HFMD in Singapore: symptoms, prevention at home, preschool return rules and what disinfectants really do

HFMD (hand, foot and mouth disease) in Singapore is a common, usually mild viral illness in young children: fever, a sore mouth with ulcers, and a rash or small blisters on the palms, soles or bottom. It's endemic here, and ECDA says 90% of children have been infected by age 12, many without symptoms. Most recover in 7 to 10 days with fluids and rest. Your child should stay home until all the blisters have dried, they've fully recovered and their medical certificate has run out, and ECDA doesn't require a doctor's letter to go back. For cleaning, soap and water beat alcohol hand sanitiser, and a diluted bleach solution works on toys and surfaces. Below are the symptoms and timeline, home care, the warning signs, a printable HFMD prevention checklist for your home, the preschool rules, and what disinfecting can and can't do.

What HFMD is, and how common it is here

HFMD is caused by a group of enteroviruses, of which coxsackievirus and enterovirus A71 (EV71) are the best known. The Communicable Diseases Agency (CDA) says it's endemic in Singapore and can affect anyone, though children under five and children in childcare or preschool are most at risk. Between 50% and 80% of infections cause no symptoms at all, which is one reason it spreads so easily in centres.

Having HFMD once only protects against the virus that caused it, so your child can catch it again from a different enterovirus. It isn't the same as foot-and-mouth disease in cattle, despite the name.

Symptoms and how long HFMD lasts

CDA lists fever, sore throat, mouth ulcers, poor appetite, tiredness, and a rash of flat or raised red spots or small blisters on the palms, soles or buttocks. Some children only get mouth ulcers with no rash, which doctors call herpangina. In babies, refusing feeds, drooling and crankiness with a fever can be the first clue, because ulcers are hard to see. The table below sets out the timeline from CDA and NUH.

How HFMD spreads

CDA says HFMD passes through stools (the faecal-oral route), through saliva, coughs and sneezes, through fluid from the blisters, and through surfaces those have touched. That's why nappy changes, shared toys and mealtimes matter so much in a household with a sick child.

Home care

There's no specific treatment, and HealthHub notes antibiotics don't work on a viral infection. Care is about comfort while your child's body clears the virus:

• Offer fluids little and often; HealthHub and NUH both put drinking first.
• Switch to soft food such as porridge or pureed fruit if the ulcers hurt.
• Give paracetamol syrup for fever and pain as your doctor prescribes. NUH says oral anaesthetic gels can also ease mouth ulcers so your child eats and drinks.
• Keep your child at home to rest, away from restaurants, playgrounds and malls, as HealthHub advises.
• Keep their toys, books, cutlery, towels and clothes separate from everyone else's.

Watch babies and young toddlers closely for dehydration, because they get there faster. Our guides to newborn care basics and baby fever and when to worry cover the basics of caring for a sick little one.

Warning signs that need a doctor

Serious complications are rare, but CDA lists inflammation of the heart muscle, fluid in the lungs, meningitis, brainstem encephalitis and sudden weakness of the limbs. HealthHub says EV71 is the virus most likely to cause them. If you're pregnant and your child has HFMD, tell your doctor; KKH has a page on HFMD in pregnancy on HealthHub.

HFMD prevention at home: a hygiene checklist

There is no vaccine, so prevention comes down to hygiene, at home and before every childcare day. HealthHub and HealthXchange give the same core advice: wash hands, don't share, keep the sick child's things apart and clean what they touch. Here it is as a checklist you can print and stick on the fridge.

If you are pregnant and an older child brings HFMD home, take extra care with handwashing and tell your gynae. Our guide to toxoplasmosis and HFMD in pregnancy explains the risks.

Preschool and childcare: when your child can go back

Singapore's rules come from CDA, through HealthHub, and from ECDA, which regulates preschools, and the table sets them out side by side.

Tell the centre as soon as your child is diagnosed, so staff can watch the other children. HealthHub also asks parents to do a four-step check every morning before childcare: take your child's temperature, look in the mouth for ulcers with a torch, check both sides of the hands for red spots or blisters, then check the tops and soles of the feet. If you find any, keep your child home and see a doctor. Our guide to kids falling sick in childcare covers the other common bugs.

What disinfectants do and don't do

Cleaning cuts the spread, but only if you use the right products. Here's what the evidence says:

• Soap and water work. HealthHub's advice is to wash hands with soap for at least 20 seconds before eating and after the toilet.
• Alcohol hand sanitiser is a weak substitute. In a 2021 lab study, none of the ethanol-based hand sanitisers tested killed enough EV71 to meet the disinfection standard, so wash with soap whenever there's a sink.
• For surfaces, KKH suggests about one tablespoon of bleach in one litre of water, or a household disinfectant, on toilets, taps, doorknobs, toys and anything with saliva or stool on it. NUH also recommends diluted chlorine bleach for contaminated toys and towels.
• Wear disposable gloves if you can, and wash your hands after cleaning.
• Disinfect your child's toys, utensils and towels again after they recover, as KKH advises.

What cleaning can't do: it won't shorten your child's illness, and it can't fully stop HFMD in a centre, because children without symptoms can spread it too, as ECDA points out. And since the virus stays in stools for 6 to 12 weeks, the handwashing has to continue well after your child looks better.

Will the rash leave marks?

The blisters dry up and fade as your child recovers. Some children's skin peels on the hands and feet a little later, which settles on its own. If the rash looks infected, oozes or spreads, see your doctor, as CDA lists secondary bacterial infection among the complications. For other childhood rashes, see our guide to baby eczema.

Frequently asked questions

How long does HFMD last in children?

NUH says symptoms usually clear within 7 to 10 days, and the fever tends to settle before the ulcers and blisters do.

When is my child no longer contagious?

CDA says children are most infectious from a few days before symptoms to about a week after, but the virus can stay in stools for 6 to 12 weeks. Return to preschool when the blisters have dried and the MC has ended, and keep washing hands.

Does hand sanitiser kill HFMD?

Not reliably. A 2021 lab study found ethanol-based sanitisers didn't kill enough EV71, so wash with soap and water, and use diluted bleach on surfaces.

Can adults catch HFMD?

Yes. CDA says HFMD can affect all ages, though most cases are in preschool children, so the same handwashing protects the adults at home.

Is there a vaccine for HFMD in Singapore?

No. CDA says there are currently no vaccines against the enteroviruses that cause HFMD. Our guide to baby vaccinations in Singapore covers the vaccines on the national schedule.

Is HFMD a notifiable disease in Singapore?

No. CDA says HFMD isn't legally notifiable, but it tracks polyclinic visits for HFMD in its weekly infectious diseases bulletin, and preschools work with CDA and ECDA on outbreaks.

For more on childhood illnesses, browse our guides.