Return to School for Hand, Foot, and Mouth Disease
Children with hand, foot, and mouth disease (HFMD) do not need to be excluded from school and can attend once they are fever-free and feel well enough to participate in normal activities. 1, 2
Why School Exclusion Is Not Recommended
The American Academy of Pediatrics explicitly recommends against excluding children with HFMD from school because exclusion policies cause unnecessary absence without meaningfully reducing transmission. 1 This approach is based on several key factors:
- By the time HFMD is diagnosed, the child has already been infectious for a significant period, making school exclusion ineffective at preventing spread. 1
- The virus can be present in feces for several weeks after symptoms resolve, making it impractical to exclude children until they are no longer shedding virus. 3
- Children are most contagious before the characteristic rash appears, so exclusion after diagnosis misses the window of peak transmission. 4
Specific Return-to-School Criteria
Your child can return to school when:
- Fever has resolved without the use of fever-reducing medications (such as acetaminophen or ibuprofen). 2
- The child feels well enough to participate in normal school activities without requiring special accommodations. 2
- There is no specific requirement to wait for blisters or lesions to heal, as the child is no longer highly contagious once fever resolves. 1, 3
Management While at School
Rather than excluding the child, the American Academy of Pediatrics recommends:
- Keep the child in class but discourage close direct head-to-head contact with others to reduce transmission risk. 1
- Emphasize hand hygiene as the primary intervention, though this has limited effectiveness once an outbreak has begun. 1, 4
- Environmental disinfection of frequently touched surfaces may help reduce transmission, though person-to-person contact is the primary route. 1
Important Clinical Context
HFMD is a self-limited viral illness that typically resolves in 7-10 days without complications. 4 The disease is caused by enteroviruses and coxsackieviruses, presenting with low-grade fever, oral ulcerations, and a rash on hands and feet. 4 Treatment is purely supportive, focusing on hydration and pain relief with acetaminophen or ibuprofen as needed. 4
Common Pitfall to Avoid
Do not confuse HFMD with conditions requiring antibiotic therapy or mandatory exclusion periods (such as measles, rubella, or varicella), as HFMD has no specific treatment and exclusion serves no purpose. 1, 5