Herpangina and Hand-Foot-and-Mouth Disease

What is herpangina?

Herpangina is an infection caused by a virus. It causes small red spots to appear at the back of the mouth. These spots then become little fluid-filled sacs (vesicles) that quickly pop, leaving small ulcers or sores. The ulcers are very small, only about 2 to 4 millimetres wide (about 1/8 of an inch). They can be very painful and may cause your child to refuse food and water.

What is hand-foot-and-mouth disease?

Hand-foot-and-mouth disease causes the same spots and ulcers in the mouth as herpangina. It also causes spots on the hands and feet. Spots may also appear in the diaper area.

Both caused by the Coxsackie A virus

Both herpangina and hand-foot-and-mouth disease are caused by a virus from the same family. There is no treatment against this virus.

The spots and ulcers in both illnesses will go away on their own within 10 days.

The virus spreads by touching or breathing

The virus is common in the summer and early fall. It is found in saliva and stool (poo).

A child with herpangina and hand-foot-and-mouth disease is most infectious during the first week of infection. However, a child can spread the virus for several weeks.

The incubation period for this virus is 3 to 6 days. During this time, a child can spread the virus without having any signs of being sick.

The virus spreads when a child touches infected stool and the puts their hand in their mouth. The virus can also be spread through the lungs by coughing and sneezing.

The virus can also survive on surfaces and objects, such as counters and toys, long enough to spread to another person.

Preventing spread and future episodes

To prevent the spread of infection, wash your hands and your child’s hands often. Be sure to do so:

  • after wiping the child’s nose
  • after changing a diaper
  • after using the toilet
  • before preparing food

There is no vaccine against the virus.

Signs and symptoms

Both herpangina and hand-foot-and-mouth disease can start with fever, sore throat, and generally not feeling well for several days before the spots in the mouth appear. Children may not want to eat and become very irritable. Older children may complain of headache, sore throat, and lack of energy.

Complications are mild

The most common complication of herpangina and hand-foot-and-mouth disease is dehydration. Dehydration means not enough water in the body. Children may refuse to drink fluids due to the pain in their mouth. However, with care at home, most children can get enough liquids to stay hydrated. 

Other complications are very rare.

Taking care of your child at home

The treatment of herpangina is support. This means keeping your child hydrated and as comfortable as possible. This will help the body fight off the infection.

Antibiotics do not work on viruses. They will not help heal herpangina or hand-foot-and-mouth disease.

Pain relief

To control pain, give your child acetaminophen (Tylenol, Tempra, or other brands), or ibuprofen (Motrin, Advil, or other brands). Pain relieving rectal suppositories can be given if your child cannot take the medicine by mouth.

You can give acetaminophen and ibuprofen at the same time. Or you can give one, then the other, every 3 hours. Always follow the instructions on the label or speak with your child’s doctor.  

Drink small amounts of fluids often

Give your child fluids often and in small amounts to prevent dehydration. Cold foods and soft foods such as ice cream and apple sauce are soothing and will not irritate the sores. Citrus, soft drinks, and salty or spicy foods may cause more irritation.

When to get medical assistance

Call your child’s regular doctor if:

  • the pain is not relieved with acetaminophen and ibuprofen​
  • the ulcers in the mouth last for more than 10 days

Go to your nearest Emergency Department or call 911 if:

  • your child has chest pain, shortness of breath, feels their heart racing, or seems overly tired
  • your child has a headache, vomiting, neck pain​ or stiffness, or a change in behaviour

Key points

  • Herpangina is a common, painful infection of the back of the mouth in children. It can last up to 10 days.
  • Herpangina and hand-foot-and-mouth disease are caused viruses from the same family.
  • The only treatment is good pain control and to make sure your child gets enough liquids to stay hydrated.
  • Be sure to wash your hands and your child’s hands often to prevent spreading the disease.

Christopher Sulowski, MD
Janine A. Flanagan, HBArtsSc, MD, FRCPC