Hand, Foot and Mouth Disease in Australia: A Parent's Guide
Hand, foot and mouth disease (HFMD) is a common childhood viral illness, most often caused by coxsackievirus A16 or enterovirus 71 (Royal Children's Hospital Melbourne, 2025). It mostly affects children under 10, with the highest rates in those aged 1 to 4, though older children and adults can get it too.
It's not the same illness as foot-and-mouth disease in livestock. Despite the similar name, the two are caused by completely different viruses and HFMD is not transmitted between humans and animals.
The illness is recognisable because it follows a pattern. A child has a day or two of being a bit off, sometimes with a low-grade fever, then small painful sores appear in the mouth, followed by a rash with small blisters on the hands, feet, and sometimes the buttocks or groin. Most children feel reasonably well in themselves once the rash arrives. The rash and mouth sores typically settle inside seven to ten days without specific treatment.
HFMD spreads easily in childcare and school settings through respiratory droplets, contact with blister fluid, and faecal contamination. Australian outbreaks happen most often in the warmer months but cases occur year round.
It looks alarming to parents the first time they see it. The important thing to know early: in healthy children, HFMD is uncomfortable but almost always self-limiting. The job for parents is to keep their child comfortable, watch for the small set of red flags that mean it's not behaving as expected, and to book an appointment with a GP if anything looks off.
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The presentation is recognisable once you know what to look for.
The typical sequence
- Day 1 to 2 (prodrome): Mild fever, often under 38.5°C. Sometimes a sore throat, reduced appetite, and a child who's clingier than usual.
- Day 2 to 3 (mouth sores): Small red spots appear inside the mouth, mostly on the tongue, gums, and inside of the cheeks. These turn into painful ulcers and are usually the reason children stop eating and drinking normally.
- Day 3 to 5 (rash): A rash develops on the palms, soles, and sometimes the buttocks, knees, or genital area. The spots are small, red, and often have a tiny grey-white blister in the centre. The rash is usually not itchy, but it can be tender.
- Day 7 to 10 (resolution): The blisters dry up and the rash fades. Skin sometimes peels lightly on the hands and feet a week or two after recovery. Fingernails or toenails can occasionally shed a few weeks after the illness. This is harmless and they grow back normally.
What's usually not HFMD
- A rash without any mouth involvement at all.
- A widespread rash across the trunk rather than concentrated on hands, feet, and buttocks.
- Large fluid-filled blisters or peeling sheets of skin (different conditions, worth a GP review).
- A child who's seriously unwell, lethargic, or very high fever. That pattern is not the typical one for HFMD and warrants in-person assessment.
How long it lasts
Most healthy children recover in 7 to 10 days. The mouth sores tend to be the most uncomfortable part and usually peak around day 3 to 5. The rash often looks worst on day 4 or 5 and then fades over the following week.
When it's contagious
- HFMD is most contagious in the first week, while the fever and rash are present.
- The virus can continue to shed in stools for several weeks after recovery, which is why hand-washing matters after nappy changes and toileting for some weeks after the illness has visibly resolved.
- Children can spread the virus through saliva, fluid from the blisters, and faeces. Sharing cups, cutlery, dummies, and food is the most common route in childcare settings.
Return to childcare and school
Australian public health advice (NSW Health, Victorian Department of Health, NHMRC Staying Healthy) is that children with HFMD can return to childcare or school once they are well enough to participate, the blisters have dried up, and any fever has resolved. Most centres apply this rule in practice. A handful require a specific exclusion period; check the policy of your child's centre.
Adults who develop HFMD should follow similar principles: stay home while feverish and unwell, return to work when feeling well and the rash is no longer weeping. People who work with vulnerable groups (immunocompromised adults, neonatal settings) may need a longer exclusion. A telehealth GP can issue a medical certificate, see online medical certificates.
HFMD is almost always self-limiting in healthy children. The small number of cases that need clinical review usually have one of these features.
Call 000 or go to an emergency department for:
- A child who's drowsy, floppy, or very difficult to rouse.
- Severe headache, neck stiffness, or sensitivity to light.
- Persistent vomiting that's preventing any fluid intake.
- Difficulty breathing, fast breathing at rest, or noisy breathing that wasn't there before.
- Seizures, twitching, or unusual movements.
- Signs of severe dehydration: no wet nappies for 8 hours, sunken eyes, no tears when crying, very dry mouth.
See a GP today (in person or telehealth) if:
- Your child won't drink enough fluids because of mouth pain. Dehydration is the most common complication of HFMD.
