How Long Do You Exclude For HFM? Despite Doctor?

[kitykids3]

I have a baby who currently has Hand, Foot and Mouth. She happened to have it a few months ago too. Luckily it didn't spread. I had it run through all my daycare kids when I was new in business about 7 years ago. Back then, I remember all the doctors of the kids telling them they couldn't come back until at least a week after it had started, and the blisters had to be dried over and they had to be fever free. So, anyways, I have always had the policy of them staying out for a week if they get HFM. I had told this mom last time that i don't feel comfortable with the baby coming back before a week was up, especially since it mouths everything and sharing the baby room with other babies.

Sunday she texts saying she took kiddo to doc on sat and that she had ear infection and going to stay home. Texts last night too and said will stay home today cuz still feeling icky. Today she calls and tells me they told her it was HFM on sat. She neglected to tell me til today, which of course makes me upset for obvious reasons. She is wanting to bring her back Thur or Fri. I told her possibly Fri, but I've told her I feel adamant about the whole week thing, even though her doc says she's not contagious.

So, at this point she's keeping her out and we'll talk Thur about Fri. What would you do? If someone at your daycare has HFM, how long do you exclude them? To you, would it make a difference if it is a baby that puts everything in the mouth? When do you let them back? Just want to get some different opinions to see the majority.

[preschoolteacher]

I've excluded until 24 hours fever free since you're contagious before the spots appear. If there are any oozing sores, I'd require them to be covered, and if that's not feasible (sores on hands, face), I'd exclude until all sores were healed over.

[kitykids3]

That's what I'm concerned about. She has sores in her mouth.

[AmyKidsCo]

My friend has a 12 mo old in her program who was diagnosed with HFM over the weekend. Dr said they're only contagious while they have the fever. But if you're concerned I'd call your health dept.

[Meyou]

At this point since Mom has lied to you once about it I would go ahead and trust my instincts and exclude for the week. My reasoning would be that I have to go by instinct since Mom withheld some of the doctors diagnosis earlier in the week and I can't go forward just on her word.

[Blackcat31]

Note: Exclusion will not reduce disease transmission because some children may shed the virus without becoming recognizably ill, and other children who became ill may shed the virus for weeks in the stool.

Here is a FANTASTIC handout/fact sheet that I just came across....

http://www.healthychildcare.org/PDF/InfDiseases/M3_HandFoot.pdf

[Angelsj]

I actually don't exclude for it at all, unless the child is too uncomfortable to participate in the day. Kids spread it before they are even aware they are ill, though I have to say, I had one get it last year, and he never missed a scheduled day. None of the other kids ever showed any symptoms.

[Blackcat31]

I actually don't exclude for it at all, unless the child is too uncomfortable to participate in the day. Kids spread it before they are even aware they are ill, though I have to say, I had one get it last year, and he never missed a scheduled day. None of the other kids ever showed any symptoms.

*knock on wood* but I've never had it come through my daycare.

If I did though, I would exclude only for the fever.

...and if the child was unable to participate but I haven't heard that is really all that common.

[Meyou]

I had it go through here last year and half the kids were so sick they had to stay home for a week. If they get mouth blisters it's really painful and they can't eat or drink properly.

I couldn't serve citrus or pineapple for over 2 weeks because it made some of them cry even after they were "better".

I excluded based on ability to participate in activities.

[nanglgrl]

I exclude until the sores are scabbed over. I've had it in my daycare the last 2 years but hadn't even heard of it the other 9 years that I've done daycare. Last year two children got rashes on Sunday (one was my child) and I closed for the week and it stayed contained to those two children. I imagine they caught it the week before from a child who wasn't showing symptoms because my parents aren't the type to dope and drop and no one had a rash or looked ill.
This year a child was on antibiotics for a bad ear infection and was a teething 1 year old so when small spots showed up around her mouth I thought it was either from antibiotics or those little spots they get from drool around their mouth. She had a fever over the weekend but again we attributed it to the ear infection. Her mom is wonderful about keeping her home if needed and asked about her coming with the spots on her mouth and I ok'd it because I was certain it was nothing. Low and behold within 2 days it was clearly HFM and within 2 more days every child that had been in daycare with her got it, the only 2 that didn't were part-timers that didn't attend while she was here. I excluded everyone until the rash scabbed over and the other 2 children stayed healthy.
Just my limited experience with it but exclusion definitely does help the spread and it is contagious even without a fever.

