HFMD - Please Help

[GirlMomma]

HFM hit the daycare Friday afternoon. This time, I don’t believe I am able to stop it.

The family that brought it in this time showed the first symptoms Friday, they had went to a playground on Labor Day.

A second family is telling me they have symptoms and blisters. I mentioned to them that the child (who is normally a great eater) barely ate any lunch Friday.

My DD is running a fever and has diarrhea, is that part of it?? My husband can stay home and care for her.

I don’t know whether to close or stay open this week. If I close, two families are totally out of care. If I’m open, I run the risk of this spreading. If I stay open, do I let all of this run its course? Is this like chicken pox??

Please help!

[Pestle]

If a child has symptoms of hand foot and mouth disease, or COVID-19, or the flu, or anything else that is highly communicable, and that child is going to be convalescing in the same home as the daycare — I would close. I have closed when my own kid had influenza. I think that's just one of the things about home-based day care; when somebody in the core household has something extremely communicable that you would exclude for, the other families have to find alternative care.

Especially since diarrhea and a fever are COVID-19 symptoms, and you want to be able to draw a firm line with your clients without them saying "but you stayed open when X was really sick."

A LOT of schools are closed right now where I live due to so many students and faculty home sick. This has happened in the past when flu season got bad, too. I think it's reasonable and responsible for even a home daycare to close when illness strikes in the family.

That said, my husband has been home with gastroenteritis since Friday morning and I haven't closed the daycare. His only symptom is lower intestinal cramps and, you know, what comes after the cramps. He has no fever, and he can easily isolate himself in the back bedroom and only come out with a KN95 mask on when he needs to get water.

So I think everybody is going to draw the line in a different place depending on what their family make up is and who it is that is sick and what they are sick with. In your position, I would think it would be safer to go ahead and notify the families of a closure due to illness right now, instead of letting this go on and just passing it back-and-forth for a couple of weeks.

[e.j.]

I've only had HFM go through my day care/home twice in 25 years so I don't have a lot of experience with it but both times, by the time I knew one child had it, it was only a day or two before every other child had it, too. It spread that quickly! By tomorrow, the question of closing or remaining open may be a non-issue for you! The other 2 families may call their kids out by morning. 😉 I remained open both times because at the time, it didn't make sense for me to close. Everyone had it, including me and my kids - and we weren't dealing with the threat of Covid. I did have the kids stay out of care until their fever was gone, the sores had scabbed over, they were feeling better and could eat and play normally. Some kids got a mild case and were back quickly. Others got more severe cases and stayed out longer because it was hard for them to eat and drink and they were very uncomfortable. My own kids were older and could isolate while I stayed open for the kids who recovered enough to be here. Had they been younger and miserable with it, I probably would have closed.

The kids did have fevers but I don't remember any of them experiencing diarrhea. I think Pestle makes a good point when she says both can be symptoms of Covid and that you may want to think about how not closing for illness, especially with these symptoms now, may be perceived by your dc parents. You may get more pushback in the future if you remain open without first making sure your child actually does have HFM vs. Covid. I know closing/staying open is a difficult decision to make! I hope everyone is feeling better soon.

[GirlMomma]

I am staying open, I am down to 2 kids plus DD once I know she’s healthy. DD’s ped thinks she has a bug, but not COVID or HFM. DH is staying home to care for her today/tomorrow. Her fever broke yesterday afternoon.

I don’t usually exclude siblings if one is sick, simply because its never been an issue - I’ve had one sibling come down with something and the other one never get it. In this case, would you exclude siblings until the fever is gone and blisters have scabbed over?

[Annalee]

HFM has been across my state with daycares....that and RSV. I have had kids sick before but never all at the same time...It was crazy!

[GirlMomma]

RSV came through in July.

I have one family that is saying he can return 24 hours after the fever but others have said when the blisters start scabbing over.

What would you do?

[Annalee]

I made my daycare kids stay out till there was no fever and the spots had scabbed...I had two kids with only sores in the throat so I told them five days....some of the others missed up to 8 days.....I had 8 with spots and two with only sores in their throat which the doctor called strep but that's a whole other issue....some doctors called it impetigo..... This is why I have in my contract that "I will make final decision on attendance".

[Cat Herder]

The CDC chart says we don't even have to exclude for Coxsackie, anymore, unless fever. That it is normal childhood illness. That they can come back 24 hours after fever subsides. Here are two different formats.

6-30 (texas.gov)

CommunicableDiseaseChart.pdf (ga.gov)

[GirlMomma]

Annalee and Cat Herder
I made decision to exclude until the spots have started to scab over. I just don’t want this to spread any more. I would think if one of those spots oozed, it would be contagious, like respiratory droplets and saliva.

I am not a doctor but this is the best decision for my business and the well being of others.

[GirlMomma]

I’m completely frustrated Sorry all - I am just at a loss on how to handle this.

