What is hand, foot, and mouth disease and how do you recognise it?
Hand, foot, and mouth disease (HFMD) is a common childhood illness that mainly affects toddlers and young children. You can recognise it by small blisters and spots on the palms of the hands, soles of the feet, in and around the mouth, and sometimes on the buttocks or legs. It often comes with fever, a sore throat, and reduced appetite because swallowing is painful. Your child can feel quite unwell and irritable from it, especially in the first few days.
The illness is caused by an enterovirus, usually the Coxsackie virus. It is highly contagious and spreads through direct contact, coughing, sneezing, saliva, and faeces. What many parents don't know: your child is already contagious before the blisters are visible. The incubation period is three to six days, and contagiousness is highest in the first week of illness.
When can your child go to childcare with hand, foot, and mouth disease?
This is the question every parent asks when the blisters appear. According to RIVM guidelines, a child with hand, foot, and mouth disease may in principle go to the daycare center (kinderdagverblijf/KDV) or after-school care (BSO), provided they otherwise feel well. The reason? The disease is so widespread that keeping them home does not prevent infection in a group. Moreover, children are often already contagious before you see the symptoms.
Yet there is an important nuance. Just as with chickenpox at childcare, the carer mainly looks at how your child feels. Does your child have fever, a lot of pain, or need one-on-one care that is not feasible in a group? Then the childcare may ask you to keep them at home, even if the RIVM guideline does not require it. Each location may have its own house rules around illness and recovery, as long as these are reasonable.
Practically speaking, most children return once the fever has passed and they can eat and drink sufficiently again. The blisters may still be present; that is not a reason to stay home. Only if they have burst and there is a secondary bacterial infection should extra caution be exercised.
What about infection in the group?
As a parent, you might be alarmed by a message that hand, foot, and mouth disease is circulating in the group. Yet outbreak control is difficult with this illness. The virus is present in saliva, nasal mucus, faeces, and the fluid from the blisters. Good hand hygiene helps, but does not fully prevent infection. Children under two years old are most susceptible.
Childcare is required to inform parents of an outbreak, so you can be alert to symptoms. Some locations take extra measures such as more intensive cleaning of toys and surfaces. With impetigo, the situation is different: stricter rules apply because it is a bacterial infection that requires targeted treatment.
Difference from chickenpox and other childhood illnesses
Hand, foot, and mouth disease is often confused with chickenpox, but there are clear differences. With chickenpox you see itchy blisters all over the body that dry out and form crusts. With HFMD, the blisters are mainly on the hands, feet, and in the mouth. Chickenpox is more contagious and has a longer exclusion period from childcare. Hand, foot, and mouth disease is generally milder, although the mouth blisters can be quite painful.
Another difference: after chickenpox you are usually immune for life. With HFMD, your child can become infected multiple times, because different viruses can cause the illness.
Practical tips for home
- Ensure sufficient fluids: Cold drinks, ice lollies, and soft foods relieve the pain in the mouth. Avoid acidic, salty, or spicy food.
- Give paracetamol for fever or pain: Follow the dosage for your child's age. If in doubt about medication at childcare, read our blog about giving medication at childcare.
- Keep the blisters clean: Keep nails short to prevent scratching. Wash hands regularly, also after nappy changes.
- Keep your child at home if they have fever or really don't feel well: This is not only better for your child, but also for the group.
When do you contact the GP?
Hand, foot, and mouth disease usually clears up on its own within seven to ten days. Call the GP if your child develops a very high fever, drinks little, is listless, or if the symptoms do not improve after two weeks. Also seek medical advice if you suspect a bacterial infection of the blisters. For infants younger than three months with fever, consultation with the GP is always necessary.
Checklist: return to childcare
Use this practical checklist to determine if your child can return to childcare:
- □ Fever has been gone for at least 24 hours without fever-reducing medication
- □ Your child can eat and drink normally again
- □ Your child has enough energy and feels well enough for group activities
- □ You have informed the childcare of the diagnosis
- □ You know what the illness policy of your location is (check the pedagogical policy plan or ask about it)
The illness policy of childcare varies by organisation. Some locations have stricter rules than others. It helps to know in advance what to expect, so you are not caught off guard.
Communication with childcare during an outbreak
Transparent communication works both ways. Report your child ill with a concrete description of the symptoms. Ask upon return if other children in the group have been ill and what measures the location is taking. With repeated outbreaks of infectious diseases, it is good to start a conversation about hygiene protocols and whether the Municipal Health Service (GGD) inspection has been recently.
On Kiddie.nl you can easily compare childcare locations on pedagogical vision, GGD reports, and practical matters such as opening hours. This way you choose childcare that fits your expectations around health, safety, and communication.
Conclusion
Hand, foot, and mouth disease is unpleasant, but usually harmless. The RIVM guideline allows return to childcare if your child feels well enough, even with blisters still present. Yet every location has its own rules, and your child's wellbeing always comes first. Check the illness policy of your childcare, communicate openly, and use your parental instinct. Sometimes an extra day recovering at home is the best choice — for your child, and for the group.
