Can I send my child to school with hand, foot, and mouth disease (HFMD)?

Hand, Foot, and Mouth Disease: School Attendance Guidelines

Children with hand, foot, and mouth disease should not attend school until their blisters have disappeared, as they are particularly infectious during this period.

Disease Overview

• Hand, foot, and mouth disease (HFMD) is a common viral illness primarily affecting children under 5 years of age, characterized by fever, vesicular rashes on hands and feet, and oral ulcers 1, 2
• The disease is typically self-limiting with symptoms lasting less than one week 3
• HFMD is most commonly caused by coxsackievirus A16, but can also be caused by coxsackievirus A6, A10, and enterovirus 71 2

Infectivity and Transmission

• HFMD is highly contagious, particularly during the active blister phase 4
• The virus can be present in feces for several weeks after symptoms resolve 4
• Transmission occurs through:
  • Direct contact with nasal discharge, saliva, fluid from blisters, and fecal matter 2
  • Respiratory droplets from coughing and sneezing 2
  • Contact with contaminated surfaces or objects 2

School Attendance Guidelines

• Children should not attend school or childcare until blisters have disappeared, as they are most infectious during this period 4
• While some sources note that exclusion from school may not be practical due to prolonged viral shedding in feces, the priority should be preventing transmission during the most infectious phase (when blisters are present) 4
• Schools should implement proper hand hygiene protocols to minimize transmission risk 5

Prevention Measures in School Settings

• Hand hygiene is the single most important method of preventing transmission:

  • Wash hands with soap and water for at least 20 seconds 5
  • If soap and water are unavailable, use alcohol-based hand sanitizers containing at least 60% alcohol 5
  • Hand washing should occur before and after each patient contact, after removing gloves, and before and after performing invasive procedures 5

• Additional prevention measures:

  • Clean and disinfect frequently touched surfaces 5
  • Avoid sharing utensils, cups, and personal items 5
  • Teach children proper respiratory hygiene/cough etiquette 5
  • Post proper hand-washing instructions in appropriate areas 5

Home Care During Illness

• Provide symptomatic treatment for fever and discomfort 4
• Ensure adequate fluid intake to prevent dehydration, especially if mouth sores make drinking painful 4
• Soft, cold foods may be easier to eat with mouth sores 4
• Monitor for rare but serious complications such as neurological symptoms, which may require immediate medical attention 2, 6

When to Return to School

• Children can return to school when:
  • Blisters have disappeared 4
  • Fever has resolved for at least 24 hours without fever-reducing medication 5
  • The child feels well enough to participate in regular activities 5

Special Considerations

• Parents should be informed about the disease and its management 5
• For children with compromised immune systems, consultation with healthcare providers is recommended before returning to school 5
• While HFMD typically resolves without complications, parents should be aware that nail changes may occur weeks after the initial infection 1