Coxsackie! What's that?

Hand, foot and mouth disease is a very common illness, which occurs mostly in infants and children under 6 years. It may also occur in older children and in adults. It is caused by a group of viruses, referred to as Group A Coxsackieviruses. The incubation period for hand, foot and mouth disease is about three to five days. Hand, foot and mouth disease is contagious. The infection is spread when there is direct contact with saliva, nasal discharge, stool or fluid from blisters of a person infected with the virus. Persons are most likely to be contagious during the first few days of the illness.

Signs and Symptoms

The illness usually starts with fever, decreased appetite and sore throat. Infants and younger children may be noted to be fussier and less playful than usual. The fever may be low grade or may be as high as 39 degrees Celsius. After a day or two of fever, sores usually develop in the mouth. These begin as small red spots, which may become blisters and then may form ulcers. The sores are usually painful. They may be present on the gums, the inner surface of the cheeks, the tongue or the palate. They are more often found towards the back of the mouth. Children may have drooling of saliva from the mouth and often refuse to eat as a result of the painful sores. A rash usually develops in the next day or two. The rash consists of red spots, which may be flat or raised. These may later develop into blisters. The spots are often present on the hands and feet. They may also be on the arms and legs as well as the buttocks and the genital region. The disease usually resolves on its own after about three days.


There is no specific treatment for hand, foot and mouth disease since the symptoms resolve on their own. Acetaminophen (or ibuprofen for children older than 6 months) can be given to relieve pain or fever. Oral intake is often decreased because of the pain caused by the mouth sores. Parents should encourage children to drink fluids to prevent dehydration. Cold liquids are helpful as they can have a numbing effect on the throat and make swallowing easier. Soft foods that are easier to swallow should be given.

When to Seek Medical Attention

Your child should be seen by a medical provider if oral intake is decreased and this has results in less urine passed than usual or if symptoms do not improve or worsen after about 3 days.


The spread of infection can be reduced by the following measures:

  1. Wash hand frequently with soap and warm water, especially after using the bathroom or after changing diapers
  2. Avoid close contact such as hugging and kissing persons with the infection
  3. Keep children out of child care facility or school for the first few days of the illness