I should add that for some children it's incredibly painful, especially the sores in their mouth. The first time it showed up in our daycare the child had to be hospitalized because he was dehydrated and also because he had asthma and the sores were irrational his breathing.
The second time the original toddler was screaming in pain by the 3rd day and wouldn't eat/drink.

[finsup]

I don't really exclude for it...unless they have a fever or are misrable. Other then that, everyone's been exposed before the rash started anyways. HOWEVER...given that this mom lied to you, a week sounds like a good time to keep them out I'd be very temped to say "Given that you lied to me about the situation to begin with, I cannot take your word on this. I do not feel comfortable providing care this week. You may bring her back on Monday." Maybe that's too strict but lying is a pretty big "NO" around here!

[melilley]

I have one out now that has hfm, but I don't think that he got it from here, no one else has it and the dcb is part time and his last day was on a Thurs. and he didn't have any symptoms until that following Monday. His doctor said he could come back that Friday, but mom has kept him out until tomorrow-it will be 2 weeks. I would probably only exclude if the child was uncomfortable.

[kitykids3]

Note: Exclusion will not reduce disease transmission because some children may shed the virus without becoming recognizably ill, and other children who became ill may shed the virus for weeks in the stool.

Here is a FANTASTIC handout/fact sheet that I just came across....

http://www.healthychildcare.org/PDF/...3_HandFoot.pdf

I understand this and I've done lots of reading. Most things say the first week is most contagious and they can be contagious after, but usually stools. With proper hand washing, that can be controlled by the teachers. It's the fact that she has sores in her mouth and I'd pretty much have to keep her in a separate room the next 2 days to feel comfortable because I don't want her mouthing toys and one of the other babies to get it. We'd have to have a teacher sitting right next to her all day. i'm thinking Friday might be ok, but not tomorrow already. I don't know if the fact that she lied is making me upset, but I have always had the exclusion of 1 week for hfm cuz I've seen what it CAN do to some kids (sores all over the body, losing fingernails and toenails). I can't control what I don't know about, but by letting her come when I Know she's contagious and putting the other babies at risk, that's just not right.
Since there seems to be differences, I was curious what the majority of you do. Thank you.

[renodeb]

I have had this through my dc now twice and I had them stay out until mouth soars were totally dry out, not drying out but dried out! Remember it s our business and our rules!
Deb

[Blackcat31]

I understand this and I've done lots of reading. Most things say the first week is most contagious and they can be contagious after, but usually stools. With proper hand washing, that can be controlled by the teachers. It's the fact that she has sores in her mouth and I'd pretty much have to keep her in a separate room the next 2 days to feel comfortable because I don't want her mouthing toys and one of the other babies to get it. We'd have to have a teacher sitting right next to her all day. i'm thinking Friday might be ok, but not tomorrow already. I don't know if the fact that she lied is making me upset, but I have always had the exclusion of 1 week for hfm cuz I've seen what it CAN do to some kids (sores all over the body, losing fingernails and toenails). I can't control what I don't know about, but by letting her come when I Know she's contagious and putting the other babies at risk, that's just not right. Since there seems to be differences, I was curious what the majority of you do. Thank you.

I would seriously consider telling her no until Monday BECAUSE she lied.

Let her know that you HAVE to be safe now so you aren't sorry later and since she lied, you just can't trust that her DD is ok so the one week exclusion policy stands.