Kidy
It is bedtime and you spot small flat marks on your toddler's palms. Then two more on a sole. Dinner went untouched and even the yoghurt was refused. Your first thought is chickenpox. Your second is whether you are now home for the whole week.
- The rash sits on palms, soles and often the nappy area, and it is usually not itchy
- Most children are through it in 7 to 10 days
- The mouth ulcers, not the spots, are what makes the week hard
- Very rarely a nail lifts weeks later; it usually grows back
Quick Reference
| Question | Short answer |
|---|---|
| What does the rash look like? | Flat or slightly raised spots, sometimes blisters, usually not itchy |
| Where does it sit? | Palms, soles, buttocks, legs and arms, plus sores inside the mouth |
| How long does it last? | Most children recover in 7 to 10 days |
| Most contagious when? | The first week of the illness |
| Itchy like chickenpox? | No, and that is one of the more useful clues |
| Back to nursery? | UK guidance: as soon as they feel well enough to be there |
| Can adults catch it? | Yes. It is commonest under 5, but anyone can get it |
Chickenpox, scarlet fever, or this?
This is the question at 9pm, so take it first.
| Hand, foot and mouth | Chickenpox | Scarlet fever | |
|---|---|---|---|
| Where it starts | Mouth, then palms and soles | Anywhere on the body | Chest and tummy, then spreads |
| Itchy? | Usually not | Very | Not the main complaint |
| The giveaway | Sores in the mouth, spots on palms and soles | Spots become blisters, then scabs | Rough sandpaper skin, strawberry tongue |
| Antibiotics? | No, viral | No, viral | Yes, prescribed by a doctor |
| Off nursery | Until well enough to be there | Until every spot has scabbed | 24 hours after the first antibiotic dose |
Chickenpox moves through three stages, spots to blisters to scabs, it turns up anywhere including inside the mouth, and it itches badly. Children stay off until all the spots have crusted, usually about 5 days after they appeared (NHS). Our fuller walkthrough is here: chickenpox in children.
Scarlet fever feels different under your hand. The rash is small raised bumps that make the skin feel like sandpaper, it starts on the chest and tummy, and the tongue ends up red and bumpy. It needs antibiotics, and children go back 24 hours after the first dose (NHS). More on that in scarlet fever in children.
The pattern that points here instead is palms and soles, plus a sore mouth, and a child who is not scratching.
What the rash looks like, and where
Fever and flu-like symptoms usually appear 3 to 5 days after your child picked the virus up. Small red spots turn up on the tongue and inside the mouth, blister, and become painful. The skin rash follows (CDC).
The CDC describes it as flat or slightly raised red spots, sometimes with blisters, and says it is usually not itchy. Palms and soles are the classic sites, along with buttocks, legs and arms. The NHS adds the groin area and the bottom, which is why plenty of parents find it at a nappy change rather than on the hands (NHS).
On darker skin the spots may look darker than the surrounding skin rather than red, and blisters may look grey or lighter, which is worth knowing before you go hunting for something pink.
The mouth is the actual problem
The spots are cosmetic. The ulcers are what ruins the week.
A child with a mouth full of sores will refuse the cup, refuse the spoon, and then refuse the thing they asked for two minutes ago. The CDC is direct about the consequence: dehydration happens here because swallowing hurts.
So the goal stops being nutrition and becomes fluid. Anything cold and smooth is on your side. German paediatricians make the same point in reverse, warning that sour or hot drinks irritate the lining further, while cool soft food such as porridge or yoghurt goes down more easily (Kinderärzte im Netz).
What tends to work: milk, yoghurt, ice cream, smoothies, cold water. What tends to backfire: citrus, tomato, vinegar, crisps, toast. Skip the straw if it makes them wince, and skip the pressure entirely. A few days of milk and ice cream will not undo anyone's diet.
The number to watch is not calories, it is wet nappies. The NHS lists passing urine less than usual as a reason to get help. If you want the fuller list of warning signs, they are in baby dehydration signs.
Painkillers exist for exactly this, and your doctor or pharmacist decides which one and how much for your child's age and weight.
How long, and how long contagious
Most children get better on their own in 7 to 10 days, and almost all of them without any specific treatment.
Contagion runs longer than the illness. Children are most infectious in the first week. After that the CDC says people can still pass the virus on for days or weeks after symptoms have gone, largely through stool (CDC). Plenty of people carry and spread it with no symptoms at all.
That has one practical consequence. Keeping a child at home for an extra week does not close the door, because the virus is already circulating in the room and in children who look perfectly fine. Handwashing after nappies and before food does more than isolation does. There is more on that arithmetic in why kids get sick so often at daycare.
There is no vaccine.
When can they go back to nursery?
Rules differ by country, so take your own setting's word over anything you read online, including this.
British guidance is the most relaxed and the most quoted. The NHS says to keep your child off school or nursery while they are feeling too unwell to be there, and that as soon as they feel better they can go back. No fixed number of days, no clearance note.
Germany does not have a statutory exclusion for this illness. It is absent from the Robert Koch Institute's readmission table under §34 of the Infection Protection Act, the table that does list chickenpox and scarlet fever (RKI).
