When Can a Child with Hand, Foot, and Mouth Disease Return to School?
Children with hand, foot, and mouth disease can return to school once their fever has resolved and mouth sores have healed, even if the skin rash on hands and feet is still present. 1
Rationale for This Approach
The timing of school return for HFMD differs fundamentally from other childhood viral illnesses because of the disease's unique transmission pattern:
- By the time HFMD is diagnosed, the child has likely been shedding virus for weeks, posing limited additional risk to classmates beyond what has already occurred 1
- Viral shedding can continue in stool for weeks after clinical recovery, making it impractical to wait for complete viral clearance 2, 3
- Exclusion based solely on healing skin lesions is not necessary since these represent the late stage of infection when contagiousness is already declining 1
Specific Return-to-School Criteria
A child may return when both of the following are met:
- Fever-free (without fever-reducing medications) 1
- Oral ulcers/mouth sores have healed sufficiently that the child can eat and drink comfortably 1
Persistent skin lesions on hands and feet are NOT a reason to exclude the child from school. 1
Prevention Measures Upon Return
When the child returns to school, emphasize these practices:
- Thorough handwashing with soap and water is more effective than alcohol-based sanitizers for HFMD prevention 1
- Avoid sharing utensils, cups, or food with other children 1
- Standard hygiene practices should be maintained, though the child is no longer highly contagious once fever and oral lesions have resolved 1
Common Pitfalls to Avoid
Do not require complete resolution of all skin lesions before school return. This unnecessarily prolongs absence and provides no meaningful reduction in transmission risk, as the child has already been infectious during the incubation period before diagnosis. 1
Do not confuse HFMD with more restrictive illnesses like measles or varicella, which have different exclusion requirements. 4
Clinical Context
This permissive approach is justified because:
- HFMD lesions typically resolve in 7-10 days without complications 2, 3
- The disease is usually benign and self-limited 3
- Common sense should prevail when deciding how contagious an individual child may be 1
- Prolonged exclusion causes unnecessary educational disruption without meaningful public health benefit 1