Herpangina: Symptoms, Causes, and How to Care for Your Child

Herpangina is a viral infection that causes painful blister-like sores in the back of the mouth and throat. It is caused by enteroviruses — most often coxsackievirus A — and most commonly affects children under 10, though older children, adolescents, and adults can also get it.¹⁵ Symptoms typically resolve in 7 to 10 days with rest, fluids, and pain relief.⁴ Serious complications are rare but possible in newborns, pregnant people, and people with weakened immune systems.

If you’re not sure which mouth condition your child has, our overview of toddler mouth sores compares the most common causes.

What Is Herpangina?

Herpangina is a common viral illness caused by enteroviruses, a family of viruses that includes many coxsackievirus strains as well as echoviruses and other types.¹⁵ It causes small blisters or shallow ulcers — each smaller than 5 mm across — on the soft palate, tonsils, uvula, and back of the throat. Children develop sores within 1 to 2 days of the fever starting.

The illness spreads easily in daycare centers and schools. Most children recover fully at home within a week.²

Herpangina Quick Facts

• What causes it? Enteroviruses — most often coxsackievirus A — are the main cause.¹⁵
• Is it contagious? Yes. It spreads through saliva, respiratory droplets, and stool, especially in daycare and school settings.³⁹
• Is it the same as hand, foot, and mouth disease? No. The two are caused by related enteroviruses, but herpangina sores stay in the back of the mouth and throat. Hand, foot, and mouth disease (HFMD) also causes a rash on the hands, feet, and sometimes buttocks.³
• How long does it last? Most cases clear in 7 to 10 days. Mouth sores usually disappear within 1 to 7 days.²⁴

Call your child’s doctor right away if your child:

• Has a stiff neck or severe headache
• Won’t drink fluids for 8 hours or more
• Shows signs of dehydration — no wet diaper for 8 hours, no tears when crying, dry mouth
• Has a rectal temperature of 100.4°F (38°C) or higher and is younger than 3 months old
• Has a seizure
• Has symptoms lasting more than 7 days
• Is a newborn, is immunocompromised, or you are pregnant and develop symptoms

See the full When to Call the Doctor section below for more detail.

What Does Herpangina Look Like?

Herpangina sores appear in the back of the mouth — on the soft palate, tonsils, uvula, and posterior throat. They start as small grayish-white blisters and quickly become shallow ulcers with a red ring around them. Each sore is usually smaller than 5 mm across.¹¹⁰

The back-of-the-mouth location is what makes herpangina different from many other childhood mouth conditions. Cold sores form on the lips and look crusted. Canker sores appear on the inner cheeks and tongue, not the soft palate. Oral thrush shows up as white patches that wipe off, leaving red skin underneath — herpangina sores do not wipe off.¹⁰

Parents searching for what herpangina looks like sometimes mistake the sores for strep throat or tonsillitis. A key difference: strep throat rarely produces visible ulcers; it causes swollen tonsils with white patches or pus. A pediatrician can confirm the diagnosis with a quick physical exam.

Herpangina Symptoms in Children

Most children develop a high fever first, followed by mouth sores a day or two later. Symptoms appear within 3 to 5 days of exposure to the virus.¹

Common symptoms include:

• High fever — Often the first sign, usually appearing before the mouth sores¹
• Sore throat and difficulty swallowing — The back of the throat becomes swollen and painful
• Mouth sores — Grayish blister-like sores appear on the soft palate, tonsils, and uvula 1 to 2 days after the fever begins. They develop into shallow mouth ulcers within 24 hours¹²
• Refusing to eat or drink — Children avoid food and fluids because swallowing hurts
• Drooling — Younger children drool more because swallowing is painful
• Fussiness and tiredness — Babies and toddlers become irritable and harder to comfort
• Headache or body aches — More common in older children and adolescents

Symptoms last about a week. Mouth sores typically resolve within 1 to 7 days, and the fever passes in 2 to 4 days.⁴¹⁰

Severe Symptoms in Children

Most herpangina is mild, but a small number of children develop more serious illness — usually when enterovirus 71 is the cause.¹ Watch for:

• Neck stiffness
• Persistent severe headache
• Confusion or unusual sleepiness
• Trouble breathing
• Seizures
• Muscle weakness

These signs need urgent medical attention. See When to Call the Doctor for the full list.