In Croatia and Spain there is no national rule we could verify either, which means the nursery's own house rules decide. Most settings land in the same place: home while feverish or clearly unwell, back once they are eating, drinking and joining in. The AAP frames it the same way, returning once the exclusion criteria are resolved and the child feels well enough to take part.
If you are heading to an appointment about any of this, preparing for a pediatric visit with your child's data is worth ten minutes.
Will the sibling get it? Will you?
It can. It spreads very easily between children living in the same house, but it is not inevitable that every child at home will get it. You can catch it too.
It is commonest in children under 5, but anyone can catch it. It spreads through droplets, saliva, fluid from the blisters, stool, and contaminated surfaces and objects. Adults often get a milder version, sometimes nothing more than a sore throat and a few spots on the fingers.
If you are pregnant, the NHS advises contacting your GP or midwife, so do that rather than working it out from a forum thread.
Siblings often fall ill about a week apart, which turns one week at home into two. That is not a failure of your handwashing.
The nails, six weeks later
This is the part almost nobody warns parents about, and it causes real panic.
Weeks after the illness has finished, a fingernail or toenail can lift at the base and come away. The CDC notes it is very rare and that a causal link is not established. The AAP mentions peeling on fingers and toes 1 to 2 weeks later and calls it harmless.
The dermatology literature puts numbers on the timing. In one published series the gap between the infection and the nail change ran from one month to 96 days, with an average of 53 days, and earlier reports give a latency of one to two months. The nail bed stays intact underneath and the nail regrows on its own, with no treatment needed (Chiu et al., Viruses, 2019).
By that point the rash is a distant memory, so almost every parent connects the falling nail to something else. It is worth mentioning to your doctor, mostly so you both stop looking for a cause.
Frequently asked questions
Can my child get hand, foot and mouth twice?
Yes. Several different viruses cause it, including coxsackievirus A16, coxsackievirus A6 and enterovirus 71, so immunity to one does not protect against the next. A second bout in the same year is annoying but not a sign that anything is wrong.
Is it dangerous?
For nearly all children, no. The CDC describes complications as rare. Dehydration is the realistic risk, because the sore mouth stops them drinking, and that is the thing to keep an eye on rather than the spots.
Should I pop the blisters?
No. The fluid inside carries virus, so opening them spreads it to hands and to whoever helps. Leave them alone and let them dry up.
How is it different from teething?
Teething does not come with spots on the palms and soles, and it does not usually bring a sore throat. If your child is drooling and off their food and you cannot see anything, look at the hands and feet before you blame a molar.
Do we need to see a doctor at all?
Usually not. Get advice if the fever lasts more than 3 days, if drinking stops, if there is no improvement after 10 days, or if your child is very young. When a fever is the main thing you are watching, fever and cough: when to monitor and when to call sets out the thresholds.
How KidyGrow helps you
This week the useful things are a cold drink and a quiet afternoon. No app changes that.
What it does hold is the timeline, and you will be asked for that timeline twice. Nursery wants to know which day the spots showed up. Your doctor wants to know when the fever started and whether your child has been drinking since.
You note the first spot, the first refused meal and the last decent drink in a couple of taps, and the app remembers which day was day one.
On day one that is a single line. By the second week the app has learned what your child's normal eating and sleeping look like, so the Daily Brief can say something closer to: "Fourth day of reduced intake, drinking normally since yesterday evening." That is a sentence you read out at the appointment instead of reconstructing it in the corridor.
It does not name illnesses and it will not tell you this is hand, foot and mouth. It connects the notes you already made, and it does that better the longer it has been reading them.
The second child is where this earns its keep. When the younger one goes off food a week later, you are not guessing whether that is the same thing arriving or a bad mood. You have the older one's week written down beside it, day by day, and the shape either matches or it does not.
Sleep is the other quiet one. Mouth pain wakes children in a way a cold does not, and the app remembers what an ordinary night looked like in this house before any of it started, which is the comparison you cannot make from memory at 3am.
Some weeks there is nothing to conclude. A cold, a bad night and a new tooth arrive together, and it says so rather than inventing a pattern.
Then, six weeks on, a thumbnail lifts at the base and your stomach drops. You open the app, see that this was the week of the rash, count back, and go to bed.
Sources
- NHS: Hand, foot and mouth disease (accessed 2026).
- CDC: Signs and symptoms of hand, foot, and mouth disease (accessed 2026).
- CDC: Causes and how it spreads (accessed 2026).
- AAP, HealthyChildren.org: Hand, foot and mouth disease (accessed 2026).
- NHS: Chickenpox and NHS: Scarlet fever (accessed 2026).
- RKI: Empfehlungen für die Wiederzulassung zu Gemeinschaftseinrichtungen gemäß § 34 IfSG (accessed 2026).
- Chiu et al.: The mechanism of onychomadesis and Beau's lines following hand-foot-mouth disease, Viruses 2019 (accessed 2026).
_Educational content. Not a substitute for medical advice._
