Toddler With Injured Lip Question

[Unregistered]

update

I'm not sure why my post didnt come up that I did before. But I was saying that I talked to the mom last night to ask her if the dr did some type of swab test to determine that it is 100% HFMD. She said the dr did not because he said it was such a mild case. She has one blister on her chin and one on the side of her tongue. Is that strange that the didnt test for it? Or do her symptoms just make a definite diagnosis without it?

The mom said the dr said the blisters should be healed up by this Saturday. But I'm a little unsure of when I should even allow her back. She had a fever & diarrhea here on Monday when she got sent home. Her blister on her chin showed up Tuesday night at home. I keep reading online that they are contagious for awhile. So Im wondering if I should keep her out longer than when the blisters are healed? I will definitely require a drs note for her to return stating that she is all better and not contagious, but I have my own policy too and dont want her to return too soon. Any advice on how long she should be out?

Im just glad the family took her to the dr when she did. She had busted her lip and that was the only reason she was being seen. So if she didnt have that lip injury then she probably would have gone undiagnosed.

I have bleached, sanitized and washed EVERYTHING here yesterday and last night. My other daycare parents were a little freaked out but seem ok this morning. So far everyone else is fine. Im hoping nobody else will get it. We'll see i guess.

Any advice on how long I should keep her out so she wont pass it around anymore than it might have already passed? THANKS!

[Unregistered]

exclude

This is a very common disease that makes its rounds through schools and daycares every year. Virtually all kids get it at some point in their life and that builds immunity to it. I got it a few years back and it was very painful. Doctor's office recommended pain reliever. Daycare required exclusion because it's contagious through touching - those lesions in the mouth and palms of hands and bottoms of feet are very contagious until they are completely dried up. The CDC has a very good form on their site describing this. I know our daycare had to report it and had to post a notice for parents so they knew. It took about 5 days for it to go completely away on it's own - I was lucky that I'd taken a Friday off work already, but my lesions were dry after 3 full days. Painful as heck though - felt just like what stepping on shards of glass would feel like. The children there at your daycare are most likely already exposed - funny thing about kids though, some get it real bad, some don't. My kid didn't get anything but a low grade fever, while I got the full blown adult version (which is very rare according my dr. office) - got lesions in mouth, palms of hands and bottoms. The one thing I could recommend to families that get it - put kid sized stretchy gloves on kids and adult versions on adults so you don't have to disinfect everything you touch, wash the gloves daily or get enough to last you through the week while you heal. Be sure to wear socks the entire time, including to bed at night. Get a chapstick that you can throw away at the end of the week. Good luck!

[Crystal]

I don't agree with this at all. I wrote a post regarding the information from the Mayo Clinic which is what I used in my decisions regarding exclusions. It has to be approved so hopefully Michael will see it and put it up.

Since this is happening real time... I would suggest the OP research it before allowing a kid back in with it.

This disease is WICKED. I even had a DCM get when it went thru my house. She missed a ton of work and was VERY sick.

One of the challenges with this disease is that the spectrum of response to what you should do is... no exclusion and "cleaning" whatever they touch (even though it's passed by respiratory droplets in part to exclude them until the blisters are dried and bleach EVERYTHING.

So you have to decide where you are in the spectrum. I choose bleach everything and exclude. It still infected half of my kids and one parent. It was very nasty.

I would NEVER allow a kid in my house with HFM. The kids passing it to each other is actually the smallest part of my decision although enough for me to be steadfast. The biggest is my son, my helper, my parents, and me. It's the BIG people I worry more about.

First, let me say it is certainly up to the provider wether she feels she can or will accomodate with HFM....but, it is contagious well after symptoms are gone, so you won't even know if children are being exposed. You'd have to exclude for WEEKS, not just during the blister stage, and you'd likely lose clients if you did so.

Yes, HFM is uncomfortable, but I have seen in a few times and while it doesn't feel good, it's not the type of illness that cause lethargy or vomiting, or any such illness so I wouldn't exclude. I would exclude if the child was a mouther of toys, or had it on full blisters on the outside of her mouth or hands, but once that passed I'd allow her to return.

BTW...the info I posted is from UC SanFrancisco and the Ca. Child Care Health program so it's valid info regarding the illness.

[Crystal]

I personally would not take the child either! Definitely would need days on antibiotics and doctors note. If I see any rash/blister I would not let them in the door at all without a note. I sure hope you are all ok- keep us posted!!

they don't give antibiotics for HFM....it's a virus that has to run it's course.

[Crystal]

and I should add, that yes, definitely bleach everything, wash bedding of this child daily, be very consistent about PROPER hand washing etc.

All but the daily bedding wash should be being done anyway, in all programs.

[Country Kids]

Did this child have this before she fell or suddenly had it when she fell? How come the mom/dad/op didn't notice anything about that till she fell? I guess I'm confused on how it went from she fell to she had HFM diesease.

[jen2651]

Did this child have this before she fell or suddenly had it when she fell? How come the mom/dad/op didn't notice anything about that till she fell? I guess I'm confused on how it went from she fell to she had HFM diesease.

me too! I posted (obviously stupidly) about teeth through lip and the next thing I know, HFM is running rampant. I feel like I missed some posts!?!

