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

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

A child with Hand, Foot, and Mouth Disease (HFMD) can return to school once fever has resolved and the child feels well enough to participate in activities, typically after 3-5 days, regardless of whether lesions are still present.

Understanding HFMD and School Attendance

Hand, Foot, and Mouth Disease is a common viral illness primarily affecting children under 5 years of age. It is characterized by:

• Fever
• Painful oral ulcerations
• Maculopapular or papulovesicular rash on hands and feet
• Self-limiting course of 7-10 days 1

Transmission and Contagiousness

HFMD spreads through:

• Fecal-oral contact
• Oral-oral contact
• Respiratory droplets 1

The child is most contagious during the first week of illness, particularly during the fever stage.

Return to School Guidelines

The approach to school attendance with HFMD follows similar principles to those established for other common childhood conditions:

1. Fever Resolution: The child should be fever-free for at least 24 hours without the use of fever-reducing medications.

2. Clinical Improvement: The child should feel well enough to participate in school activities.

3. No Exclusion Based on Lesions Alone: Similar to the American Academy of Pediatrics' guidance on head lice, the presence of skin lesions alone should not restrict school attendance once the child feels well 2.

Key Points for Healthcare Providers and Parents

• No Prolonged Exclusion Necessary: Unlike outdated "no-nit" policies for head lice that unnecessarily kept children out of school 2, there is no evidence supporting prolonged exclusion for HFMD once fever resolves and the child feels well.

• Focus on Hand Hygiene: Proper handwashing is more effective at preventing transmission than exclusion from school 2. Schools should emphasize hand hygiene practices among all students.

• Common Pitfalls to Avoid:

  • Requiring complete resolution of all skin lesions before return to school (unnecessary and can lead to excessive school absences)
  • Focusing only on visible symptoms rather than fever and overall wellness
  • Failing to emphasize hand hygiene as the primary prevention strategy

Practical Recommendations

1. For Healthcare Providers:

   • Advise parents that children can return to school after fever resolution and when the child feels well enough to participate
   • Emphasize that lesions may persist for 7-10 days but are not a reason for continued exclusion

2. For Parents:

   • Ensure your child is fever-free for 24 hours without medication
   • Teach and reinforce proper handwashing
   • Send your child back to school when they feel well enough to participate

3. For Schools:

   • Implement hand hygiene education and practices
   • Allow children to return once fever-free and feeling well
   • Avoid policies requiring complete resolution of skin lesions

By following these evidence-based guidelines, we can minimize unnecessary school absences while still taking appropriate measures to limit disease transmission.