Hand, foot and mouth disease (HFMD) — what parents in Singapore need to know

About this guide

Hand, foot and mouth disease (HFMD) is a fact of life for Singapore families with young children. It circulates all year round, spreads quickly through preschools and playgroups, and most children catch it at least once before primary school. For the great majority it is an unpleasant week of fever, mouth ulcers and spots, and then it is over.

This guide explains what HFMD is, how it spreads, what to expect day by day, how to keep a child with a sore mouth drinking, the uncommon warning signs that need urgent care, and the rules on staying away from preschool.

What HFMD is

HFMD is caused by a group of viruses called enteroviruses. In Singapore the commonest are Coxsackievirus A16 and Coxsackievirus A6; a less common one, Enterovirus A71 (EV-A71), is the type occasionally linked to serious complications. Because several different viruses cause HFMD, and immunity is specific to each, a child can catch HFMD more than once.

It is not related to foot-and-mouth disease in farm animals.

HFMD is a legally notifiable disease in Singapore. When we diagnose it, the clinic notifies the Ministry of Health, and preschools report clusters to MOH and the Early Childhood Development Agency (ECDA). This is how outbreaks in a centre are tracked and contained.

How it spreads

The virus is present in saliva and nasal secretions, in the fluid from blisters, and in stool. It passes from child to child through:

• Coughs, sneezes and shared cutlery, cups and bottles
• Hands, toys and surfaces that have been in contact with saliva or blister fluid
• Nappy changes, because the virus is shed in stool for several weeks after recovery

A child is most infectious in the first week of illness, while the fever and blisters are present, but can pass the virus on for a while after that. This is why hand washing after nappy changes and before meals matters even once a child is back to normal.

The incubation period (from catching the virus to the first symptom) is usually 3 to 5 days, and can be up to a week.

What to expect, day by day

Days 1 to 2. Fever, usually mild to moderate, with a sore throat, poor appetite, tiredness and general grizzliness. Some children have a runny nose or loose stools.

Days 2 to 3. Painful ulcers appear in the mouth: on the tongue, gums, inside the cheeks and at the back of the throat. This is the stage parents find hardest, because a child with a sore mouth refuses food and often drink. At about the same time, a rash of small red spots appears, typically on the palms, the soles, and often the buttocks, knees and elbows. The spots may turn into small greyish blisters. They are usually not itchy, and do not tend to leave marks.

Days 3 to 7. The fever settles, the mouth improves, and appetite returns. The spots dry and fade.

By day 7 to 10. Most children are fully recovered.

Two later things can surprise parents, particularly after Coxsackievirus A6 infection, which tends to cause a more widespread rash on the face, limbs and body:

• Peeling skin on the fingers, toes, palms and soles a week or two after the illness
• Nails lifting off or shedding (onychomadesis) 4 to 8 weeks later. This looks alarming but is painless, and the nails grow back normally.

Adults can catch HFMD too, usually from their children, and often have a milder illness with sore throat and a few spots. Anyone who is pregnant and has been exposed should let their doctor know; HFMD is generally mild in pregnancy, but it is worth mentioning.

What helps at home

There is no antiviral treatment for HFMD, and antibiotics do not work against viruses. Treatment is about comfort and hydration.

• Pain relief before meals and drinks. Paracetamol (or ibuprofen from 6 months of age, if drinking well) 30 minutes before a meal makes swallowing easier. Doses are by weight; we give you the exact millilitres for your child.
• Cold, soft and bland. Cold milk, yoghurt, ice cream, ice lollies, smoothies, jelly, cold porridge, mashed potato, soft noodles. Cold food numbs the mouth and is easier to take.
• Avoid what stings: citrus fruit and juice, tomato, salty and spicy food, crisps and anything sharp-edged.
• Fluids in small amounts, often. A straw or a syringe helps some children. Breastfed babies should feed on demand, in shorter, more frequent feeds if needed.
• Watch the urine. A child who is passing urine at least three or four times a day, or wetting nappies as usual, is getting enough fluid even if they are eating very little. Solid food can wait a few days; fluid cannot.
• Mouth care for older children. Rinsing with warm salt water can soothe ulcers. Numbing gels have limited benefit and some are not suitable for young children; ask us before using one.
• Do not burst the blisters. Keep the skin clean and dry.

Warning signs: when HFMD needs urgent care

Serious complications are rare, and are mostly linked to EV-A71 infection, which can affect the brain and heart. The signs to watch for, particularly in the first few days, are:

• High fever (39°C or more) persisting beyond 48 hours, or a fever that goes on for more than 3 days
• Unusual drowsiness, difficulty waking, or a child who is limp and not responding as usual
• Persistent irritability that cannot be settled
• Jerking or twitching of the limbs, especially during sleep (myoclonic jerks), or trembling
• Unsteadiness when walking, or weakness in a limb
• Persistent vomiting
• Breathlessness, fast breathing, or a fast heart rate; cold, pale or mottled skin
• Signs of dehydration: no urine for 8 hours, a dry mouth, no tears, sunken eyes
• A stiff neck or severe headache
• Seizures

If any of these occur, go to a children’s emergency department (KK Women’s and Children’s Hospital or the National University Hospital) or call 995. Do not wait for a clinic appointment.

