Medically reviewed by Aaron Wiegmann, MD, MS Plastic Surgeon January 18, 2024| Written by Zenda Nel

Everything You Need to Know About Hand Foot and Mouth Disease

Hand, foot, and mouth disease (HFMD) is a mild clinical syndrome that usually resolves within 7 to 10 days. It mainly affects infants and young children but can also affect adults. The infection causes painful blisters on the hands, feet, and mouth. On rare occasions, thegenitals and buttocks are also infected.

Don't Confuse Hand, Foot, and Mouth Disease (HFMD) with Foot-And-Mouth Disease

People often confuse hand, foot, and mouth disease (HFMD) with foot-and-mouth disease, also called hoof-and-mouth disease. Foot-and-mouth disease is an animal disease that affects cows, sheep, goats, and pigs. It is caused by a different virus and doesn't affect humans.

What Causes HFMD?

The viruses that cause HFMD are from the Enterovirus group of viruses. The two viruses mostly associated with HFMD are the Coxsackievirus A16 and enterovirus A71. Recent studies have identifiedCoxsackievirus A6 as another cause of HFMD. 

Infection with enterovirus 71 (EV71) can causesevere complications and may even be fatal. These cases have often been associated with meningitis and encephalitis. But in rare occasions, such a patient may also suffer severe neurological, cardiovascular, and respiratory problems. 

Asia has seen several epidemic outbreaks caused by EV71 leading to many fatalities.

How Does HFMD Present?

HFMD presents as painful blisters in the mouth, including the tongue, gums, and inside of the cheeks. The onset of the disease is a fever. But within two days, a skin rash develops on the palms of the hands and soles of the feet. Occasionally, this rash occurs on the buttocks and/or genitalia. Typically, the rash doesn't itch and may or may not feature blisters. 

In addition to the blisters and rash, the person may feel sick, lose interest in food, and may complain of a sore throat.  

The biggest risk with an HFMD infection is dehydration since the painful sores in the mouth will make swallowing difficult. 

HFMD is highly contagious and can spread like wildfire through childcare centers.

What is the Treatment for HFMD?

HFMD is a mild condition that doesn't require treatment. Also, there is no specific medicine to treat the condition. According to the CDC, most peoplerecover within 7 – 10 days without medical intervention.

It is best to treat symptoms like pain and fever with over-the-counter (OTC) medications. For relief from mouth pain, there are numbing mouthwashes or sprays that may help.

It's important to ensure that the person, usually a child, drinks enough. Due to painful swallowing, many patients don't want to drink anything, but that can be dangerous. However, ice-creams and ice cubes might help with dehydration without causing much pain. 

Soft foods like yogurt, custard, jellies, and soup may also be helpful. Keep the food at room temperature as heated food might hurt the mouth.

The Role of Food in the Recovery from HFMD

The best way to prevent and treat contagious viral infections like HFMD is to practice cleanliness and take steps to boost the immune system. To boost immunity, ingesting a balanced diet consisting of nutrient-dense foods is crucial.

Nutrition is an essential aspect of taking care of young children during the period of illness and recovery. For children to have an effective resistance against viruses that cause illness, they need to foods rich in nutrients. 

Foods rich in nutrients like vitamins, minerals, fatty acids, and beneficial compounds such as polyphenols can boost the immune system and help fight against viruses.

Research shows that nutrients are required to optimize immunity and can also help fight viral infections. They can fight a viral infection either directly by interfering with the target viruses or indirectly by activating the cells of the adaptive immune system. 

Obtaining adequate amounts of vitamins and minerals, including vitamins A, B6, B12, C, D, E, and K; folate; and copper, iodine, iron, magnesium, selenium, and zinc is crucial for a robust immune system. Meanwhile, a deficiency can adversely affect immune function.

What Food to Eat? 


