Hand, Foot, and Mouth Disease (HFMD) is a common, highly contagious viral infection that most frequently affects infants and children younger than five years old. It is caused by viruses belonging to the enterovirus family. The illness is typically mild and self-limiting, causing a characteristic rash on the hands and feet, along with painful sores in the mouth. When a child receives this diagnosis, parents must quickly assess their own risk of infection and determine how to manage their work and childcare responsibilities.
How Hand, Foot, and Mouth Disease Spreads
HFMD transmission occurs primarily through direct contact with an infected person’s respiratory secretions, such as saliva, nasal mucus, and droplets from coughing or sneezing. The virus is also present in the fluid from the blisters, meaning contact with broken lesions can spread the infection. A major route of transmission, particularly in childcare settings, is the fecal-oral route, where the virus is passed through contact with stool.
The incubation period typically ranges between three and six days. An individual is most contagious during the first week of the illness, often before the rash even appears. The virus can continue to shed in the stool for several weeks after all visible symptoms have disappeared.
Determining if the Parent is Contagious
Adults are susceptible to HFMD, though they often experience milder symptoms due to prior exposure. Many adults can contract the virus and remain completely asymptomatic, meaning they can unknowingly transmit the infection to others. When adults do develop symptoms, they are similar to a child’s, including fever, sore throat, and the characteristic rash.
If a parent develops symptoms, such as a fever or new skin lesions, they should treat themselves as contagious and should not go to work. An adult with symptoms is advised to stay home until the fever has resolved and any open sores or blisters have begun healing. For the asymptomatic parent caring for a sick child, strict hygiene protocols are necessary to prevent viral spread to coworkers or the workplace environment.
Frequent and thorough handwashing with soap and water for at least 20 seconds is the most effective preventative measure, especially after changing diapers or assisting a child with toileting. Parents should also regularly clean and disinfect surfaces and objects the child has touched, such as toys, doorknobs, and countertops. Avoiding the sharing of food, utensils, or cups with the infected child limits the risk of passing the virus through saliva.
When the Child Can Return to Daycare or School
The timeline for a child’s return to a group setting is dictated by the facility’s exclusion criteria, which vary but follow general public health guidelines. Most daycares and schools require that the child be fever-free for a full 24 hours without the use of fever-reducing medication, ensuring the child is no longer in the most contagious phase of the illness.
Another common stipulation is that any open blisters or weeping sores must have dried up or crusted over. This rule is in place because the fluid inside these lesions contains a high concentration of the virus, posing a direct transmission risk. If the child has painful mouth sores, they may also be excluded if they are unable to eat, drink, or control excessive drooling.
Some facilities may not require exclusion solely because of a residual rash or faded spots, provided the child meets all other wellness criteria. Since the virus can continue to be found in the stool for several weeks, exclusion beyond the acute symptomatic phase is often considered ineffective for stopping transmission. Parents should confirm their specific facility’s policy, but once the child is well enough to participate and free of fever and open lesions, they are typically cleared for re-entry.