What Causes Herpangina and How It Spreads

Herpangina is caused by enteroviruses, a family of common viruses. Coxsackievirus A is the most frequent cause, with coxsackievirus B and enterovirus 71 also responsible for many cases.¹ Less common causes include echoviruses and other enteroviruses.¹⁵ Herpangina has no relation to herpes simplex infections — the name refers to the blister-like (“herpetic”) appearance of the sores, not to the herpes virus.⁵

How Herpangina Spreads

The viruses that cause herpangina spread easily, which is why outbreaks happen quickly in daycares, preschools, and schools. The main routes of transmission are:³⁹

• Saliva and other mouth secretions
• Respiratory droplets from coughing, sneezing, or talking
• Stool (especially in diaper-age children)
• Direct contact with fluid from blisters
• Contact with surfaces or toys that have the virus on them

Humans are the only known carriers, but enteroviruses survive on surfaces for hours to days.⁹

Incubation and Contagious Period

The incubation period — the time between exposure and symptoms — is about 3 to 5 days.¹ Children are most contagious during the first week of illness, when fever and sores are present. The virus can continue to shed for several weeks afterward, especially in stool, which is why thorough handwashing matters even after a child seems better.¹⁹

Herpangina vs. Hand, Foot, and Mouth Disease

The main difference: hand, foot, and mouth disease (HFMD) causes a rash on the hands and feet; herpangina sores stay in the mouth. Both are caused by overlapping enteroviruses, so the virus families and many symptoms look similar.³

Feature	Herpangina	Hand, Foot, and Mouth Disease
Where sores appear	Back of the mouth: soft palate, tonsils, uvula, throat	Mouth, hands, feet, and sometimes buttocks or genitals
Body rash	Not typical — a rash on the hands, feet, buttocks, arms, or legs points to HFMD or a related enterovirus illness3	Red spots or blisters on hands, feet, knees, elbows
Typical cause	Coxsackievirus A, occasionally enterovirus 71	Coxsackievirus A16 and enterovirus 71 most often3
Age group	Mostly children under 10	Mostly children under 5
Course	7 to 10 days, supportive care	7 to 10 days, supportive care

If your child only has sores in the back of the mouth with no rash on the body, it’s more likely herpangina. If there’s also a rash on the hands, feet, or buttocks, it’s more likely HFMD. A pediatrician can tell the two apart on exam. The treatment is the same either way: rest, fluids, and pain relief.²

How to Care for Your Child at Home

Herpangina has no specific treatment. Antibiotics and antiviral drugs do not work against enteroviruses.¹² Care focuses on keeping your child hydrated, comfortable, and rested while the infection runs its course.

What helps:

• Cold fluids and soft foods — Popsicles, ice cream, smoothies, applesauce, yogurt, and cold milk soothe sore throats. Encourage small sips often, even if appetite is low¹⁰
• Pain and fever relief — Ask your pediatrician about acetaminophen or ibuprofen dosing for your child’s age and weight. Do not give ibuprofen to infants under 6 months without medical guidance, and never give aspirin to children
• Saltwater rinses — For older children who can rinse and spit, a warm saltwater rinse a few times a day eases mouth pain¹⁰
• Rest in a quiet, well-ventilated room — Helps recovery and limits spread to other family members
• Avoid irritants — Skip hot drinks, citrus juices, spicy foods, salty snacks, and crunchy or acidic foods that sting the sores

Watch hydration closely. Pediatric oral rehydration solutions (like Pedialyte) help if your child won’t drink much water or milk.

What to Eat and Avoid

Many children struggle to swallow when herpangina sores are at their worst, and they refuse to eat. Prioritize fluids over solids. If your child won’t touch food, that’s okay for a few days — staying hydrated is what matters.

Good choices: popsicles, ice cream, cold yogurt, soft bread, scrambled eggs, cold pasta, applesauce.

Avoid: orange juice and citrus drinks, hot soups or tea, spicy foods, salty chips or crackers, carbonated drinks.

Recovery and Immunity

Most children recover fully within 7 to 10 days.⁴ Recovery usually gives immunity to that specific virus strain, but a child can get herpangina again from a different enterovirus.²

When to Call the Doctor

Call your pediatrician or seek emergency care if your child has any of these red flags. Most herpangina is mild, but these signs need a same-day call or an ER visit.

Call your pediatrician right away if your child:

• Refuses fluids or has not had a wet diaper for 8 hours⁷
• Shows signs of dehydration: no tears when crying, dry mouth or tongue, sunken eyes, fewer wet diapers, unusual drowsiness⁷
• Has a rectal temperature of 100.4°F (38°C) or higher and is younger than 3 months old⁶
• Has a fever over 104°F at any age⁶
• Has a fever lasting more than 3 days, or a fever that returns after going away⁶
• Has symptoms lasting more than 7 days
• Has a weakened immune system (cancer treatment, transplant, immune disorder)
• Is a newborn (under 1 month) with any symptoms

Seek emergency care if your child has:

• A stiff neck or persistent severe headache⁶
• Confusion, extreme drowsiness, or unusual irritability⁶
• Trouble breathing⁶
• A seizure
• Persistent vomiting⁶

If you are pregnant and develop symptoms of herpangina or believe you were exposed, contact your OB-GYN promptly.