It is well known that economically disadvantaged communities with protein malnutrition have an increased risk of infection. High-quality proteins are an essential component of an anti-inflammatory diet being crucial for the optimal production of antibodies.

Ascientific review found that protein contributes to an optimal nutrient status, reducing inflammation and oxidative stress, which boosts the immune system.

Animal protein sources include red meat, poultry, fish, eggs, and dairy. Plant-based protein sources include legumes, nuts, tofu, seeds, edamame, quinoa, green peas, and breads made from sprouted grains.

Vitamin A

People who don't get enough vitamin A are more susceptible to infections. Vitamin A providesimmune support by stimulating the production and activity of white blood cells, which have antiviral and anti-tumor functions.

Animal sources of vitamin A include dairy products, eggs, fish, and organ meats. Plant sources include leafy green vegetables like spinach and broccoli, orange and yellow vegetables like carrots, sweet potatoes, and pumpkin, and fruits like apricots and mangoes. 

Vitamin C

Vitamin C is a water-soluble vitamin found in many foods. Research has found that Vitamin C can neutralize free radical molecules, which can damage cells. Also, it’s involved in the body’s immune system by stimulating the activity of white blood cells. Severalclinical studies have shown that vitamin C can increase resistance against many viruses and bacterial infections.

Fruit sources include citrus (oranges, kiwi fruit, lemons, limes, and grapefruit), apricots, guavas, strawberries, and cantaloupe. Vegetable sources include bell peppers, tomatoes, broccoli, Brussels sprouts, cabbage, cauliflower, and white potatoes.

Vitamin D

Vitamin D plays an important role in the functioning of the immune system. The skin makes vitamin D when it is exposed to the sun. This process is most effective around noon when the UVB rays are most intense. Since a sick child should not go out in the sun, the vitamin should be taken in via food. 

Vitamin D can be found in fortified juices, milk, eggs, and fatty fish.

Vitamin E

Like vitamin C, vitamin E is also a potent antioxidant. This function supports the immune system. Vitamin E is a substance that can neutralize free radicals in cellular membranes, which helps to maintain normal immune function. 

Sunflower seeds, almonds, pumpkin, and red bell peppers are good sources of vitamin E, but your sick child will probably be happy with a peanut butter sandwich. The slice of whole-wheat bread and the peanut butter are both good sources of vitamin E. You can also try a slice of cold mango.

Supporting the Immune System with Vitamins

Vitamins A, C, D, and E are all essential for a healthy immune system, and a healthy immune system can fight viral infections like HFMD. Although it is not a life-threatening condition, it's nonetheless prudent to see that the patient's nutritional needs are met to ensure recovery.

In terms of vitamins, a range of fresh vegetables and fruit, plus some nuts, eggs, fatty fish, and dairy should be sufficient. 


The importance of minerals for a healthy body cannot be overstated. Most people tend to focus on vitamins, but ingesting adequate minerals through your diet is equally important. In fact, minerals are fundamental to immune function.

There are two kinds of minerals: macrominerals and trace minerals. Macrominerals include calcium, phosphorus, magnesium, sodium, potassium, chloride, and sulfur. The trace minerals include iron, manganese, copper, iodine, zinc, cobalt, fluoride, and selenium. 

Macrominerals and trace minerals are equally essential for optimal health. Macrominerals are required in larger quantities, and trace minerals are required in tiny amounts, but they are all integral to immune function.

Micronutrient deficiency has been shown toincrease the risk of death from measles, pneumonia, and diarrheal disease, all common infections worldwide.  

Not only do trace elements play a protective role against infections, but they also act as antioxidants, boosting both the adaptive and innate immune systems, as well as the production of antibodies. It is even possible to predict certain viral and bacterial infections by looking at an individual's nutritional status.

