When to Return to Daycare After Hand, Foot, and Mouth Disease
Children with Hand, Foot, and Mouth Disease (HFMD) can return to daycare once fever resolves and mouth sores heal, even if skin rash is still present. 1
Understanding HFMD
- HFMD is a common viral illness caused by enteroviruses (primarily coxsackieviruses) that predominantly affects children under 5 years of age 2
- Characterized by low-grade fever, painful oral ulcerations, and maculopapular or papulovesicular rash on hands and feet 2
- Lesions typically resolve in 7-10 days without specific treatment 2, 3
- The disease is highly contagious and spreads through:
- Fecal-oral contact
- Oral-oral contact
- Respiratory droplets 2
Return to Daycare Guidelines
- Children should avoid close contact with others until:
- Fever has resolved AND
- Mouth sores have healed 1
- The presence of skin rash alone (on hands and feet) is not a reason to exclude a child from daycare once fever is gone and mouth sores have healed 1
- No-nit policies for head lice have been abandoned as they are not evidence-based, and similarly, exclusion based solely on healing skin lesions for HFMD is not necessary 4
Rationale for Guidelines
- Children are most contagious during the first week of illness 3
- The virus may be present in feces for several weeks, making complete exclusion until all viral shedding stops impractical 3
- By the time HFMD is diagnosed, the child has likely had the infection for weeks, posing limited additional risk to others 4
- Common sense should prevail when deciding how contagious an individual child may be 4
Prevention Measures When Returning to Daycare
- Hand hygiene is the most important preventive measure 1
- Thorough handwashing with soap and water is more effective than alcohol-based hand sanitizers for enteroviruses 1
- Environmental cleaning of toys and objects that may be placed in children's mouths is crucial 1
- Standard precautions should be followed in childcare settings 1
- Avoid sharing utensils, cups, or food 4
Special Considerations
- Immunocompromised children may experience more severe disease and should be monitored closely 1
- In rare cases, HFMD can lead to neurological complications, particularly with Enterovirus 71 infections 5
- Atypical presentations with widespread rash beyond hands, feet, and mouth may occur 1
Important Caveats
- Exclusion from daycare based solely on the presence of skin lesions is not necessary once fever is gone and mouth sores have healed 1, 3
- Unlike bacterial infections where return to daycare may require negative cultures, HFMD does not require laboratory confirmation of viral clearance before return 3
- The focus should be on practical prevention measures rather than extended exclusion periods that provide minimal additional benefit 3
Remember that while these are general guidelines, local daycare policies may vary, and parents should communicate with daycare providers about specific requirements for return.