Hand, foot and mouth disease at daycare, what to expect

Hand, foot and mouth disease goes through group care settings regularly, and it produces a very particular kind of parental alarm. The name sounds serious. The spots look dramatic. And a child with blisters in their mouth is genuinely miserable for a few days.

It also produces one of the questions we are asked most often, and one where the honest answer surprises people: a child who feels well enough to join in can usually keep attending.

Here is the illness, the timeline, and the reasoning behind that.

What it is

Hand, foot and mouth disease is caused by a group of viruses called enteroviruses. It has nothing to do with foot and mouth disease in farm animals, despite the similar name, and the two are unrelated.

It is most common in children under 10. Older children and adults can catch it, and often have milder symptoms when they do. In a room of young children it moves easily, which is why most families with a child in group care encounter it at some point.

It clears up on its own. The spots and blisters usually go away after about 7 to 10 days, and most children need nothing beyond comfort and fluids.

The timeline

The sequence is fairly consistent, which helps when you are trying to work out what you are looking at.

Symptoms start 3 to 6 days after a child is infected. The first signs are general and unremarkable: fever, sore throat, headache, or a loss of appetite. At this stage the illness looks like the beginning of any ordinary bug, which is a large part of why it spreads. Nobody knows yet what it is.

About two days after the fever begins, painful blisters develop inside the mouth. This is usually the point at which a parent realises something specific is going on, because a child who was eating normally suddenly refuses food and drink.

Red spots then appear on the hands and the feet, and sometimes elsewhere on the body. This is the stage the illness is named after and the stage parents find most alarming to look at.

Then it resolves. Spots and blisters generally clear within about 7 to 10 days from the start.

How it spreads

Several routes, and one of them explains everything about the exclusion guidance.

It spreads through close contact with an infected person, through shared utensils, through coughing and sneezing, and through contact with the fluid inside the blisters. All of that is fairly intuitive.

It also spreads through contact with feces. The virus lives in the bowels, which is what puts the "entero" in enterovirus, and this is the route that matters in a room where children are in diapers or learning to use the toilet.

The fact that changes everything

A child is most contagious during the first week of the illness.

After that, the virus can remain in the feces for several weeks, and can still spread during that time.

Sit with that for a moment, because it reshapes the whole question. A child whose spots faded three weeks ago may still be shedding the virus. There is no clean point at which a recovered child becomes non-infectious.

This is why HealthLink BC's guidance reads as it does: a child may continue to attend daycare if they feel well enough to take part in activities, and the risk to other children is not great where proper hygiene practices are followed.

The alternative would be excluding well children for many weeks with no realistic end point, and it still would not close the window. On top of that, in any room where the virus is circulating, some children carry it with no visible symptoms at all. An exclusion policy built around visible spots misses those children entirely while penalising the ones whose symptoms happened to show.

What actually reduces spread

The answer is repetitive and unexciting, which is probably why it gets less attention than it deserves.

Handwashing, done properly and done every time. After every diaper change. After every trip to the toilet. Before food is handled. By adults as much as by children, because an educator's hands move between more children than any child's hands do.

Cleaning shared surfaces and toys, particularly the ones that reliably end up in mouths in a room of toddlers.

Those routines run every day in a licensed centre regardless of what is going around, and they are what makes the difference during an outbreak of an illness that spreads this way. Licensed centres in British Columbia operate under the Child Care Licensing Regulation, which sets requirements for health, hygiene, and sanitary practice.

So when does a child stay home

The BC Centre for Disease Control's guidance for child care settings gives one test that covers illness generally.

A child should stay home if they are sick and unable to participate fully in the routine activities of the day. They can return when their symptoms have improved enough for them to take part again. BCCDC also states that child care facilities do not need to monitor children or staff for symptoms of illness.

Applied to hand, foot and mouth, that usually means a few days at home during the worst of it. The mouth blisters are the deciding factor far more often than the spots are. A child whose mouth hurts too much to drink is not going to manage a day in a group room, and is a child who needs watching at home.

A child who is comfortable, eating, drinking, and joining in is a different case, even with visible spots still on their hands. Our post on when to keep your child home sick from daycare works through the same test for the other illnesses that come round each year.

How the rash actually looks to a parent

The spots are the part families find hardest to look at, and they are also the part that matters least.

Red spots across the hands and feet look far more serious than they are. They fade on their own, they do not scar, and they are a visible sign of an illness that is already running its normal course. A parent seeing them for the first time often assumes something has gone badly wrong. In the great majority of cases nothing has.

What deserves attention is how the child is doing rather than how the rash looks. A child who is drinking, sleeping reasonably, and interested in what is going on around them is recovering, spots or no spots. A child who will not drink needs watching closely, even on a day when the rash looks better than it did.

Peeling skin and nails, weeks later

One late effect catches families by surprise, because it arrives long after everyone has stopped thinking about the illness.

