Quick answer. Hand, foot and mouth disease (HFMD) is a common, usually mild childhood infection caused by enteroviruses, including coxsackieviruses and enterovirus 71 (EV71). It causes fever, sore throat, mouth ulcers and a blister-like rash on the hands, feet and buttocks. It spreads easily through saliva, blister fluid, faeces and contaminated surfaces or toys. There is no specific cure, so care is supportive with fluids and paracetamol. In Singapore, keep your child home until the blisters dry up, they fully recover, or the medical certificate expires. Seek urgent care for high fever, drowsiness, poor drinking, persistent vomiting or breathing difficulty.
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Hand, foot and mouth disease (HFMD) is a very common viral infection in Singapore, especially among young children in preschools and childcare centres. It is usually mild and clears up on its own within about 7 to 10 days.
It is caused by a group of enteroviruses, including coxsackieviruses and enterovirus 71 (EV71). EV71 is important because it is more often linked to rare but serious complications, so parents should know the warning signs and Singapore’s childcare exclusion rules.
At a glance
| Aspect | What to know | Action |
|---|---|---|
| Cause | Enteroviruses: coxsackieviruses, EV71 and others | No antibiotics; viruses do not respond to them |
| Incubation | Usually 3-5 days (range 2-14 days) | Watch closely after known exposure |
| Spread | Saliva, blister fluid, faeces, droplets, toys/surfaces | Wash hands; disinfect toys and surfaces |
| Stay home | Until blisters dry, full recovery, or MC expiry | Inform childcare centre or school promptly |
| When to worry | EV71 complications are rare but serious | Go to A&E for red-flag symptoms |
Symptoms and how long it lasts
HFMD usually begins with fever, followed by:
- Sore throat and ulcers in the mouth, throat and on the tongue
- A rash with small blisters on the hands, feet and buttocks (sometimes the knees or genital area)
- Poor appetite and reduced drinking, often because mouth ulcers are painful
- Tiredness; sometimes headache, vomiting or diarrhoea
The incubation period is usually 3 to 5 days (range 2-14 days), and most children recover within 7 to 10 days. Some infected people, including adults, have very mild or no symptoms but can still spread the virus.
How HFMD spreads
HFMD is highly contagious and spreads through:
- Direct contact with saliva, nasal discharge or fluid from the blisters
- Contact with an infected person’s faeces (for example during diaper changes)
- Respiratory droplets from coughing or sneezing
- Contaminated surfaces, shared toys, utensils and food
A child is most infectious in the first week of illness, but the virus can be shed in stools for several weeks afterwards, so good hygiene matters even after recovery.
Childcare and school exclusion rules in Singapore
To limit spread, the Communicable Diseases Agency advises that unwell children stay at home until the blisters have dried up, until they have fully recovered, or until the medical certificate (MC) issued by the doctor expires.
Practical steps for parents:
- Inform your child’s preschool or childcare centre promptly once HFMD is diagnosed, so other children can be monitored.
- Some centres require a doctor’s clearance or fitness certification before your child returns.
- If cases cluster in a centre, MOH/ECDA may direct the centre to take additional precautions or, in larger outbreaks, to close temporarily to break transmission, especially when EV71 is involved.
When to worry: EV71 and red flags
Most HFMD is mild, but EV71 in particular can rarely cause serious complications such as brain inflammation (encephalitis), meningitis, heart muscle inflammation (myocarditis) or breathing problems. Take your child to A&E urgently if you notice:
- Persistent high fever that does not settle
- Drowsiness, lethargy, difficulty waking, or being unusually irritable
- Poor drinking or signs of dehydration (very little or no urine for 6-8 hours, no tears, dry mouth)
- Persistent vomiting
- Breathing difficulty, fast breathing or turning blue
- Seizures (fits), severe headache, neck stiffness or limb weakness
Supportive care at home
There is no specific antiviral treatment for HFMD, and it usually settles on its own. Focus on comfort and hydration:
- Encourage frequent small sips of fluids to prevent dehydration; cold drinks and ice lollies can soothe a sore mouth
- Offer soft, cool, bland foods and avoid spicy, salty or acidic foods that sting ulcers
- Use paracetamol for fever and pain (follow weight-based dosing for children)
- Ensure plenty of rest at home
See a doctor if your child cannot drink, looks dehydrated, or you are worried about any red-flag symptom.
Prevention and vaccine availability
Good hygiene is the main protection:
- Wash hands thoroughly with soap and water, especially before eating and after using the toilet or changing diapers
- Cover coughs and sneezes; avoid sharing cups, utensils and food
- Clean and disinfect toys, surfaces and shared items regularly
- Keep unwell children home and away from group activities
There is currently no routinely available HFMD vaccine in Singapore. An inactivated EV71 vaccine is licensed in some countries such as China, but it only protects against EV71 (not the other HFMD viruses) and is not registered locally. Hygiene therefore remains the most effective prevention.
What to expect at the clinic
A doctor usually diagnoses HFMD from the typical mouth ulcers and the blister-like rash on the hands, feet and buttocks, so tests are rarely needed. The doctor will check how well your child is drinking and look for signs of dehydration or any red-flag symptoms. If your child is fit to be cared for at home, you will be given advice on comfort and hydration and, where appropriate, a medical certificate. Ask when your child can safely return to childcare or school.
Helping your child at home
- Offer frequent small sips of fluids; cold drinks, ice lollies or chilled foods can soothe a sore mouth.
- Choose soft, bland foods and avoid spicy, salty or acidic items that sting ulcers.
- Use paracetamol for fever or pain, following weight-based dosing for children.
- Wash hands carefully after nappy changes and disinfect shared toys and surfaces.
Special situations: pregnancy and adults
Adults and pregnant women can catch HFMD, often with mild or no symptoms, but can still pass it on. If you are pregnant and have been in close contact with an infected child, practise careful hygiene and mention it to your doctor, who can advise you.
Common questions
Can my child get HFMD more than once?
Yes. Several different enteroviruses can cause it, so immunity to one does not prevent infection by another.
How long should my child stay home?
Keep your child home until the blisters have dried, they have fully recovered, or the medical certificate expires, and inform the childcare centre or school.
Related guides
- Best GP & Family Clinics in Singapore — our editorial shortlist
- GP & family clinics directory
- Dengue fever
- Influenza (flu)
- Shingles (herpes zoster)
Sources
- HealthHub (HPB) – Hand, Foot and Mouth Disease
- Communicable Diseases Agency (CDA) – HFMD (Public)
- Communicable Diseases Agency (CDA) – HFMD (Professionals)
- NUH – Hand, Foot and Mouth Disease (Children)
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