Hand, Foot, and Mouth Disease: What Child Care Providers Need to Know

Child care centers in Massachusetts and Rhode Island frequently encounter outbreaks of hand, foot, and mouth disease (HFMD), especially during the spring, summer, and early fall. As a pediatric nurse and health care consultant, I work with child care providers to help them manage contagious illnesses while keeping children safe and centers in compliance with state regulations. Understanding HFMD is essential for child care staff who are on the front lines of preventing illness in young children.

What is Hand, Foot, and Mouth Disease?

HFMD is an unpleasant, but common viral illness caused most often by the Coxsackievirus A16 or Enterovirus 71. It typically affects infants and children under 5, though older children and adults can also contract it. The illness is highly contagious, spreading quickly in group settings such as daycares and preschools.

Symptoms to Watch For

Child care staff should be alert for the following signs:

• Fever (often the first symptom)

• Sore throat

• Painful sores in or around the mouth (blisters on the tongue, gums, and inside of cheeks)

• Rash with blisters on the hands, feet, buttocks, or legs

• Irritability and decreased appetite

Symptoms usually appear 3–6 days after exposure and last about a week.

How HFMD Spreads in Child Care Centers

HFMD spreads easily through:

• Coughing and sneezing

• Close contact such as hugging or sharing toys

• Contact with contaminated surfaces

• Diaper changing and stool exposure

This makes infection control policies in child care centers critical.

Exclusion and Return to Care Guidelines

The Massachusetts Department of Public Health (DPH) and the Rhode Island Department of Health recommend exclusion policies for children who:

• Have a fever AND a rash or sores that make participation difficult

• Cannot participate in routine activities

• Require more care than staff can provide without compromising other children’s safety

Children may typically return once they are fever-free for 24 hours, able to participate in normal activities, and when blisters are healing. Since HFMD can still be contagious after symptoms improve, strict hygiene practices are essential even after return.

Prevention Strategies for Child Care Providers

To minimize outbreaks:

• Practice rigorous hand hygiene (especially after diaper changes, bathroom use, or wiping noses)

• Disinfect toys and surfaces daily using approved cleaning solutions

• Teach children to cover coughs and sneezes

• Encourage no sharing of cups, utensils, or pacifiers

• Work with a child care health consultant to ensure infection control policies align with state licensing requirements

Why Having a Health Care Consultant Matters

In both Massachusetts and Rhode Island, licensed large group and school-age child care programs are required to have a health care consultant. A consultant helps centers develop policies, train staff, and stay compliant with EEC regulations and public health guidelines.

At PediNurse LLC, I specialize in supporting child care centers with:

• Guidance on illness exclusion policies

• Staff training on infection control

• Compliance with state health and safety regulations

• Ongoing support through remote consultation

Hand, foot, and mouth disease may be a routine childhood illness, but for child care providers, it poses serious challenges in keeping classrooms safe and compliant. With the right knowledge, policies, and support from a qualified health care consultant, child care centers can confidently manage HFMD outbreaks while maintaining a healthy environment for children and staff.

👉 Learn more about how I can support your child care program at www.pedinurseconsulting.com.

References

• Centers for Disease Control and Prevention (CDC). (2024). Hand, Foot, and Mouth Disease (HFMD). Retrieved from https://www.cdc.gov/hand-foot-mouth/index.html

• American Academy of Pediatrics. (2021). Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide (5th ed.). Elk Grove Village, IL: AAP.

• Massachusetts Department of Public Health. (2024). Infectious Disease Exclusion Guidelines for Child Care and Schools.

• Rhode Island Department of Health. (2024). Communicable Disease Guidelines for Schools and Child Care Programs.