A Note on Febrile Seizures

High fevers in young children can occasionally trigger a brief febrile seizure. It is frightening to witness, but most febrile seizures are short and not dangerous on their own.⁸ If your child has a seizure, lay them on their side on a safe surface, stay with them, do not put anything in their mouth, and call your pediatrician once it passes.⁸

Call 911 if:⁸

• It’s your child’s first seizure
• The seizure lasts more than 5 minutes
• Your child has trouble breathing
• Your child was injured during the seizure
• Your child does not wake up afterward
• Another seizure starts before your child has returned to normal

Herpangina in Adults

Adults can get herpangina, though it is less common than in children. Cases have been reported in adolescents and young adults — particularly in parents, caregivers, and teachers exposed to young children — and severity can be higher in adults with weakened immune systems, pregnant people, and newborns exposed to the virus.¹

Symptoms in Adults

The symptoms are the same as in children but can feel more intense. Adults more often experience headache, back pain, and body aches alongside the sore throat and mouth sores.¹ The illness still typically resolves in 7 to 10 days.

Higher-Risk Adults

Most adults recover without problems. Three groups need closer attention:

• Pregnant people — See the pregnancy section below
• People with weakened immune systems — Cancer treatment, organ transplant, HIV, or immune-suppressing medications can lead to more severe or prolonged illness. Contact your doctor early⁹
• Newborns under 1 month with symptoms or a known close exposure — Call the pediatrician promptly. Seek immediate medical evaluation if the newborn has a fever, is feeding poorly, seems unusually sleepy, has trouble breathing, or shows any other signs of illness⁹

Herpangina and Pregnancy

Contact your OB-GYN if you develop herpangina symptoms during pregnancy or are exposed to someone who has it. One older population-based study reported an association between herpangina in pregnancy and outcomes including low birth weight, preterm delivery, and small-for-gestational-age infants.¹¹ The CDC currently states there is no clear evidence that non-polio enterovirus infection during pregnancy increases the risk of miscarriage, stillbirth, or congenital problems, but recommends pregnant people contact their doctor if exposed.⁹

There is no antiviral treatment for herpangina, so management in pregnancy is supportive: rest, fluids, pain relief approved by your OB, and monitoring for complications.

Treatment for Adults

Adult treatment mirrors pediatric care: rest, fluids, soft cold foods, saltwater rinses, and over-the-counter pain relievers. See your doctor if you have a high fever lasting more than 3 days, severe difficulty swallowing, signs of dehydration, neurological symptoms, or symptoms that last more than 7 days.

How Herpangina Is Diagnosed

A pediatrician or doctor diagnoses herpangina with a physical exam and a review of symptoms. Tests are rarely needed because the sore location — back of the mouth, soft palate, and tonsils — is distinctive.²⁴ In rare cases where a specific enterovirus is suspected — such as severe illness, neurological symptoms, or a local outbreak — a doctor may order a PCR test on a throat or sore swab, a stool sample, or another specimen to identify the virus.⁴

How to Prevent the Spread of Herpangina

Good hygiene is the strongest protection against herpangina. Research on enterovirus 71 outbreaks found that handwashing by children and adult caregivers significantly reduced transmission.¹²¹³

What helps:

• Wash hands often — Use soap and warm water for at least 20 seconds, especially after diaper changes, coughing or sneezing, and before eating. Help young children wash thoroughly
• Disinfect surfaces and toys — Enteroviruses survive on surfaces for hours to days, so wipe down high-touch items (doorknobs, toys, light switches) with an EPA-approved disinfectant⁹
• Cover coughs and sneezes — Use a tissue or elbow, then wash hands
• Keep sick children home — Keep your child home while they have fever, feel too sick to participate, or have uncontrolled drooling from mouth sores. Follow your daycare, school, and local health department’s return-to-care rules³
• Avoid sharing utensils, cups, or food — Especially within a household when someone is sick

Even after symptoms clear, the virus can shed for weeks in stool. Continue strict handwashing for at least 2 weeks after recovery.¹

When to See a Doctor

Herpangina is usually a mild illness that resolves in 7 to 10 days with home care. Call your pediatrician if your child shows signs of dehydration, has a high fever lasting more than 3 days, or has symptoms that persist beyond a week. Seek emergency care for a stiff neck, seizure, trouble breathing, persistent vomiting, or any symptoms in a newborn.

If you’re still unsure what’s causing your child’s mouth sores, our toddler mouth sores guide walks through the most common causes and how to tell them apart.