Hand, foot and mouth disease, known in Swedish as höstblåsor (literally autumn blisters), is a viral infection that causes fever, a sore throat and small blisters in the mouth, on the hands and on the feet. It is most common in children under five, clears up on its own in about a week, and your child can go back to förskola (municipal preschool, from age one) once they are free of fever and have the energy to join in, even if the blisters are still visible.
The Swedish name is misleading: höstblåsor are around all year, but peak in autumn when the förskolor fill up again. It is one of those infections that sweeps through a whole group in three weeks, and one of the ones parents worry about most unnecessarily. Here is what it is, how to ease it and when your child can go back.
A Wednesday in October, half past four, in a flat in Hägersten. The three-year-old who usually eats two sandwiches for her afternoon snack doesn't want any, points into her mouth and cries when she drinks juice. Her forehead is warm. Two days later small blisters appear on her palms, and the förskola rings to say half the group has the same thing. That is how hand, foot and mouth disease usually shows up.
What hand, foot and mouth disease is, and who gets it
Hand, foot and mouth disease is caused by enteroviruses, most often coxsackievirus. It is a common virus that most children meet during the förskola years, and because several different viruses cause the same illness, you can get it more than once. From infection to symptoms usually takes three to six days. It is most common in children under five, but school-age siblings and sometimes parents can get it too, usually more mildly.
There is no vaccine and no medicine that shortens it. The treatment is to ease the symptoms, keep fluids up and wait. It sounds passive, and it is exactly what the healthcare service recommends.
Symptoms, in the order they appear
- Fever and a sore throat, sometimes with less appetite, for a day or two.
- Small blisters or sores in the mouth: on the tongue, the inside of the cheeks and the roof of the mouth. These are the ones that hurt.
- Blisters on the hands and feet, sometimes around the mouth, on the bottom or on the legs. They rarely itch and rarely hurt.
- Healing within a week. Sometimes the nails come off a few weeks later; it is harmless and they grow back.
Hand, foot and mouth, or something else?
Blisters in the mouth and a fever can be several things. These are the most common mix-ups:
| Hand, foot and mouth | Chickenpox | Cold sore virus (herpes), first infection | |
|---|---|---|---|
| Where | Mouth, palms, soles, sometimes bottom and legs | The whole body, including the scalp, comes in waves | The mouth, gums, lips |
| Itching | Rarely | Severe | No, but it hurts |
| Fever | Mild, one to two days | Often a few days | Often high, several days |
| Age | Usually under five | All ages | Usually one to three |
| Stay at home | Until free of fever and able to join in | Until the blisters have dried up | Until free of fever and eating |
Chickenpox has its own guide: Chickenpox. The odd sore in the mouth without fever is usually a mouth ulcer and clears up in a week without being contagious.
What helps
- Cold drinks. Water, milk, smoothies, anything cool and not acidic. Avoid orange juice and tomato, they sting the sores.
- Soft, cold food. Ice cream, yoghurt, cold porridge, välling (the Swedish drinkable oat or milk cereal). It is fine to live on ice cream for three days.
- A straw. Many children drink more easily when the liquid bypasses the sores.
- Pain relief in the dose for age and weight, on advice from 1177 or the apotek (pharmacy), especially before meals.
- Rest. Let your child decide how much.
Three days of ice cream, yoghurt and cold välling never hurt a child. What matters is the fluids. A child who drinks, even a little at a time, will be fine. A child who refuses to drink for twelve hours is one you need to call 1177 about.
Food that usually goes down
- Cold porridge, filmjölk (Swedish soured milk) or yoghurt without bits
- Banana and milk smoothie, not citrus or berries with seeds
- Soft pasta or mashed potato, lukewarm, not hot
- Ice cream, ideally dairy ice cream, and fruit purée from the fridge
- Cold välling in a cup with a straw
- Avocado and banana in pieces
- Avoid: salty, sour, hot, hard bread, crisps and anything with sharp edges
Contagion, and what actually protects
Hand, foot and mouth disease spreads through saliva, blister fluid and stools. Your child is most contagious in the first days, but the virus can remain in the stools for several weeks afterwards. Keeping a well child at home therefore helps little; washing hands after nappy changes and before meals helps a lot. Siblings often catch it, and that is rarely avoidable.