Minerals Implicated in the Maintenance of a Healthy Immune System


Selenium is an importanttrace mineral. Selenium is key to several biological processes:

  • Enhancing immunity
  • Free radical scavenging
  • Protecting against oxidative stress
  • Cellular differentiating
  • Maintaining antibody levels

Brazil nuts are an excellent source of selenium. Fish, shellfish, red meat, grains, eggs, chicken, liver, and garlic are also good sources. Brewer's yeast, wheat germ, and enriched bread are also good sources of selenium.

Many plant foods contain selenium. However, the amount of selenium depends on whether the plants were grown in selenium-rich soil. The same goes for animal sources of the mineral. Meats from animals that feed on grass that grows in selenium-rich soil will be good sources of the mineral. 


Zinc affectsmultiple aspects of the immune system. The mineral is crucial for the normal development and function of cells involved in innate immunity, including those white blood cells that help fight against infections. The mineral is also involved in the regulation of immune responses. 

Adequate zinc levels are necessary to keep the immune system functioning optimally so it can resist infections.

Good food sources of zinc are red meat, poultry, and seafood, especially oysters. Plant foods high in protein also deliver good amounts of zinc, such as beans, nuts, whole grains, seeds, and dairy products.


Iron is an essential mineral and its workings in the body are complex. It supports vital human functions, such as making hemoglobin and myoglobin. It is involved in cellular energy metabolism and the development and functioning of the immune system. It helps to make collagen, hormones, amino acids, and neurotransmitters.

Iron deficiency causes anemia and it is currently themost common nutrient deficiency in the world. In fact, a quarter of the world's population is affected by iron deficiency.

Iron is an essential nutrient which means the body cannot produce it. It must be taken in through food. Good sources of iron are red meat, especially organ meats, fish, turkey, and shellfish. Plant sources of iron include spinach, raisins, legumes, pumpkin seeds, and broccoli. Tofu is also a good source of iron. 

Tip: Cook your food in a cast-iron pot. Thisincreases the iron content of food.


Copper is an important mineral that is key to many biological processes. Copper has excellentantiviral as well as antimicrobial properties. Interestingly, it has been used as an antimicrobial even by ancientEgyptian and Roman civilizations. 

Research has found the mineral effective against the COVID-19 virus that devastated the global population not so long ago. An article inScientific American explains that copper in large quantities is toxic for almost all living cells. However, the body knows how to use copper to boost the immune system. When faced with an invader, white blood cells surround any invading bacteria and then boost levels of copper ions to bust the bacteria.

While large amounts of copper are damaging to the body, insufficient levels weaken the human immune system and make it more susceptible to illness and infection.

Since our bodies cannot produce minerals including copper, we must get these via food. Food sources of copper are shellfish, whole grains, beans, nuts, potatoes, organ meats, spinach and other leafy greens, dried fruits, cocoa, and black pepper.

To summarize, the fight against viral infections requires a robust immune system. Since about 70-80% of the immune tissue is located within the digestive system, what we eat has a potent impact on the immune system. 

A battle-ready immune system is built with a balanced diet that provides macro- and micronutrients. The micronutrients with thestrongest evidence for immune support are vitamins C and D as well as zinc.

What Food to Avoid?


Sugar is the immune system's worst enemy. Sugar intakeincreases inflammatory cytokines and damages blood vessels, signaling the immune system to take action, but it is needed to protect the body against dangerous bacteria, fungi, and viruses. The scientists note that while glucose is vital for the proper function of immune cells and their reproduction, a high amount of glucose may lead to impaired function of the immune system and ill health.

The effect of having a soda drink or a cupcake is to weaken the immune system temporarily, giving viruses and bacteria an unprotected host to invade. Ever wondered why people who have diabetes are prone to infections? This is the reason. Their immune system is busy fighting conditions created by sugar intake instead of fighting foreign agents attacking the body.

Furthermore,studies have shown that high sugar intake that raises blood sugar levels leads to changes in gut bacteria, gut permeability, and inflammation. 

