Isolation Period for Children with Hand, Foot, and Mouth Disease
Children with hand, foot, and mouth disease (HFMD) should be kept in isolation until their blisters have dried up and crusted over, typically for 24-48 hours after the onset of symptoms, though they may remain contagious for several weeks through fecal shedding.
Understanding Hand, Foot, and Mouth Disease
Hand, foot, and mouth disease is a common viral illness primarily affecting children under 5 years of age. It is characterized by:
- Fever
- Sores in the mouth
- Rash on the palms of hands and soles of feet
- Occasionally rash on buttocks and other areas
The disease is caused by enteroviruses, most commonly:
- Coxsackievirus A16 (traditional cause)
- Coxsackievirus A6 (increasingly common cause in recent years)
- Enterovirus 71
Isolation Recommendations
Duration of Isolation
- Minimum isolation period: 24-48 hours after symptom onset 1
- Extended isolation: Until all blisters have dried up and crusted over
- School/childcare return: Children can return when fever-free and blisters have dried
Rationale for Isolation Timing
The isolation period is based on the period of highest contagiousness, which occurs during the acute phase of illness when vesicular lesions are present. Studies suggest that:
- The virus is most contagious during the first week of illness
- Viral shedding may continue in stool for several weeks after symptoms resolve 2
- Transmission risk decreases significantly once blisters have dried
Prevention of Transmission
Hygiene Practices
- Hand hygiene: Frequent handwashing with soap and water, especially after diaper changes and before handling food 1
- Avoid sharing: Don't share utensils, cups, towels, or other personal items
- Surface cleaning: Clean frequently touched surfaces and toys with disinfectant
Additional Precautions
- Avoid close contact (kissing, hugging, sharing utensils) with infected individuals
- Cover mouth and nose when coughing or sneezing
- Properly dispose of tissues and wash hands immediately after
Special Considerations
Daycare and School Settings
While complete exclusion from childcare until the virus is completely cleared from stool is impractical 2, the following guidelines should be followed:
- Keep children home during the most contagious period (when they have fever and active blisters)
- Inform the school or daycare about the diagnosis
- Ensure proper handwashing facilities and protocols are in place
Family Transmission
HFMD can spread within families, including to adults 3. Adult caregivers should:
- Practice good hand hygiene
- Avoid direct contact with blisters or secretions
- Be aware that immunocompetent adults can contract HFMD, though often with milder symptoms
Treatment During Isolation
Treatment is supportive and focuses on symptom management:
- Adequate hydration (cold liquids may be better tolerated with mouth sores)
- Pain relief with acetaminophen or ibuprofen as needed
- Soft, non-spicy foods that don't require much chewing
- Cold treats (popsicles, ice cream) may soothe mouth sores
When to Seek Medical Attention
While isolation continues, seek medical attention if the child develops:
- Signs of dehydration (dry mouth, decreased urination)
- High fever that doesn't respond to medication
- Unusual drowsiness or lethargy
- Neurological symptoms (headache, stiff neck, seizures)
Remember that while the isolation period is relatively short (24-48 hours after symptom onset until blisters dry), the virus may continue to be shed in stool for weeks, so continued good hygiene practices are essential even after the child returns to normal activities.