- Wash hands with soap after every nappy change and trip to the toilet, for several weeks after your child is well again
- A separate towel for the sick child
- Don't share dummies, spoons, cups or toothbrushes between siblings
- Wash toys that have been in the mouth
- Expect little sister to get it anyway, and keep ice cream in the freezer
When your child can go back to förskola
| Can go back | Stay at home |
|---|---|
| Free of fever for a day | Fever |
| Eating and drinking | Refuses to drink because of the pain |
| Has the energy to play and join in | Only wants to lie on the sofa |
| Blisters still visible, which doesn't matter | New blisters appearing and the child is listless |
The line from Folkhälsomyndigheten (the Public Health Agency of Sweden) is that it is your child's general condition that decides, not the blisters. Tell the förskola what your child has had. They usually put up a notice so other parents know what to look for. If you need to stay home with your child, the usual VAB rules apply (VAB is the Swedish paid leave for caring for a sick child), see VAB.
The nails that come off
A few weeks after hand, foot and mouth disease, one or more nails may come off, on fingers or toes. It looks dramatic and rarely hurts. A new nail grows out underneath the old one. Don't cut, don't pull, let it fall off on its own. This is one of those things förskola staff have seen a hundred times and new parents never.
When to seek care
Call 1177 if your child is not drinking and is weeing less than usual, if the fever lasts more than three days, if your child is very drowsy or if the blisters become infected: redness, swelling, pus. It is unusual, but those are the cases the healthcare service wants to hear about.
- Your child is not drinking and is weeing less than usual, or has dry lips and cries without tears
- Fever for more than three days, or fever that comes back after going away
- Your child is drowsy, hard to get through to or complains of headache and a stiff neck
- The blisters become red, swollen or filled with pus
- Your child is under three months and has a fever: always call
How we do it with our families
Sanna comes to a family in Hägersten every Tuesday and Thursday at four o'clock. One Tuesday in October the three-year-old doesn't want her snack, which has never happened, and whimpers when she drinks. Sanna looks in her mouth with the torch on her phone, sees two small sores on the tongue and writes on the note: ”Didn't want to eat, sores in mouth, a little warm, drank cold yoghurt through a straw.” She swaps the sandwich for cold filmjölk with banana, skips the playground and reads on the sofa instead. When Mum gets home she knows what is coming and rings the förskola. The following Thursday the fever is gone, the blisters are showing on the hands, and Sanna can see it is the same child as usual, just with ice cream for a snack. That is why we send the same nanny every time: she can tell the difference between listless and ill, because she knows what the child is usually like at four o'clock on a Tuesday. If your child is at home with hand, foot and mouth and you have to work, the nanny can take the day if she is free. Let us know in good time and we will see what is possible. More on that in A nanny when your child is sick.
This article is general information and does not replace advice from BVC (the child health clinic every family is enrolled in), your vårdcentral (local health centre) or 1177. If you are worried about your child, call 1177. In an emergency, call 112.
Would you like a nanny who knows your child, knows what is normal for them and notices when something is different? Book a free first meeting with the nanny in your home.
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Frequently asked questions
How long is hand, foot and mouth disease contagious?
Mostly during the first days with fever and new blisters, but the virus can remain in the stools for several weeks after your child is well again. That is why hand washing after nappy changes and trips to the toilet is what actually matters, not how long your child is kept at home. Siblings often catch it anyway; it is rarely avoidable.
When can my child go back to förskola?
When your child is free of fever, has the energy to take part and can eat and drink. The blisters don't need to have gone; they are often visible for another week. It is your child's general condition that decides, according to Folkhälsomyndigheten's recommendations. Tell the förskola what your child has had, so they can inform other parents.
Can adults get hand, foot and mouth disease?
Yes, but it is unusual and usually milder: a slightly sore throat, a few blisters on the hands, tiredness. Most adults met the virus as children and have some protection. Pregnant women should mention it to their midwife if they catch it, to be on the safe side, but the risk to the unborn baby is considered small.
Can you get hand, foot and mouth disease more than once?
Yes, because several different enteroviruses cause the same illness. A child who had it one autumn can get it again the next year from a different virus. The second time is often milder, but not always. There is no vaccine, and there is no way to prevent it other than hand washing.
Do we have to tell the förskola?
Yes, do tell them. The förskola wants to know what is going round so staff can be extra careful with hand washing and put up information for other parents. It helps you too: you find out whether more children in the group have it, and the förskola can tell you what they usually require before a child comes back.