Hand, foot and mouth disease in children: mouth ulcers, rash and getting back to nursery

The illness is common in children but can affect adults, and symptoms are usually mild and the same in both. NHS inform says it is caused by many different viruses, which explains why a child can have it more than once and why most people become immune to these viruses as they get older. It spreads easily through coughing, sneezing, poo and the fluid in blisters.

The NHS describes a first stage with a sore throat, high temperature and not wanting to eat. A few days later the second stage begins, with painful mouth ulcers and a raised rash of spots on the hands and feet, sometimes the groin area and bottom. The spots can look pink, red or darker than the surrounding skin, and may become blisters that are grey or lighter than the skin and can be painful.

NHS inform adds that red spots appear on the tongue and inside the mouth after one or two days and can develop into larger yellow-grey ulcers with red edges, which make eating, drinking and swallowing hard. The ulcers should pass within a week, and the skin spots usually last up to 10 days.

Fluids are the priority because a sore mouth makes children reluctant to drink. The NHS suggests:

• cool fluids to soothe the mouth, avoiding acidic drinks such as fruit juice

• soft foods such as yoghurt, and avoiding hot, salty and spicy foods

• paracetamol or ibuprofen for a sore mouth or throat

• asking a pharmacist about mouth ulcer gels, sprays and mouthwashes that are suitable for children (NHS and NHS inform)

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if a child has a very high temperature or feels hot, cold or shivery, is peeing less than usual (which may mean dehydration) or if you are worried. NHS inform words it similarly and also lists a child who is not peeing as often as normal.

It advises seeing a GP if symptoms do not improve after 7 to 10 days, or if you are pregnant and develop the illness. Because it can spread, the NHS suggests phoning the surgery first, as they may offer a phone consultation.

The NHS says you can start spreading it a few days before symptoms, most likely in the first 5 days after they start. Hygiene steps from the NHS include frequent handwashing with soap and water for adults and children, tissues for coughs and sneezes, prompt binning of tissues, not sharing towels, cups or cutlery, and washing soiled bedding and clothing on a hot wash. NHS inform adds disinfecting surfaces and objects often.

The NHS says to keep a child off school or nursery only while they are too unwell to go, and that as soon as they feel better they can go back. There is no need to wait until all the blisters have healed, and keeping children away for longer is unlikely to stop the illness spreading. UKHSA agrees that no exclusion is required for hand, foot and mouth disease and that settings do not need to contact the health protection team.

The NHS says there is usually no risk to the pregnancy or baby but it is best to avoid close contact with anyone who has the illness, because catching it shortly before giving birth can mean the baby is born with a mild version. NHS inform similarly says there is a small chance it could make a baby ill if infection occurs shortly before birth. Speak to a GP or midwife if you have been in contact.