Hand, Foot, and Mouth Disease vs. Strep: How to Tell the Difference

When a “Strep” Throat Isn’t Strep at All

Your child has a fever, they don’t want to eat or drink, they say their throat hurts, you’re thinking strep. Well, maybe not. Look at their hands and feet too, because we’re seeing a virus going around a lot called Coxsackie virus, and it causes hand, foot, and mouth disease. And normally, only kids six months to five years old used to get it, but now we’re seeing older children and even adults getting it too.

How Hand, Foot, and Mouth Disease Spreads

Coxsackie virus lives in mucus and saliva… the child coughs or sneezes and doesn’t wash their hands, again, there’s the hand washing. It can also be spread through contact with the skin blisters if the hand and feet rash does start to blister, which does happen, and it can also be spread through bowel movements. Another good reason to wash your hands after you go to the bathroom.

So kids are most likely to spread the virus to others during the first week that they have symptoms, but the virus can continue to spread for days or even weeks after the symptoms go away. So your child may have been exposed to hand, foot, and mouth, and you wouldn’t have known it because the child they were exposed to is done with their symptoms.

Hand, Foot, and Mouth Disease Symptoms

Symptoms usually start about a week after the child comes into contact with the virus and again, it has the fever, the sore throat, stomach pain, headaches, all the things you think of with strep and quite often people will say, “I looked in the back of their throat and it’s got these blisters at the back and it’s really red and I know it’s strep.” Not necessarily. You cannot diagnose strep without the swab to test for the strep bacteria.

So, if you see the red spots at the back of the mouth, look also for any red spots, they’ll look like little raised purplish red bumps, usually on the fingertips and on the palms, on the bottoms of the feet, you can see them on the top of the feet and on the top of the feet sometimes but much more likely it’s going to be on the palms and the soles. We also see it on the legs and on the buttocks, and around the mouth.

So what about the fever? Well, the fever actually takes about five days before it will go away, but the mouth blisters, the skin blisters, the little bumps there, they can last up to ten days or even two weeks, and everyone always says, “Well, can’t you do a blood test to make sure this is the virus they have?” Most pediatricians can just take one look at your child and go, “Yep, they’ve got hand, foot, and mouth disease.” Unfortunately, there is no specific treatment for it, though. Antibiotics don’t help; it’s a virus.

Helping Your Child Feel Better with Hand, Foot, and Mouth Disease

What can you do to make your child feel better? The biggest things are pain and fever control, and hydration. You’re going to make sure that your child has their pain under control with Tylenol or Motrin. Kids who are a little bit older and who have that can actually—you can get some magic mouthwash prescription. It’s got some Benadryl, some Maalox, and if your child is old enough to be responsible enough not to swallow it, you can actually have viscous lidocaine in it, and your child will be able to gargle and spit that out, and that sometimes helps, but most of the time, just Tylenol, Motrin.

Cold things, popsicles, Gogurts, apple sauce, ice cream, this is one time where we say, “Go ahead and have some ice cream,” because you know your child’s at least going to get something in there. Those are actually really good ways just to help with the pain. Kids who have the mouth sores are going to be very reluctant to eat or drink much because it hurts, so they’re at high risk for having dehydration and that’s where you need to make sure popsicles, things like that, things that are high in water content to begin with are going to help them stay hydrated while they get through the mouth sores.

When to See the Pediatrician

Again, the mouth sores can linger for a while. They’re usually the most painful in the first couple of days after they show up, and then they get a little bit better, but they can linger, so you definitely want to make sure that your child stays hydrated.

So next time your child wakes up and you think they have strep, look at their hands and their feet. It’s always good to come on in. We always do a strep test anytime we see those symptoms with fever, sore throat, red back of the throat, tummy ache, headache, things like that. Usually, if the strep test is negative and we have those other findings, you’re pretty assured it’s a virus.

_{updated: November 13, 2025
originally published: August 30, 2014}