When can a child with Hand, Foot, and Mouth Disease (HFMD) return to daycare?

When Can a Child with Hand, Foot, and Mouth Disease Return to Daycare

Children with hand, foot, and mouth disease (HFMD) can return to daycare after all lesions have dried and crusted over, typically 7-10 days after symptom onset, as they are no longer considered contagious at this point. While there are no specific guidelines from infectious disease societies addressing HFMD return-to-daycare timing, this recommendation follows standard infection control practices for viral exanthems.

Understanding Hand, Foot, and Mouth Disease

HFMD is a highly contagious viral illness primarily affecting children under 5 years of age. It is characterized by:

• Low-grade fever
• Maculopapular or papulovesicular rash on hands and feet
• Painful oral ulcerations
• Transmission through fecal-oral, oral-oral, and respiratory droplet contact

The disease is most commonly caused by enteroviruses, particularly coxsackieviruses A6, A10, A16, and enterovirus 71 1.

Contagious Period and Return to Daycare Criteria

The contagious period for HFMD begins before symptoms appear and continues until:

• All blisters/lesions have dried up and crusted over
• No new lesions have appeared for at least 24 hours
• Child has been fever-free for at least 24 hours without fever-reducing medication

While specific HFMD guidelines are limited, we can apply principles from similar infectious diseases:

1. For impetigo (another contagious skin condition), children can return to daycare after 24 hours of effective antibiotic therapy 2
2. For other infectious diseases, public health authorities recommend exclusion until the risk of transmission is minimized 3

Key Considerations for Daycare Return

Factors Supporting Return:

• Complete resolution of fever for at least 24 hours without antipyretics
• All lesions have dried and crusted over (typically 7-10 days after onset)
• Child feels well enough to participate in activities
• Child can maintain good hygiene practices

Prevention of Transmission:

• Proper handwashing for both the child and caregivers is crucial
• Disinfection of potentially contaminated surfaces and toys
• Covering mouth and nose when coughing or sneezing

Special Considerations

1. Atypical or Severe Cases: Some HFMD cases, particularly those caused by Coxsackievirus A6, may present with more extensive lesions or atypical distribution 4. These cases may require longer exclusion periods.

2. Local Regulations: Some jurisdictions may have specific requirements for return to childcare settings. Parents and healthcare providers should consult local public health authorities for guidance 3.

3. Immunocompromised Contacts: If there are immunocompromised children or staff at the daycare facility, additional precautions may be warranted.

Practical Advice for Parents and Daycare Providers

• Ensure the child is well-hydrated and comfortable before returning to daycare
• Inform the daycare provider about the diagnosis so they can monitor for symptoms in other children
• Continue good hand hygiene practices after returning to daycare
• Be aware that the virus may continue to be shed in stool for several weeks, emphasizing the importance of proper handwashing after toileting

Remember that while HFMD typically follows a benign and self-limiting course, it is highly contagious. Following proper exclusion guidelines helps prevent outbreaks in daycare settings and protects vulnerable populations.