Hand, Foot and Mouth Disease and Other Toddler Rashes

Hand, foot and mouth disease (HFMD)

A common virus in children under 5, especially in childcare, mostly in summer and fall. - Starts with fever, sore throat and a cranky, off-food child. - Then painful sores in the mouth, and flat or bumpy spots or small blisters on the hands, feet, diaper area, and sometimes arms and legs. - Lasts about 7-10 days. Weeks later, fingernails or toenails may peel or fall off; they grow back.

Care: - Mouth pain is the main problem, so focus on drinks: cold milk, water, ice pops and smoothies. Soft, cool foods like yogurt work well. Skip salty, spicy and acidic foods. - Pain or fever medicine, dosed by weight, makes drinking easier. - Watch for dehydration: fewer wet diapers, dry mouth, no tears. - The virus stays in stool for weeks. Wash hands after diapers and before food. - Children can usually return to childcare when fever-free and not drooling from mouth sores, following the program's rules.

Other rashes parents see often

• Roseola: 6 months to 2 years. Several days of high fever in a fairly well child, then a pink, spotty rash on the trunk as the fever breaks.
• Viral rash: blotchy pink spots during or after a cold. Usually fades in a few days.
• Hives: raised, itchy welts that move around. Often from a virus, sometimes a food or medicine. Hives with swelling, vomiting or breathing trouble can be anaphylaxis.
• Fifth disease: bright red "slapped" cheeks, then a lacy rash on the arms and legs. Tell any pregnant contacts, since it can affect pregnancy.
• Scarlet fever: a red, sandpaper-feel rash with a sore throat and fever, from strep. It needs a strep test and antibiotics.
• Impetigo: sores with honey-colored crusts, often around the nose and mouth. Needs treatment; it spreads easily.
• Molluscum: small, firm, pearly bumps. Harmless and usually go away on their own over months.
• Heat rash, eczema and diaper rash: see the diaper rash and eczema guide.
• Chickenpox and measles: both are now uncommon because of vaccines, but measles outbreaks happen. Measles brings high fever, cough, runny nose and red eyes, then a rash that spreads from the face down. Call ahead before going in, so the office can protect other patients.

The glass test

Press a clear glass or your finger on a rash. Most rashes fade under pressure. Tiny red-purple dots or bruise-like spots that don't fade, especially with fever, need care right away.

Skin of color

Redness can look purple, brown or gray on darker skin, and can be harder to see. Feel for raised bumps, warmth or roughness, and look at the inner lips, palms and soles.

When to check in

• Ask the pediatrician about a rash that lasts more than a few days, keeps spreading, blisters, crusts or looks infected.
• See them the same day for fever lasting 5 days or more, especially with red eyes, cracked lips or swollen hands and feet.
• If a rash doesn't fade with pressure and comes with fever, or your child has hives with swelling or trouble breathing, call 911.