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Coxsackievirus Infections: Symptoms & How to Treat

Here’s how to get your child relief for hand, foot, and mouth disease.
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Medically reviewed by
Assistant Professor, University of Massachusetts Medical School
Last updated September 19, 2020

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What is coxsackievirus?

Coxsackievirus belongs to a group of viruses called enteroviruses. The most common strains are hand, foot, and mouth disease (HFMD) and herpangina. There are other very rare and more serious strains that will not be discussed here.

Both hand, foot, and mouth disease and herpangina are common in toddlers and school-aged children. HFMD causes fever and painful, fluid-filled sores in the mouth called vesicles (small blisters). You may also notice blisters on the hands, feet, and buttocks (“butt”).

Herpangina causes fever and painful blisters and open sores (ulcers) on the roof of the mouth and back of the throat. The blisters don’t spread beyond the mouth area.

Both HFMD and herpangina are highly contagious viral infections. The viruses peak in summer and fall. While the sores can be very painful, they should go away on their own with home care.

Pro Tip

Herpangina has nothing to do with herpes and nothing to do with angina. It is a terrible name! It is a virus causing mouth sores that children can have once and recover quickly from. The virus can easily spread to other children, so keep your child home until sores are dry and crusty. —Dr. Heather Finlay-Morreale

What are the symptoms of coxsackievirus?

Dr. Rx

A child with small red marks or blisters on their feet, hands, diaper area, or near their mouth most likely has hand, foot, and mouth disease. Some children have fevers but not all. Parents are often concerned about chicken pox, but chicken pox blisters start on the trunk then spread to the limbs in about a week. —Dr. Finlay-Morreale

Kids with HFMD usually have a fever for 1 to 2 days. Usually, you’ll know it’s HFMD after seeing small blisters on the hands, feet, buttocks, or mouth. Some children get the blisters at all locations and others only get them at some of these locations. Some children have only a few blisters and others are covered head to toe. The blisters are usually painful.

Herpangina usually begins with fever and then small painful blisters and ulcers arise in the mouth—typically on the roof of the mouth and the back of the throat.

The main concern with both infections is that children will often reduce how much they eat or drink due to pain and they can become dehydrated.

For both, symptoms generally improve within a week. Sometimes, people may also have overall malaise (generally feeling ill), fatigue, sore throat, and irritability.

Main symptoms

  • Vesicles
    • HMFD: Painful blisters in the mouth and on the tongue, hand, feet, and butt and diaper area.
    • Herpangina: Painful blisters and sores on the roof of the mouth and back of the throat
  • Fever
  • Fatigue
  • Sore throat
  • Decreased appetite
  • Irritability and crying

Risk factors

Pro Tip

An important question to ask your doctor about this illness is: Is my child dehydrated? The main concern is coaxing your child to take in fluids. Offer them whatever their favorite is even if it’s ice cream for breakfast or apple juice whenever they want. —Dr. Finlay-Morreale

Toddlers and young children are most likely to get Coxsackie. Outbreaks often happen in daycare centers, schools, and camps. The virus can live on shared toys and can also spread in swimming pools.

Next steps

Keep your child at home until blisters are dry and crusty. Give them plenty of fluids. If needed, treat pain and fever with medication recommended by your pediatrician. (Never give aspirin to children.)

Watch how often your child is urinating or the number of wet diapers. A child should have a wet diaper every 6 hours.

If symptoms worsen, contact your pediatrician. Also if you become concerned about dehydration from not drinking enough liquids.

Go to the ER if your child is lethargic or worsening or not drinking and having few wet diapers.

Is there any treatment for coxsackievirus infection?

  • Give acetaminophen or ibuprofen (if older than 6 months) for pain and fever.
  • Encourage drinking fluids like water, juice, Pedialyte, etc.
  • Offer frozen sweets like ice cream, ice pops, etc. The coldness may numb some of the pain, making it easier to eat.
  • Avoid foods—particularly acidic and spicy and salty—that can make sores in the mouth hurt even more.
  • For mouth pain, your pediatrician may prescribe “magic mouthwash.” It’s a combination of medications that your child can “swish” if they are able to spit or to be painted onto sores with a small sponge or cotton swab.
  • Do not use oral gels without asking your pediatrician as some contain substances that aren’t safe for children. Studies have shown that children can have serious side effects from using lidocaine and other numbing medications. Check with your pediatrician before applying any topical medications.

Follow up

If symptoms last for more than a week, or your child is unable to drink enough (because their mouth hurts too much), contact your pediatrician. They may want to try additional treatment or make sure it isn’t a different illness.

Prevention

Coxsackievirus is very contagious. Like all viruses, the best way to protect you and your family is with careful handwashing. Everyone should be reminded to regularly wash their hands—be especially careful after changing diapers—with soap and water for 20 seconds.

The virus can be found in stool for several weeks so anyone changing diapers needs to be especially careful about handwashing.

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Dr. Kang received her BA from Harvard University with a degree in psychology and received her medical degree from Case Western Reserve University. She is currently a pediatric resident at Columbia University pursuing a career in pediatric gastroenterology.

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