HealthLink BC reports that peeling skin and loss of fingernails or toenails have been seen, mostly in children, within weeks of having hand, foot and mouth disease. It also notes that the link is uncertain, so this is something observed after the illness rather than something the virus is known to cause.

Either way it looks alarming and is generally harmless. A nail lifts at the base and comes away, usually without pain, and a new one grows in behind it over the following months. Because it happens weeks after the spots faded, parents rarely connect the two and often assume the nail was knocked. If a nail comes off cleanly and the skin underneath looks normal, keeping it clean is enough. Speak to your health care provider if the surrounding skin looks red, swollen, or sore.

Looking after a child at home

Fluids are the thing to watch. Mouth blisters make swallowing painful, and a child who stops drinking can become dehydrated faster than parents expect.

Cool drinks tend to go down more easily than warm ones. Soft, bland foods are usually more manageable than anything hot, salty, spicy, or acidic, and citrus juice in particular is likely to be refused. Small amounts offered often work better than a full cup presented at set times.

Contact your health care provider if your child will not drink at all, if you notice fewer wet diapers than usual, if a high fever persists, if they seem unusually drowsy, or if anything about how they look worries you. Those are the signs worth a professional opinion rather than a wait-and-see.

Telling the centre

Please tell us when your child is diagnosed, even if they are staying home for a few days anyway.

It lets us mention to other families in general terms that it is going around, so they know what the first fever might turn into. It lets us tighten hygiene routines in the room. And it means that if another child develops a fever the next day, we already know what we are probably looking at.

We will not identify your child to other families. What we share is that an illness is circulating, which is the part other parents actually need.

Frequently asked questions

What is hand, foot and mouth disease?

It is a common childhood infection caused by a group of viruses called enteroviruses. It is most common in children under 10, though older children and adults can catch it too. It produces painful blisters inside the mouth and a rash of red spots on the hands and feet, and it usually clears up on its own within about 7 to 10 days.

How long after exposure do symptoms appear?

Symptoms usually start 3 to 6 days after a child is infected with the virus. The first signs tend to be a fever, a sore throat, a headache, or a loss of appetite, which look like the start of any ordinary illness. The distinctive spots and blisters arrive after that.

What is the usual timeline of the illness?

It generally begins with fever and other general symptoms. About two days after the fever starts, painful blisters develop inside the mouth. Red spots then appear on the hands and feet, and sometimes elsewhere on the body. The spots and blisters usually go away after about 7 to 10 days.

Can my child still attend daycare with hand, foot and mouth disease?

HealthLink BC's guidance says a child may continue to attend daycare if they feel well enough to take part in activities, and that the risk to other children is not great where proper hygiene practices are followed. In practice the mouth blisters are what usually keep a child home for a few days, because they are painful and can stop a child eating and drinking comfortably.

How does it spread?

Through close contact with an infected person, shared utensils, coughing and sneezing, and contact with the fluid inside the blisters or with feces. That last route is why handwashing after diaper changes and toilet trips matters so much in a group setting, and why it stays relevant long after a child looks well again.

How long is my child contagious?

A child is most contagious during the first week of the illness. After that the virus can remain in the feces for several weeks and can still be passed on during that time. This is the fact that changes what a sensible response looks like, because there is no realistic point at which a recovered child stops being able to spread it.

If the virus lasts weeks in the stool, why not keep my child home longer?

Because it would not achieve what it appears to. Keeping a well child home for several extra weeks would not close the window, and the virus would still be present when they returned. Consistent handwashing, clean surfaces, and clean toys are what actually reduce spread in a group room, which is why guidance points there rather than at longer exclusions.

What is the general rule for keeping a child home from a BC daycare?

The BC Centre for Disease Control's guidance for child care settings uses one test: a child should stay home if they are sick and unable to participate fully in routine activities, and can return when their symptoms have improved enough for them to take part again. BCCDC also states that child care facilities do not need to monitor children or staff for symptoms of illness.

What should I watch for while my child is recovering at home?

Drinking is the main thing. Mouth blisters hurt, and a child who refuses fluids can become dehydrated. Cool drinks and soft, bland foods are usually easier than anything hot, salty, or acidic. Contact your health care provider if your child will not drink, if you see fewer wet diapers than usual, if a high fever persists, or if they seem unusually drowsy or unwell.

Can adults catch it from their child?

Yes, though it is much less common than in young children. Adults who do catch it often have milder symptoms, and some have no visible symptoms while still being able to pass the virus on. The same handwashing routine that helps in the centre helps at home, particularly around diaper changes and before preparing food.

Before you visit

How a centre handles illness is worth asking about before you enrol, and we will give you a straight answer. If you are looking at options in Port Coquitlam or Coquitlam, contact us to arrange a visit and ask whatever you want about our health and hygiene routines.