Hand-Foot-and-Mouth Disease—Child Care and Schools

What is hand-foot-and-mouth disease?

Hand-foot-and-mouth disease is a common set of symptoms associated with viral infections that are most frequently seen in the summer and fall. This illness is generally mild.

What are the signs or symptoms?

• Tiny blisters in the mouth and on the fingers, palms of hands, buttocks and diaper area, and soles of feet, lasting just over a week. These blisters can affect 1, several, or all of these body sites.

• Common cold symptoms like fever, sore throat, runny nose, and cough may be present. The most troublesome symptom is blisters in the mouth, which can make eating or drinking difficult.

• Signs of dehydration include dry mouth, no tears, or no urine for 8 hours.

• Some children will drool excessively because it hurts to swallow the saliva.

• Less common symptoms include vomiting and diarrhea.

• Hand-foot-and-mouth disease may rarely cause neurologic symptoms.

What are the incubation and contagious periods?

• Incubation period: 3 to 6 days.

• Contagious period: Virus may be shed for weeks to months in the stool after the infection starts; respiratory shedding of the virus is usually limited to 1 to 3 weeks.

How is it spread?

• Respiratory (droplet) route: Contact with large droplets that form when a child talks, coughs, sneezes, or sings. These droplets can land on or be rubbed into the eyes, nose, or mouth. The droplets do not stay in the air; they usually travel no more than 3 feet and fall onto the ground.

• Contact with respiratory secretions or contaminated objects from children who carry these viruses.

• Fecal-oral route: Contact with feces from an infected person, typically when the person contaminates their fingers and touches an object another person then touches. Children who have contact with the contaminated surface may place their fingers into their own or another person’s mouth.

Blisters inside a child’s mouth

AMERICAN ACADEMY OF PEDIATRICS, COURTESY OF GEORGE NANKERVIS, MD

A close-up view of a child's open mouth shows several blisters scattered on the roof of the mouth. The blisters have a red ring around the exterior and a pale center.

Blisters on a child’s feet

AMERICAN ACADEMY OF PEDIATRICS.

A view of the tops of a child's feet with circular blisters across the surface and toes of both feet. Pink and red blisters appear scattered and in clusters on the child's left foot, and the child's right foot has faint scattered blisters.

How do you control it?

• Use good hand-hygiene technique at all the times listed in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition , especially after toilet use and handling soiled diapers.

• Prevent contact with respiratory secretions. Teach children and educators to cough or sneeze into a disposable tissue or their inner elbow/upper sleeve and to avoid covering the nose or mouth with bare hands. After coughing or sneezing, practice hand hygiene to prevent the spread of respiratory droplets. Ensure that anyone who contacts mucus or debris on their skin or surfaces washes their hands and any other contaminated skin immediately. Change or cover clothing soiled with mucus. Dispose of facial tissues that contain nasal secretions after each use.

What are the roles of the educator and the family?

• Report the infection to the staff member designated by the early childhood education program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms.

• Encourage the family to seek medical advice if the child is very uncomfortable with signs of illness from the infection, such as an inability to drink or eat, or if the child seems very ill.

Exclude from educational setting?

No, unless

• The child has mouth sores with uncontrolled drooling that staff members find difficult to manage.

• The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

• The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition ).

• In some cases, the local health department will determine if exclusion is needed to control an outbreak.

Note: Exclusion does not reduce disease transmission because some children may shed the virus without symptoms, and those who are ill can shed the virus in their stool for weeks.

Readmit to educational setting?

Yes, when all the following criteria are met:

When exclusion criteria are resolved, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group

Note: Sores do not need to be healed for the child to return.