Hand, Foot, and Mouth Disease (HFMD) is a common viral illness that frequently affects infants and young children, often leading to outbreaks in daycare and school settings. The illness typically presents with a mild fever, followed by painful sores in the mouth and a characteristic rash on the hands and feet. Determining the appropriate time for a child to return depends on meeting specific health criteria designed to limit further transmission. This guidance clarifies the necessary symptom resolution required before a child can safely return to school or childcare.
How the Virus Spreads
HFMD is caused by viruses belonging to the Enterovirus genus, most commonly Coxsackievirus A16, which is highly contagious. The virus is primarily spread through direct contact with an infected person’s respiratory secretions, such as droplets dispersed by coughing or sneezing.
Transmission also occurs through contact with the fluid from the blisters on the skin and mouth. The virus is also shed in the stool, leading to the fecal-oral route of transmission, especially common where diaper changing is frequent. A child is considered most contagious during the first week of the illness.
The Required Symptom Checklist for Return
The decision to allow a child back into a group setting is based on the resolution of the most infectious and disruptive symptoms, as mandated by institutional guidelines.
Fever Resolution
A child must be completely free of fever for a full 24 hours before readmission. This fever-free status must be achieved naturally, without the use of fever-reducing medications like acetaminophen or ibuprofen.
Lesion Status
The status of the characteristic blisters and mouth sores is an important consideration for return. While residual spots or scabs on the hands and feet may remain, any open, weeping, or draining lesions must be dried out or crusted over. Crucially, the mouth sores must be healed sufficiently so the child is not experiencing uncontrolled drooling, which is a major vehicle for viral spread through saliva.
General Health and Hydration
The child’s general state of health and comfort must permit full participation in the classroom environment. They should be able to eat and drink enough to stay hydrated without requiring excessive individual attention from staff due to pain or discomfort. If mouth pain is still causing significant difficulty with swallowing or leading to fussiness and lethargy, the child is not considered well enough to return.
Managing Hygiene After Rejoining School
Although the acute symptoms have passed, the virus can continue to be shed from the body for an extended period, particularly in the stool. Viral shedding through feces can persist for several weeks after the child has fully recovered and returned to school. This prolonged shedding highlights the need for rigorous hygiene practices to prevent secondary spread.
Strict handwashing is the primary defense against the continued risk of transmission. Parents should ensure the child washes their hands with soap and water for at least 20 seconds, especially after using the toilet or before eating. This protocol must also be strictly followed by parents and caregivers after changing diapers or assisting the child in the bathroom.
Teaching the child proper respiratory etiquette is also important, which includes covering all coughs and sneezes with a tissue or the elbow. Routine cleaning and disinfecting of shared items and surfaces remains a necessity. Frequently touched objects like toys, doorknobs, and tables should be cleaned regularly to mitigate the risk posed by any lingering viral particles.