[Symphony]

We had it here once too, yikes. I don't have a lot to add from what most people have already said, except plan blander meals (or ask for parents to provide them) when the child does return. When we had it, it seemed like the kids mouths were still real sensitive to spices and acids for awhile after the disease was gone.

[nannyde]

First, let me say it is certainly up to the provider wether she feels she can or will accomodate with HFM....but, it is contagious well after symptoms are gone, so you won't even know if children are being exposed. You'd have to exclude for WEEKS, not just during the blister stage, and you'd likely lose clients if you did so.

Yes, HFM is uncomfortable, but I have seen in a few times and while it doesn't feel good, it's not the type of illness that cause lethargy or vomiting, or any such illness so I wouldn't exclude. I would exclude if the child was a mouther of toys, or had it on full blisters on the outside of her mouth or hands, but once that passed I'd allow her to return.

BTW...the info I posted is from UC SanFrancisco and the Ca. Child Care Health program so it's valid info regarding the illness.

Yes that's what I did. I just excluded until the blisters were healed over. I called our health department to ask for advice from their nurses and did a lot of internet searching to see if there was a way to do a one stop spray clean. Nothing I found that was sprayable was okay for kids so we ended up just doing bleach.

When it hit my house the group of little boys all got it within a few days of each other. The bigger girls didn't get it but none of the girls were "****ers". The little boys were still at the age of everything to the mouth.

When the boys came back we kept them away from the girls and made sure they didn't have any toys in common. They also slept in separate rooms. We gloved for all the diaper changes for about a month after the last kid had it IIRC.

It was A LOT of work doing the bleaching. It took my SA and I two weeks to do the whole house. We bagged whatever we couldn't bleach and put that up.

It was very expensive to do the cleaning and it was a difficult thing to manage because the opinions on re-entry into day care and exlusion are so varied.

[Kaddidle Care]

If they've got it bad, the kids are usually feeling pretty miserable and shouldn't be sent to Daycare anyway. And unfortunately, there's not much you can do for them except tylenol and salt water mouth rinses (and that's only if they're old enough to know not to drink it).

You can also spray lysol over surfaces but I honestly don't have a whole lot of faith in that. Bleach is cheap and it's good stuff.

[nannyde]

If they've got it bad, the kids are usually feeling pretty miserable and shouldn't be sent to Daycare anyway. And unfortunately, there's not much you can do for them except tylenol and salt water mouth rinses (and that's only if they're old enough to know not to drink it).

You can also spray lysol over surfaces but I honestly don't have a whole lot of faith in that. Bleach is cheap and it's good stuff.

I don't think lysol kills the polioviruses, coxsackieviruses, echoviruses, and enteroviruses which are the HFM viruses.

I did a lot of research on this when it happened and IIRC it wasn't worth it to do the lysol because the kids who got HFM didn't have blood tests to see the cause of the HFM. The only thing I could find that killed all the possible causes of it was bleach.

I found one hospital grade spray that we could use but it wasn't safe for kids so I couldn't just spray the toys and be done.

[Unregistered]

Update

Did this child have this before she fell or suddenly had it when she fell? How come the mom/dad/op didn't notice anything about that till she fell? I guess I'm confused on how it went from she fell to she had HFM diesease.

This is how it all happened:

I sent the girl home Monday morning for having a fever of 101.2 and diarrhea. Per my policy they had to keep her home the next day. So Tuesday they kept her home. Wednesday morning the mom tells me that the girl had fallen Monday night on their tile and busted her top and bottom lips open on the inside. She tells me that they will take her to the dr because she might need stitches (2 days later!!! -- but thats how they are!).

She ends up having this blister pop up on her chin Monday night after her fall. So anyway - Wednesday morning they take her to the dr. Dr finds a blister on her tongue and the one blister on her chin and diagnosis her with HFMD. The girl also has a history of chewing on the inside of her cheeks as a habit. So I guess that was infected too.

Apparently she hasnt developed anymore sores anywhere else but I'm still excluding her from daycare possibly thru next week. Nobody else has shown any signs of catching it. Since the dr didnt do any type of test to 100% determine its HFMD, I'm HOPEFUL that it was an infection from her chewing on her cheeks... but that doesnt explain the blister.

Thanks for all your advice. My house smells like a big bleach and lysol bomb here!

[Crystal]

I have found that Head Start uses Quat cleaner:

http://solutions.3m.com/wps/portal/3M/en_US/Building-Life/Cycle/Products/Catalog/?PC_7_RJH9U52300PM102FLRECAB2K44_nid=8D34KBGTWBbeQB2XRP1WS8gl

Do you know anything about that one Nan?

[nannyde]

I have found that Head Start uses Quat cleaner:

http://solutions.3m.com/wps/portal/3M/en_US/Building-Life/Cycle/Products/Catalog/?PC_7_RJH9U52300PM102FLRECAB2K44_nid=8D34KBGTWBbeQB2XRP1WS8gl

Do you know anything about that one Nan?

I looked into Quat but I don't think it covers all the viruses that cause HFM. Also, I think it has to be rinsed off for kids under two.

Once you have to do that level of cleaning then it's no benefit to just not use bleach. The TIME in the cleaning is the handwashing (friction cleaning to remove dirt and germs), bleaching, rinsing the chemical off, and air drying.