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Wednesday, April 1, 2009

Hand, Foot and Mouth Disease

Mouth and thumb
Ulcers in the mouth and on the thumb.
(Photograph courtesy of KK Women's and Children's hospital)

Hand-foot-and-mouth disease (HFMD) is caused by the Coxsackie virus and Enterovirus 71. The throat and tonsils develop small ulcers while the hands, feet, and diaper area are affected by a rash with characteristic vesicles (very small blisters). This is usually a mild illness with the rash healing in 5 to 7 days.

Blisters on the palm and fingers. (Photograph courtesy of KK Women's and Children's hospital)

HFMD is spread from person to person by direct contact with the nasal discharge, saliva, faeces and fluid from the rash of an infected person. Both adults and children can be affected, but young children below five years are particularly susceptible.


  • fever
  • sore throat
  • ulcers in the throat, mouth and tongue
  • headache
  • a rash with vesicles (small blisters, 3-7 mm) on hands, feet and diaper area. The vesicles are typically on the palm side of the hands the sole side of the feet and very characteristic in appearance
  • loss of appetite

Blisters on the soles of the feet.
(Photograph courtesy of KK Women's and Children's hospital)


There is no specific treatment for the infection. Symptomatic treatment is given to provide relief from fever, aches and pain.

Treatment with antibiotics is not effective and is not indicated. Acetaminophen can be used to treat fever. Aspirin should not be used in viral illnesses in children under age 12 years.

Salt water mouth rinses (½ teaspoon of salt to 1 glass of warm water) may be soothing if the child is able to rinse without swallowing. Ensure an adequate fluid intake because swallowing may be painful. Extra fluid is needed when a fever is present.

HFMD in Singapore

HFMD is present all year round in Singapore. Outbreaks do occur in childcare centres, kindergartens and schools. HFMD became legally notifiable on 1 October 2000. Although usually a mild disease, it has been associated with fatalities usually due to complications involving the heart and nervous system.

Advice for parents

Parents are advised to consult a doctor early if their child has symptoms of HFMD. They should also be alert to any change in their child's normal behaviour, e.g. irritation and sleepiness. Should they refuse to eat or drink, have persistent vomiting or drowsiness, parents should bring their child immediately to hospital.


Children should be kept away from crowded public places (such as schools, preschools, play groups, markets and public transport) if they show signs of infection. Family members are advised to follow good hygiene practices, including frequent hand washing, to limit the spread of the infection.