Staying home from preschool and school

Because HFMD spreads so easily among young children, there are clear rules:

• A child with HFMD must stay away from preschool, childcare, school and enrichment classes until fully recovered: fever-free, mouth ulcers healed, and all blisters dried up. This usually takes about 7 to 10 days, sometimes longer.
• Most preschools require a medical certificate covering the exclusion period, and many ask for a doctor’s letter confirming recovery before the child returns. We provide both.
• Preschools with an HFMD case will screen children daily for fever, mouth ulcers and rash, and may ask siblings of an affected child to stay home during the incubation period. Check your centre’s policy.
• Avoid playgrounds, indoor play areas, swimming pools and gatherings with other young children until your child has recovered.

MOH publishes weekly HFMD case numbers and preschool cluster information; your centre will tell you if there is an outbreak.

Preventing spread at home

• Wash hands with soap and water after nappy changes, after toileting, before preparing food and before eating. Alcohol hand rub is less effective against enteroviruses than soap and water.
• Do not share cups, bottles, cutlery, towels or toothbrushes.
• Clean toys, tables, high-chair trays and door handles with a household disinfectant (dilute bleach solutions work well).
• Dispose of nappies and tissues promptly, and wash soiled clothing and linen with normal detergent.
• Keep the sick child’s contact with siblings to a minimum where you can. In practice this is hard with small children, and siblings often catch it anyway; the aim is to reduce the chance rather than to eliminate it.

There is currently no HFMD vaccine available in Singapore.

When to see a doctor

Come in if:

• You think your child has HFMD and need a diagnosis, a medical certificate and advice on care and exclusion
• Your child is not drinking enough: fewer wet nappies or toilet trips than usual, or refusing all fluids for several hours
• The fever lasts more than 3 days, or your child seems more unwell rather than better after day 3
• Mouth ulcers are so painful that your child will not swallow, and pain relief is not helping
• The spots become red, swollen, warm or weepy, which may mean a bacterial skin infection
• Your child has a long-term condition or a weakened immune system
• Your preschool needs a clearance letter before your child returns
• You are simply worried

How we manage HFMD at our Punggol clinic

Children with suspected HFMD are seen as walk-ins, Monday to Saturday, and can be booked online. At the visit:

• Examination and diagnosis. HFMD is diagnosed by looking: the pattern of mouth ulcers and spots is usually clear. Tests are rarely needed.
• A hydration plan that suits your child, with paracetamol or ibuprofen doses written out for your child’s weight and timed before drinks and meals.
• Warning-sign advice, so you know exactly what would make this an emergency.
• A medical certificate for the expected exclusion period, and a recovery review and clearance letter for preschool when the blisters have dried.
• Notification to MOH, which the clinic does; nothing is required of you.
• Prompt referral to a children’s emergency department if any warning sign is present or your child cannot keep fluids down.

Cross-links

• Fever in children: comfort measures, dosing by weight, and warning signs
• Common childhood rashes: how HFMD differs from chickenpox, hives and other rashes
• Colds, coughs and fevers in children: including return-to-school rules for other infections
• Vomiting and diarrhoea in children: keeping a child hydrated

Get in touch

Punggol: 658 Punggol East, #01-04, Singapore 820658 · Tel 6312 4589 · Walk-ins welcome Mon–Sat

Joo Chiat: 172 Joo Chiat Road, #01-01, Singapore 427443 · Tel 6920 1952 · By appointment

Email: admin@ktmc.sg

References

• Ministry of Health Singapore. Hand, foot and mouth disease: disease information, notification requirements and weekly infectious disease bulletin. moh.gov.sg
• HealthHub, Ministry of Health Singapore. Hand, foot and mouth disease (HFMD). healthhub.sg
• Early Childhood Development Agency (ECDA). Guidelines on the management of HFMD in preschools. ecda.gov.sg
• KK Women’s and Children’s Hospital (KKH). Hand, foot and mouth disease, patient information. kkh.com.sg
• US Centers for Disease Control and Prevention (CDC). Hand, foot, and mouth disease: symptoms, complications and prevention. cdc.gov
• World Health Organization, Western Pacific Region. A guide to clinical management and public health response for hand, foot and mouth disease (HFMD). 2011.

This information is for general education only and is not a substitute for medical advice. If your child has any of the warning signs above, seek emergency care. v1.0 · September 2026 · Review due September 2028.