Sugar in itself is not necessarily always bad, but consuming excess amounts of it is. And that level is easily reached. The ideal limit is 25 grams of sugar a day, but enjoying sweet things quickly stacks up to much more than that. 

Here is a small reference list that may help you make wise diet choices: 

  • One can of soda  - 40 grams 
  • Dairy-free milk alternatives - 13 grams per cup
  • A low-fat, sweetened yogurt - 47 grams, depending on the brand
  • One cupcake - 46 grams 
  • Ranch and Caesar salad dressings - 20 grams per serving
  • Sports drinks - up to 35 grams

Note: Artificial sweeteners are not better. Increasing evidence suggests that artificial sweeteners may be involved in gut bacteria imbalances. Some researchers postulate that overusing artificial sweeteners may be detrimental to immune health.

In adetailed analysis of artificial sweeteners, food additives, and emulsifiers the researchers conclude that "these additives should not be considered as innocuous and must have their use controlled and labeled with regard to possible undesirable effects".

Processed Food

Processed food is food that has been altered during preparation to extend its shelf life and make it more palatable. The alteration takes the form of a range of additives that are hard or impossible for the body to digest. These include emulsifiers, colorants, flavorings, sugar, and salt.

When you read food labels, you will see numbers like E101 (tartrazine) - a colorant; E211 (Sodium benzoate) - a preservative in bottle sauces; and so forth. Food additives are usually indicated by E numbers and you'll be surprised athow many there are. 

Heavily processed foods include:

  • Ice cream
  • Ham
  • Sausages 
  • Potato chips
  • Mass-produced bread
  • Breakfast cereals 
  • Biscuits 
  • Soft drinks
  • Fruit-flavored yogurts
  • Instant soups 
  • Margarine
  • Condiments like salad dressings, BBQ Sauce, etc.

Tip: Look for short ingredient lists. Long ingredient lists are long because they list non-nutritive additives.

Fried Foods

Modern diets contain high levels of advanced glycation end products (AGEs). AGEs are naturally present in uncooked animal-based foods, but the levels increase when these foods are cooked through grilling, broiling, roasting, searing, and frying. 

These additional AGEs are called dietary advanced glycation end products (dAGEs). They are known to contribute toincreased oxidant stress and inflammation, which compromises the immune system.

Whatever you do, don't give a sick child foods like French fries, potato chips, fried chicken, fried bacon, or fried fish.

Refined Grains

A diet high in refined grains like white bread, pasta, and white rice can compromise the immune system. These are high glycemic foods that result in blood sugar and insulin level spikes. Research shows that these foods can increase the production of free radicals and inflammatory proteins.  

In their natural state, all grains are whole grains. Milling strips them of their most nutritional parts, namely the bran and the germ. The germ contains most of the vitamins and minerals present in whole grains. Because they have been stripped of their bran, these foods digest quickly, leading to rapid spikes in blood sugar and insulin levels.

Refined grains also affect the immune system through their effect on gut bacteria. People who eat a lot of refined carbs increase their risk of type 2 diabetes. 

Whole grains can help with managing inflammation levels in the body.Research has found that diets high in fiber can cut C-reactive protein (CRP) levels by up to 40%. Scientists know that CRP is a marker for inflammation.

Whole-wheat bread, brown rice, quinoa, barley, millet, rye, and oats are whole grains.  

Final Thoughts

A healthy immune system that delivers an optimal response to threats depends on a nutritious diet high in vitamins, minerals, macronutrients, and trace elements to keep infections like HFMD at bay. 

The body needs sufficient protein for optimal antibody production. A lack of micronutrients like vitamin A or zinc can increase a person's risk of contracting an infection. In fact, scientists have determined that poor nutrition is associated with inflammation and oxidative stress, both of which damage the immune system.

When someone has been diagnosed with HFMD, the best way to help them is by providing a healthy plant-based diet rich in fruits, vegetables, whole grains, nuts, and legumes, keeping processed and sugary foods to a minimum.