Hand, Foot and Mouth Disease: Daycare Policy and Return

Updated November 2026.

Hand, foot and mouth disease (HFMD) is a common viral illness in children under 5. It usually starts with a fever and sore throat, followed by painful mouth sores and a rash on the hands, feet and often the diaper area. Most children recover in 7 to 10 days. Many daycares let children return once they are fever-free for 24 hours, can eat and drink, and feel well enough to join in, even if some spots are still visible.

Policies vary, so check with your center. Here is what to know.

Symptoms

Fever, often the first sign
Sore throat, fussiness and poor appetite
Painful sores or blisters in the mouth, on the tongue and gums
A rash of flat red spots or small blisters on the palms and soles
Spots on the knees, elbows, bottom or diaper area

Some children have only a few spots. Others have many. A few weeks later, some children lose fingernails or toenails. It looks alarming but the nails grow back.

How it spreads

HFMD is usually caused by enteroviruses, most often coxsackieviruses. It spreads through:

Saliva, nose drips and coughs
Fluid from blisters
Stool, especially during diaper changes
Toys and surfaces touched by an infected child

Children are most contagious during the first week. The virus can stay in stool for weeks after symptoms go away, which is why handwashing and diaper hygiene matter so much in daycare.

When can my child go back to daycare?

Health guidelines used by many child care programs say children with HFMD do not always need to be kept home once they feel well, because the virus spreads before symptoms appear and keeps spreading after. Children should stay home when they:

Have a fever
Have mouth sores and are drooling a lot
Cannot eat or drink enough
Are too uncomfortable to take part in the day

Many centers also ask that blisters be dry or crusted before return. Your center's sick policy is the one to follow.

Home care

Fluids first. Mouth sores can make children refuse to drink. Try cold water, milk, ice pops and smoothies.
Soft, cool foods like yogurt, applesauce, mashed potatoes and pudding.
Avoid acidic and salty foods such as orange juice, tomato sauce and chips, which sting.
Pain and fever relief with acetaminophen or ibuprofen, dosed by weight as your pediatrician advises. Do not give aspirin to children.
Leave blisters alone. Do not pop them.

When to call the doctor

Signs of dehydration: few wet diapers, no tears, dry mouth, unusual sleepiness
Fever lasting more than 3 days, or any fever in a baby under 3 months
A stiff neck, severe headache, confusion or unusual weakness
Symptoms getting worse after a week
Your child seems very ill or you are worried

Serious complications are rare, but they need prompt care.

Preventing the spread

Wash hands with soap and water after diaper changes, using the toilet and before meals.
Clean and disinfect toys, high chairs and changing areas.
Do not share cups, utensils or towels.
Cover coughs and sneezes.
Tell your daycare so staff can watch for new cases and step up cleaning.

Adults can catch HFMD too. Pregnant parents who are exposed should let their health care provider know.

Can my child get it again?

Yes. Several different viruses cause HFMD, so children can catch it more than once. Each infection builds protection against that specific virus.

For general sick-day rules, see daycare fever rules and how often daycare kids get sick.

Frequently asked questions

How long is hand, foot and mouth disease contagious?

Children are most contagious in the first week. The virus can remain in stool for several weeks, so keep up handwashing.

Can my child go to daycare with hand, foot and mouth spots?

At many centers, yes, once the fever is gone, your child is eating and drinking, and blisters are dry. Ask your center.

What does the HFMD rash look like?

Flat red spots or small blisters on the palms, soles and often the bottom or diaper area, along with sores in the mouth.

Is there a vaccine for hand, foot and mouth disease?

There is no vaccine available in the United States.

Health and safety at Children's Land

At Children's Land, if a child becomes sick during the day, they rest away from other children and our director calls your emergency contact. Children return once they meet our health policy. Read our FAQ or find a location.

Hand, Foot and Mouth Disease: Daycare Policy and Return