Does hand, foot, and mouth disease affect kids' sleep?

Updated Aug 21, 2023
baby feet

Hand, foot, and mouth disease (HFMD) is a common viral illness that causes mouth sores and a rash on the hands and feet. It most often affects babies and children under 5 years of age, although older children and adults are occasionally affected.


What causes it?

What are the symptoms?

How is it diagnosed?

How is it treated?

How does it affect sleep?

HFMD is usually caused by a type of virus called coxsackievirus. The virus can be spread by infected saliva, blister fluid, or poop. A child with HFMD who rubs his nose and touches a shared toy or goes to the bathroom and does not wash his hands can easily spread it to another child. Children are the most contagious during the first week of illness.

HFMD commonly begins with fever, sore throat, tiredness, and decreased appetite. The fever lasts only a day or two and is followed by painful sores or ulcers inside the mouth. A rash also develops on the skin, typically small red bumps and blisters on the hands, feet, and buttocks. HFMD usually resolves on its own within a week without serious problems.

A doctor will most often diagnose HFMD by the typical appearance of mouth sores and rash. Further testing is usually not necessary. Blood tests or a sample of blister fluid may be helpful if the diagnosis is uncertain.

There is no treatment for HFMD that will shorten the illness. However, you can help your child feel better during the illness by giving:

  • Acetaminophen or Ibuprofen to relieve pain and reduce fever.

    Note: ibuprofen should only be given to children older than six months.

  • Cold foods like popsicles or smoothies to soothe the throat and stay hydrated. Avoid spicy or acidic foods that can irritate the mouth.

Since the virus can sometimes remain in the poop for weeks even after symptoms have resolved, hand-washing is especially important to prevent the spreading of the disease to other children. Wash hands frequently with soap and water for at least 20 seconds.

  • Has severe pain

  • Has a fever for more than 3 days

  • Is unable to drink or appears dehydrated, peeing fewer than 3 times a day

Children are often more tired and need more sleep when they are fighting an illness like HFMD. Some children only experience mild symptoms from HFMD. Unfortunately, other children with HFMD can experience significant pain from their mouth sores, disrupting the sleep they dearly need. Because of the pain, they may have difficulty falling asleep, wake up frequently during the night, and wake up earlier than usual in the morning. If HFMD is affecting your child’s sleep:

  • Set an earlier bedtime since your child will likely need more sleep than usual. Your child may become overtired (and as a result have more trouble falling asleep) sooner than normal.

  • Try a pain reliever like acetaminophen about a half hour before naps or bedtime. Keep in mind that there should be at least 4 hours between each dose of acetaminophen (not exceeding 5 doses in 24 hours) when planning the timing of a dose. Ibuprofen should not be given more frequently than every 6 hours.

  • Encourage fluids so that thirst is not an extra factor in keeping your child awake. Your child may try to avoid drinking because of the painful mouth sores.

  • Remember that HFMD is a self-limited illness that will likely resolve in less than a week. Do your best knowing that you can get back to your normal routine once your child is feeling better.

Dr. Nina Akalis is a board-certified primary care pediatrician who received her MD from Harvard Medical School. She currently works as a medical consultant and enjoys medical writing and editing.

Note: The content on this site is for informational purposes only and should not replace medical advice from your doctor, pediatrician, or medical professional. If you have questions or concerns, you should contact a medical professional.