HFMD in children: symptoms, how long it’s contagious, home care and warning signs

HFMD in Malaysia

HFMD has been a notifiable disease in Malaysia since 2007, and cases rise and fall from year to year. 2025 was a very large year: Malaysia recorded 239,907 cases by late August, and more than 1,100 childcare centres and kindergartens were ordered to close in the first months of the year to stop the spread.

2026 has been much quieter. The Ministry of Health reported 40,879 cases as of 22 August 2026, about 83% fewer than in the same period of 2025. Most infections this year were caused by coxsackievirus A6 and other enteroviruses. Enterovirus 71 (EV71), the type more often linked to serious complications, made up only 1.5% of enteroviruses detected.

When there is an outbreak, health officers can order a nursery or kindergarten to close for 10 days, roughly two incubation periods, under the Prevention and Control of Infectious Diseases Act 1988.

HFMD symptoms in babies and children

Symptoms usually start 3 to 5 days after a child catches the virus:

1. First 1 to 2 days: fever, sore throat, tiredness and not wanting to eat or drink.
2. Then: painful mouth ulcers on the tongue, gums and inside the cheeks, and a spotty rash on the palms and soles, sometimes on the bottom, legs or arms. The spots can turn into small blisters. The rash is usually not itchy.

In babies and toddlers, you may notice irritability, drooling, refusing feeds or the bottle because the mouth hurts, and fewer wet nappies. Not every child gets all the symptoms. Some have only mouth ulcers or only a rash.

Very rarely, a child’s fingernails or toenails may peel or fall off a few weeks later. They grow back normally.

How long is HFMD contagious?

• A child can spread HFMD a few days before symptoms appear.
• They are most contagious in the first week of illness.
• The virus can stay in saliva for days and in stools for weeks after the child feels better, and people without symptoms can spread it too.

It spreads through saliva, coughs and sneezes, fluid from blisters, and stools, for example during nappy changes, or from shared toys and cups.

When can my child go back to taska or school? The Ministry of Health advises keeping children with symptoms at home and away from childcare centres and public places. Overseas guidance suggests returning once the child feels well and has no fever or uncontrolled drooling. Many nurseries have their own rules and may ask for a doctor’s letter, so check with them.

Children and adults can catch HFMD more than once, because several different viruses cause it.

Caring for a child with HFMD at home

There is no specific medicine for HFMD, and antibiotics don’t work against it. Care focuses on comfort and fluids:

• Keep them drinking. Dehydration is the main risk. Offer small sips often: cool water, milk, or oral rehydration salts. Ice chips or cold drinks can soothe mouth ulcers. Avoid acidic drinks such as orange juice, which sting.
• Soft, cool foods such as yoghurt, porridge, soup and soft rice. Avoid hot, salty and spicy food.
• Paracetamol for fever and mouth pain, dosed by your child’s weight. A pharmacist can suggest a mouth gel suitable for your child’s age. Never give aspirin to children.
• Skin: the rash usually needs no treatment. Keep blisters clean and dry, and let them dry up on their own. Calamine lotion isn’t usually needed. If a spot is itchy, use it only on unbroken skin, never in the mouth or on burst blisters, and ask a doctor first for children under 2.

Avoid ibuprofen if your child is dehydrated or if dengue is possible. See our guide to fever medicine for children.

Warning signs that need urgent care

Serious complications are rare, but some viruses, especially EV71, can affect the brain or heart. Children under 5, and especially under 2, are at highest risk.

See a GP sooner if your child is under 6 months old, has a weak immune system, or isn’t improving after 7 to 10 days.

Preventing HFMD

• Wash hands with soap and water, especially after nappy changes and using the toilet, and before eating. Teach children to do the same.
• Clean toys, toilets and surfaces regularly with soap or a household disinfectant.
• Don’t share cups, cutlery, towels or toothbrushes.
• Keep sick children at home until they are well.

Is there an HFMD vaccine? Not in Malaysia. Vaccines against EV71 are used in China, and an application to bring one to Malaysia for children aged 6 months to 6 years is under review by the NPRA. These vaccines protect only against EV71, not the other viruses that cause most HFMD.

HFMD or measles?

Searches for measles have been rising alongside HFMD. Measles is far more serious, and both cause fever and a rash, so it helps to know the difference:

Malaysia recorded 3,791 measles cases in 2024, up from 2,002 in 2023, and 3 children died, all unvaccinated. The National Immunisation Programme gives the MMR vaccine at 9 and 12 months, with an extra early dose in Sabah. The Ministry of Health has extended its free catch-up measles-rubella dose until 31 December 2026 for children who missed it. Book through MySejahtera or ask at a Klinik Kesihatan.

If you think your child has measles, call the clinic before you go, so staff can keep other patients safe.

Where to see a doctor for HFMD

A GP can confirm HFMD, check your child for dehydration and give a letter for the nursery if needed. Call ahead so the clinic can keep other children from catching it. Our directory lists GP clinics across Kuala Lumpur, Selangor and other states, including clinics open at weekends.

Browse the clinic directory

Frequently asked questions