HFMD (hand, foot and mouth disease): signs, care and when your child can go back

Hand, foot and mouth disease (HFMD) is a common viral infection in young children. It causes fever, a sore throat, mouth ulcers and a rash or small blisters on the palms, soles and bottom. The Communicable Diseases Agency (CDA) says it is endemic in Singapore and most often affects children under 5. SingHealth says most children recover in about a week.

HFMD symptoms to look for

CDA lists fever, sore throat, mouth ulcers, poor appetite, lethargy, and flat or raised red spots or small blisters on the palms, soles or buttocks. HealthHub says the blisters are usually 3 to 7 mm across and sit on the palm side of the hands and the soles of the feet. Some children also vomit or have diarrhoea.

Not every child shows every sign. CDA says 50% to 80% of infections cause no symptoms at all. Some children get mouth ulcers with no rash, which doctors call herpangina.

How HFMD spreads at home and in childcare

The virus is in nose discharge, saliva, stools and fluid from the blisters, HealthHub says, and CDA adds contaminated surfaces. A child is infectious from a few days before symptoms until about a week after they start. The virus keeps coming out in stools for 6 to 12 weeks, CDA says, so keep washing your hands after every nappy change long after your child seems well.

HealthHub suggests a four-step check before each childcare day: take your child's temperature, shine a torch into the mouth to look for ulcers, then check both sides of the hands and the feet for small red bumps or blisters. If you find any, keep your child home and see a doctor.

Caring for your child at home

There is no specific treatment, and antibiotics do not work against a virus. You can see a family doctor or polyclinic; SingHealth says there is no need to rush to Children's Emergency just to confirm HFMD. HealthHub suggests:

• plenty of fluids, little and often
• soft food such as porridge or pureed fruit if the ulcers hurt
• fever and pain medicine such as paracetamol syrup, as your doctor prescribes
• rest at home, away from playgrounds, malls and restaurants
• separate toys, cups, cutlery, towels and clothes

When HFMD needs Children's Emergency

Serious complications are rare. HealthHub says they are usually caused by the EV71 virus and can affect the brain, lungs or heart. KKH, via SingHealth, says bring your child to Children's Emergency if they:

• drink very little, cannot swallow or keep vomiting
• have a dry tongue or pass much less urine
• are lethargic, drowsy, irritable, crying non-stop or confused
• have a fit
• have trouble breathing
• look ashen, pale or blue
• complain of a bad headache or giddiness, or have a stiff neck

If your child has a fit with a high fever, our page on febrile seizures explains what to do while it happens.

Going back to preschool, and if you are pregnant

HealthHub says keep your child at home until all the blisters have dried up, they have fully recovered and the medical certificate (MC) from your doctor has run out. Tell the centre as soon as you know. SingHealth puts the minimum at one week from the start of the illness.

If you are pregnant and your older child has HFMD, KKH says HFMD in pregnancy can lead to miscarriage or stillbirth, and to severe illness in the newborn if you catch it close to delivery. Wash your hands after every contact, do not prick the blisters, and tell your gynae.

Our full HFMD guide for Singapore parents has a printable hygiene checklist and the ECDA preschool rules.

Frequently asked questions

What is HFMD and what does it stand for?

HFMD stands for hand, foot and mouth disease, named after where the rash and ulcers appear. CDA says it is caused by a group of enteroviruses and is generally mild and gets better on its own.

Can my child get HFMD more than once?

Yes. CDA says an infection only protects against the virus that caused it, so a different enterovirus can cause HFMD again.

Can adults get HFMD?

Yes. HealthHub says both adults and children can be affected, although children under 5 are most at risk. Watch other family members for fever and ulcers.

Is there an HFMD vaccine in Singapore?

No. CDA says there are currently no vaccines against the enteroviruses that cause HFMD, so prevention comes down to handwashing, not sharing utensils and keeping sick children home.

Related terms

• Polyclinic: A public primary care clinic with subsidised fees, where Singapore families can take children for jabs and checks.
• Febrile Seizure: A fit in a young child with a fever. Usually brief and harmless, and most common from 6 months to 6 years.
• Fever in a Newborn: A raised temperature in a baby under 3 months, which Singapore hospitals treat as a reason to come in straight away.

See every term in the glossary