a horizontal groove. The skin on the palms and soles can peel too. It looks alarming but it's harmless and painless, and the nails grow back normally. If you aren't sure that's what's happening, the child's pediatrician can take a look.

How to treat hand, foot, and mouth at home

There's no antiviral medicine for hand, foot, and mouth disease, and antibiotics don't help. Treatment means keeping your child comfortable and, above all, drinking. The immune system clears the virus on its own.

Keeping a sore mouth hydrated

1. Give pain relief before meals and drinks. A dose of children's acetaminophen or ibuprofen, as the label or your pediatrician directs, about 30 minutes before eating makes swallowing easier.
2. Go cold. Ice pops, cold water, cold milk, smoothies, yogurt, and ice cream soothe the sores. Many kids who won't touch a cup will lick a popsicle.
3. Offer small sips often. A few sips every 10 to 15 minutes adds up. Try a spoon, a medicine syringe, or a straw if the cup hurts. For babies, keep offering the breast or bottle.
4. Skip anything that stings. Orange juice, lemonade, tomato, salty chips, spicy food, and crunchy snacks. Soft, bland foods like mashed potatoes, applesauce, pasta, scrambled eggs, and pudding go down easier.
5. Keep the mouth clean, gently. Brush with a soft toothbrush and a small smear of toothpaste, going easy near the sores. Older kids and adults can rinse with warm salt water (½ teaspoon of salt in a cup of water) and spit. Our home care instructions have more on gentle brushing.
6. Watch the wet diapers. Fewer wet diapers than usual, dark urine, no tears when crying, a dry mouth, or unusual sleepiness are signs of dehydration. Call your child's doctor right away if you see them.

For the skin

• Leave blisters alone. Don't pop them. The fluid carries the virus.
• Keep the skin clean, and wash your hands after touching the rash.

Over-the-counter pain relief

Pain control is the single most useful thing you can do for a child with hand, foot, and mouth sores, because a child in less pain drinks more.

What a dentist can do (and who's in charge)

Hand, foot, and mouth disease is managed by your child's pediatrician or family doctor. Fevers, dehydration, and anything involving the rest of the body belong with them. We say that plainly because parents sometimes call a dentist first when the mouth is the obvious problem.

That said, mouth sores are our territory, and there are real ways we can help:

• Help sort out what it is. If you're not sure whether you're looking at hand, foot, and mouth, herpangina, a herpes infection, or canker sores, we can look at the pattern of sores and gums and point you to the right next step, which is often a call to the pediatrician.
• Coach mouth comfort. Practical advice on brushing around sores, what to eat, and which products are safe for your child's age.
• Reschedule routine visits. If your child (or you) has an active infection, call us and we'll move cleanings and checkups until you're well. That keeps you comfortable and protects other patients.
• Check things that don't fit. Sores that last more than 2 weeks, keep coming back, or show up in an adult without the usual illness deserve a closer look. We can examine them, coordinate with your physician, and biopsy or refer for a biopsy if needed. Our mouth sore evaluation page explains how that works.
• Follow-up care. Once everyone's better, it's a good time to get back on track with family dental checkups, especially if a week of popsicles and smoothies replaced the usual brushing routine.

How to stop hand, foot, and mouth from spreading

There's no vaccine for hand, foot, and mouth disease in the US. (A vaccine against enterovirus 71 is used in China, but it doesn't cover the viruses common here.) Prevention comes down to habits:

• Wash hands with soap and water, especially after diaper changes and using the toilet and before eating. Soap and water is the better choice here; hand sanitizer doesn't work as well against these viruses.
• Clean shared surfaces and toys, including high chairs, changing tables, and doorknobs.
• Don't share cups, utensils, or toothbrushes. Store toothbrushes so the heads don't touch.
• Hold off on kissing and close cuddling with someone who's sick, and don't let kids share pacifiers or teethers.

Back to daycare or school: most kids can go back once they have no fever, feel well enough to take part, and aren't drooling uncontrollably from mouth sores. Some daycares and health departments have their own rules during outbreaks, so check with yours.

Hand, foot, and mouth disease in adults

Can adults get hand, foot, and mouth? Yes. It's less common because most adults have built up immunity to some of these viruses, and many infected adults have no symptoms at all. But it happens, usually to parents, grandparents, teachers, and health care workers around young children. The coxsackievirus A6 strain seems to cause more adult cases: in one CDC report of a US outbreak, about 1 in 4 patients were adults.

When adults do get sick, it can be rougher than in kids. Expect fever, achiness, a very sore mouth and throat, and painful spots on the hands and the soles of the feet that make walking uncomfortable. The care is the same: fluids, pain relief, soft cool foods, and rest. Adults can use an over-the-counter numbing gel as the label directs. See a physician if you can't keep fluids down, the fever won't break, or you have a stiff neck or bad headache.

Can you get hand, foot, and mouth twice? Yes. Several different viruses cause it, and getting over one doesn't protect you from the others. Kids sometimes have it more than once in a few years.

Babies, pregnancy, and weak immune systems

Babies and toddlers

Hand, foot, and mouth disease in toddlers is the classic case, and dehydration is the main worry. Call the pediatrician for any baby under 6 months with these symptoms, and for any child who isn't drinking well. Teething gels with benzocaine aren't safe under age 2, so don't reach for them here either.

Pregnancy

Most pregnant women who catch it have a mild illness or none at all. If you're pregnant and think you've been exposed, call your obstetrician. The main concern is infection right before delivery, which can pass to the newborn; babies usually have mild illness, but it's occasionally serious. For pain and fever, acetaminophen is generally the go-to in pregnancy. The FDA advises avoiding ibuprofen and similar NSAIDs from 20 weeks on unless your doctor recommends them, so check with your OB before taking anything.

Weakened immune systems

Children and adults on chemotherapy, after a transplant, or with other immune problems should call their medical team at the first sign of fever and mouth sores. Mouth sores can be harder to tell apart in these patients, and they can get dehydrated or infected faster. If you're in head and neck cancer treatment or have a complex medical history, we work alongside your oncology and medical teams on mouth care.

When to call the doctor or dentist

Hand, foot, and mouth disease FAQ

Related conditions

Sources

1. Centers for Disease Control and Prevention. Symptoms of Hand, Foot, and Mouth Disease and How Hand, Foot, and Mouth Disease Spreads. CDC.
2. Saguil A, Kane SF, Lauters R, Mercado MG. Hand-Foot-and-Mouth Disease: Rapid Evidence Review. Am Fam Physician. 2019;100(7):408–414. PMID 31573162.
3. Centers for Disease Control and Prevention. Notes from the Field: Severe Hand, Foot, and Mouth Disease Associated with Coxsackievirus A6, Alabama, Connecticut, California, and Nevada, November 2011–February 2012. MMWR. 2012;61(12):213.
4. MedlinePlus, National Library of Medicine. Herpangina. Reviewed 2025.
5. U.S. Food and Drug Administration. Risk of serious and potentially fatal blood disorder prompts FDA action on oral over-the-counter benzocaine products. 2018.
6. U.S. Food and Drug Administration. FDA recommends avoiding use of NSAIDs in pregnancy at 20 weeks or later because they can result in low amniotic fluid. 2020.

This page is for general education and isn't a diagnosis. Every mouth is different. If you have a sore you're worried about, see your dentist or physician. Photos marked Wikimedia Commons are used under their listed licenses and may have been cropped or resized.