HFMD in Singapore: Symptoms, School Rules & Home Care

Hand, foot and mouth disease (HFMD) is a common viral infection in young children, and it spreads easily in Singapore’s preschools and childcare centres. It usually starts with fever, sore throat and poor appetite, followed by painful mouth ulcers and a rash or small blisters on the hands, feet and sometimes the bottom. Most children recover at home in 7 to 10 days. Your child should stay home until all the blisters have dried up, and see a doctor urgently if they’re not drinking, very drowsy or unwell in other ways.

This guide covers the symptoms, how HFMD spreads, the rules for returning to school, how to care for your child at home, and the warning signs to watch for, including those linked to the EV71 strain.

What causes HFMD?

HFMD is caused by a group of enteroviruses. Coxsackievirus A16 and A6 are common causes and usually lead to mild illness. Enterovirus 71 (EV71) is less common but more likely to cause serious complications. Because several viruses are involved, your child can catch HFMD more than once.

It mostly affects children under 5, but older children and adults can catch it too, often with milder symptoms. HFMD is endemic in Singapore, meaning cases occur all year, with rises in some months.

Symptoms of HFMD

Symptoms usually appear 3 to 5 days after exposure, though the incubation period can range from 2 to 14 days, according to Singapore’s Communicable Diseases Agency.

• Fever, often the first sign, usually lasting 2 to 3 days
• Sore throat, tiredness and poor appetite
• Mouth ulcers on the tongue, gums and inside the cheeks. These are painful and are the main reason children refuse to eat and drink.
• A rash or small blisters on the palms and soles, and sometimes the knees, elbows, buttocks and nappy area
• Drooling in babies and toddlers because swallowing hurts

Some children have only a few spots or mouth ulcers. Others, particularly with Coxsackievirus A6, get a more widespread rash. A few weeks after recovery, some children’s fingernails or toenails peel or fall off. This looks alarming, but the nails grow back normally. For a different pattern, where a rash appears only after a high fever has gone, see our guide to roseola and its tell-tale rash. Our guide to chickenpox in children covers another common childhood rash with blisters.

How HFMD spreads in childcare

HFMD spreads through contact with an infected person’s saliva, nose and throat secretions, blister fluid and stools, and through contaminated toys and surfaces. Young children mouth toys, share snacks and need nappy changes, which is why outbreaks are common in infant care and preschool classes. The same hygiene habits help limit other common childcare infections, such as pink eye (conjunctivitis) in children.

• Children are most infectious during the first week of illness.
• The virus can stay in stools for several weeks after recovery, so careful handwashing after nappy changes remains important.
• Some infected children and adults have no symptoms but can still pass on the virus.

Preschools in Singapore carry out daily health checks at arrival, often looking at the hands and mouth, and may send a child home if there are signs of HFMD. Centres follow national infection control guidelines, including cleaning and disinfecting toys and surfaces. When outbreaks are large or prolonged, the authorities can require a centre to close temporarily for cleaning.

When can my child go back to school?

Singapore’s Communicable Diseases Agency advises that unwell children should stay home until the blisters have dried up, or until they have fully recovered, or until the medical certificate given by their doctor has expired.

• Keep your child home from childcare, preschool and playgroups, and away from crowded places and other young children.
• Tell the centre as soon as your child is diagnosed, so they can alert other parents and step up cleaning.
• Your centre may ask for a doctor’s note or a check before your child returns. Rules can vary, so ask.
• Keep siblings who are well under close watch for symptoms, and let their school know if they develop any.

For more on childcare centres and backup care for sick days, see our guide to childcare options in Singapore.

Home care: helping your child feel better

There’s no specific treatment for HFMD. Antibiotics don’t work against viruses. The aim is to keep your child comfortable and well hydrated while the illness runs its course.

• Fluids are the priority. Offer small, frequent sips of water, milk or breast milk. Babies may feed better in shorter, more frequent sessions. A cup or spoon can be easier than a teat when the mouth is sore. Our guide to spotting dehydration in babies lists the signs to watch for.
• Cold, soft foods are easier on ulcers: cool porridge, yoghurt, soft tofu, mashed banana, chilled smooth purees and ice lollies for older children.
• Avoid acidic, salty or spicy foods such as orange juice, crisps and chilli, which sting.
• Pain and fever relief: paracetamol can ease pain and fever. Follow the label or your doctor’s or pharmacist’s advice for your child’s age and weight. Never give aspirin to children. Ask your doctor before using any mouth spray or gel.
• Blister care: keep blisters clean and dry and don’t pop them. Loose, breathable cotton clothes help in Singapore’s heat.
• Rest at home until your child is better.

If your baby is under 3 months and has a fever, see a doctor straight away. Our guide on baby fever and when to see a doctor has age-by-age thresholds.

EV71: why doctors watch it more closely

Most HFMD is mild. EV71 is the strain most linked to rare but serious complications, such as viral meningitis, encephalitis (brain inflammation), paralysis and heart or lung problems. Children under about 3 are at higher risk of severe illness. HFMD became a notifiable disease in Singapore in 2000, after an outbreak linked to EV71.

You can’t tell which virus your child has from the rash, so the practical advice is the same for everyone: watch for the red flags above, especially changes in behaviour, drowsiness, persistent vomiting and refusal to drink. There is currently no approved HFMD vaccine in Singapore. An EV71 vaccine is used in some other countries.

Preventing HFMD at home and in school

• Wash hands with soap and water for at least 20 seconds after nappy changes, using the toilet, and before eating. Soap and water work better than hand sanitiser against the viruses that cause HFMD.
• Clean and disinfect toys, door handles, tables and high chairs, especially when someone is ill. Diluted household bleach is effective. Follow the product instructions.
• Don’t share cups, cutlery, towels or toothbrushes.
• Teach older children to cover coughs and sneezes and keep hands away from their mouths.
• Keep sick children home until they’ve recovered, to protect others.

Pregnant women who come into contact with HFMD, especially close to their due date, should mention it to their doctor. Adults caring for a sick child should wash their hands carefully too.

The bottom line

• HFMD causes fever, painful mouth ulcers and a rash or blisters on the hands and feet, and usually clears in 7 to 10 days
• Keep your child home until all blisters have dried up or they’ve fully recovered, and tell the centre
• Focus on fluids, cold soft foods and pain relief as per the label or your doctor’s advice
• Watch closely for dehydration, drowsiness, persistent vomiting and jerky movements, and seek urgent care if they appear
• Handwashing with soap and water is the best protection

Read more on the Communicable Diseases Agency’s HFMD page, or browse our baby health hub. If your child also has a runny nose and cough, our guide to baby cough and cold remedies may help, and our guide to croup and barking coughs covers that harsher cough. Routine visits are a good time to raise any health questions; our guide to baby checkups in the first year explains what each one covers.