- The fever is high (above 39°C) or has lasted more than three days.
- The rash spreads widely beyond hands, feet, and mouth, or any blisters become red, hot, swollen, or weeping pus.
- Your child is under 6 months old, is immunocompromised, has a heart condition, or is medically complex.
- You're not sure it's HFMD. Several other rashes look similar and warrant a GP review.
For any out-of-hours uncertainty, Healthdirect on 1800 022 222 is a free 24-hour nurse triage line that can advise whether to wait, see a GP, or go to ED.
Because HFMD is viral, the focus is comfort and hydration, not killing the virus.
For mouth sores and pain
- Cold or room-temperature fluids are usually better tolerated than warm ones. Ice blocks, cold yoghurt, and milkshakes are popular for a reason.
- Avoid acidic foods and drinks that sting the ulcers: orange juice, tomato sauce, pickles, salty crackers.
- Soft, bland foods: pasta, plain rice, custard, scrambled eggs, smooth soup, mashed potato.
- Paracetamol or ibuprofen at the correct weight-based dose, for pain and fever. Always check the product label and dosing for your child's weight.
- For older children, a salt-water mouth rinse can soothe ulcers.
For the rash
- The rash is usually not itchy. Avoid the temptation to apply creams unless a GP advises one.
- Don't pop the blisters. Let them dry on their own.
- If the rash is uncomfortable, cool damp cloths can help. Loose cotton clothing is more comfortable than tight or synthetic fabrics.
To prevent spread within the household
- Wash hands well and often, especially after nappy changes and before food preparation.
- Don't share cups, cutlery, towels, or dummies with the unwell child.
- Wash any items that came into contact with blister fluid on a hot wash.
- Keep the child home from childcare or school while they're feverish or actively unwell.
Online appointments for kids' health
Abby Health is an Australian online-first clinic with GPs available seven days a week. For HFMD specifically, telehealth fits the typical case well because the diagnosis is usually clinical: the GP can see the rash and mouth sores over video and confirm the pattern.
- Same-day or first-available appointments. If you're not sure what the rash is or your child is more unwell than expected, you can speak with an Australian GP without leaving the house.
- A clear plan for home care including what to watch for, what specifically would mean a return visit, and what would mean ED. Parents leave the consultation knowing what's normal and what's not.
- Medical certificates and carer's certificates issued during the same appointment. Useful when you need time off work to look after an unwell child.
- Continuity if the illness doesn't follow the expected pattern. The same care network holds your child's history, so a follow-up GP knows what was already assessed.
What telehealth can't do is replace a hands-on physical examination if one is clinically needed. If a GP needs to feel the abdomen, check hydration in person, or arrange same-day in-person review, Abby's clinicians make that call openly. For obvious emergencies, parents should call 000 or go to an emergency department rather than start a telehealth consult.
Abby Health is bulk billed for eligible patients with a valid Medicare card. Strict eligibility criteria apply.
How long is hand, foot and mouth contagious?
Most contagious in the first week while the rash and fever are present. The virus can continue to shed in stools for several weeks after recovery, so hand-washing matters during nappy changes and toileting for a few weeks even after the rash has gone.
Can my child go to childcare with hand, foot and mouth?
Australian public health advice is that children can return once they're well, the blisters have dried, and any fever has resolved. Some childcare centres apply a specific exclusion period, so check your centre's policy.
Can adults get hand, foot and mouth?
Yes. It's less common in adults but does occur, particularly in parents of unwell children. The illness in adults can be more painful than in children, particularly the mouth ulcers.
Is hand, foot and mouth the same as foot-and-mouth disease in animals?
No. The names are similar but the viruses are different. HFMD is a human illness only and is not transmitted to or from livestock.
What's the treatment for hand, foot and mouth?
There's no specific antiviral. Treatment is supportive: comfortable fluids, soft bland foods, paracetamol or ibuprofen for pain or fever, and watching for the red flags. Antibiotics don't help because it's not a bacterial infection.
Can I prevent my other children from catching it?
You can reduce the risk but not eliminate it. Frequent hand-washing, not sharing cups, cutlery, or dummies, and keeping the unwell child away from siblings as much as practical will all help. Most siblings catch it anyway because the virus spreads before the rash appears.
Do nails really fall off after hand, foot and mouth?
Sometimes, a few weeks after the illness, fingernails or toenails can shed (a condition called onychomadesis). It's harmless and the nails grow back normally. It's worth knowing about so you're not alarmed if it happens.
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