I had a parent message me last night and tell me their child had a rash and mouth sores, the parent was positive it was HFM. Child wouldn’t be attending.

The parent JUST text me and said the sores in her mouth aren’t bothering her & the bumps never blistered… magically.

Would you require a doctor to examine the child to clear HFM?


This swept through here QUICKLY. I have two kids in care.

[Sparkles]

I can almost guarantee that it's HFM. I had it come through my daycare a couple years ago and EVERY single child got it, including my own.

Some didn't get blisters, some just had bumps, some had it on their knees, others had it on their hands and mouth. One child had it very mild and just had a few bumps in a couple spots.

I ended up closing for the week because my own child got it the worst and was absolutely miserable. I needed to be there to care for him.

I've heard it both ways - that they can attend once they are fever free for 24 hours or after the sores have crusted over. I personally would require both. But, if the child is not feeling well, then they can't attend regardless of fever or blisters.

I hope I never have to deal with it again.

[e.j.]

I remember feeling very frustrated, too, when it went through my house for the first time and it wasn't any easier the second time around. It's so hard to know what to do! Some websites said you're most contagious the first week after getting sick, others said you're good to go 24 hours after the fever breaks. I had read that the virus sheds through your saliva for possibly a few weeks after getting the virus and that it sheds through the stool for months possibly. I assumed that as long as I wore gloves and washed my hands after changing the kids' diapers and the diaper kept the stools contained, we could at least decrease the chance of spreading the virus but what do you do when you have kids who mouth all of the toys and go around licking and chewing everything in sight? Obviously you don't want the kids who haven't come down with HFM yet to get it if you can help it but it's not realistic to expect parents to keep their kids out of care for months, especially when their child is feeling fine. I was lucky enough both times that all of the kids caught it quickly so I just had them come back once the fever was gone, the sores were scabbed over and they were feeling well enough to participate.

If I were in your shoes, I wouldn't require a doctor's exam; I'd just assume she got away with a relatively mild case of HFM. I might ask the parents to keep the kid with the mouth sores home for another day just to make sure she's ok with eating and drinking. Otherwise, I'd probably allow her back and just try to keep her separated from the other 2 kids as much as possible, sanitize anything she mouths and otherwise, cross my fingers and hope for the best. Not saying it's the best thing to do; just what I imagine I would do in your situation. It is a very frustrating thing to have to deal with!

[GirlMomma]

I stuck with my initial gut feeling and I told DCM she’d need to have DCG examined by a doctor to rule out the bumps and mouth sore being HFM before she can return. I believe she has a mild case of it. It’s like my husband said, if I did accept her into care and the rash flares up, I’ll end up sending her home anyways. It’s best to avoid the hassle and possible contamination all together until a doctor can rule it out.

I am sticking with the “24 hour fever free and blisters crusting over” plan. Last month, I had ONE child get HFM and the doctor pulled him from DC for a week/until the blisters dried out.

I have heard the same thing about the virus being in their saliva and stool for weeks/months.

The frustration stems from the parents of course and the feeling of them pushing to bring their children back to me because “they’re paying me for it.”

[GirlMomma]

Here’s an update for everyone but mostly for me to vent 🙃

I am now down to my DD’s and one other DCB and an after school kid.

Family 1 was thinking of returning tomorrow/Friday but can’t confirm if DCK2 has open mouth sores or not. Oh, DCM mentioned she thinks she has the flu… so obviously I don’t want them to return too soon, contaminated with that… giving us yet another bug. 🤦♀️

Family 2 planned to return today, until I asked about open mouth sores and that put DCK2 out for at least another day, possibly the rest of the week.

Family 3 was healthy until DCK3 had diarrhea - which is likely the same bug but my DD caught. Hopefully not HFM.

Family 4 has been the family I’m going back and forth with. Oh, it’s also the new family I accepted and took a risk on a few weeks ago… the one with red flags I chose to overlook. So maybe I’m just being a big bitter or maybe they’re pushing back to see what they can get away with. Probably both.

Anyways, to recap: Sunday the family said DCK3 popped up with bumps/mouth sores and would stay home with DCK1. Monday, the family asked to bring the children back claiming DCK3 wasn’t going to infect anyone else because it wasn’t HFM. I requested a doctors note. Never got one/didn’t hear anything at all. Last night, I asked the family how the children were doing, something I do with all of my families. I was informed that the blisters are clearing up (so obviously my gut feeling was right 🙄) and DCK1 is still symptom free. I told the family the DCK’s could return on Friday. DCM pushed back and asked if they could return Thursday. I explained that I would prefer Friday. Because I know they were exposed last Friday and symptoms can pop up 3-6 days after exposure, I don’t want someone to come back Thursday, potentially expose the healed/healthy DCK and put us right back in the same boat next week.