When can a child with hand, foot, and mouth disease (HFMD) return to school?

When to Return to School After Hand, Foot, and Mouth Disease

Children with hand, foot, and mouth disease can return to school once they are fever-free for 24 hours without fever-reducing medication and feel well enough to participate in classroom activities, even if they still have a rash. 1

Understanding Hand, Foot, and Mouth Disease

Hand, foot, and mouth disease (HFMD) is a common viral illness primarily affecting children under 5 years of age, caused by enteroviruses, most commonly coxsackieviruses. It presents with:

• Low-grade fever
• Maculopapular or papulovesicular rash on hands and feet
• Painful oral ulcerations
• Symptoms typically lasting 7-10 days 1

Return to School Guidelines

Key Criteria for Return:

• Fever-free for 24 hours without using fever-reducing medications
• Child feels well enough to participate in school activities
• No specific requirement to wait until all lesions have resolved

Important Considerations:

• HFMD is most contagious during the first week of illness
• Transmission occurs through:
  • Fecal-oral contact
  • Oral-oral contact
  • Respiratory droplets 1

Prevention of Transmission

To minimize spread of HFMD in school settings:

1. Hand hygiene is crucial:

   • Regular handwashing with soap and water
   • Use of alcohol-based hand sanitizers when soap is unavailable 2

2. Environmental measures:

   • Disinfection of frequently touched surfaces
   • Proper cleaning of shared items 3

3. Behavioral guidance:

   • Avoid close contact with infected individuals
   • Discourage sharing of food, drinks, and personal items
   • Cover mouth when coughing or sneezing 2

Common Pitfalls to Avoid

1. Unnecessary exclusion: Unlike with head lice where some schools have implemented "no-nit" policies that unnecessarily keep children out of school 2, there is no need to keep children with HFMD out of school once fever has resolved and they feel well enough to participate.

2. Overestimation of contagion risk: While HFMD is contagious, the risk of transmission decreases significantly after the acute phase of illness has passed.

3. Confusing with other conditions: HFMD can be confused with other conditions like herpes simplex virus, herpangina, or erythema multiforme 4. Proper identification is important for appropriate management.

Special Situations

• For severe cases with complications (rare): Return to school should be delayed until cleared by a healthcare provider
• For immunocompromised children: May require individualized return-to-school plans

Remember that HFMD typically resolves spontaneously within 7-10 days without complications 5, and keeping children out of school unnecessarily can negatively impact their education and social development.