Hand, Foot and Mouth Disease: School Rules for Parents

My School Agent | 8 July 2026

The nursery called at 10:30am. "We've noticed some spots on your daughter's hands. We think it might be hand, foot and mouth. Can you collect her?"

I Googled it in the car park. The photos looked alarming. Blistery red spots all over tiny hands and feet. Mouth ulcers. The name alone sounded medieval.

Turns out it's common, mild, and doesn't actually require exclusion from school. But nurseries often have stricter rules.

What Hand, Foot and Mouth Disease Is

Hand, foot and mouth disease (HFMD) is a viral infection common in young children. It causes spots or blisters on the hands, feet, and mouth. Sometimes the nappy area too.

The spots start as small red dots. They turn into grey or white blisters with a red base. In the mouth they're painful ulcers, usually on the tongue, gums, or inside the cheeks.

It's caused by viruses in the enterovirus family (usually coxsackievirus). It spreads through coughs, sneezes, and contact with fluid from the blisters or from infected poo (nappy changes).

It's not related to foot and mouth disease in animals. Your child can't catch it from a farm visit.

The NHS Rule: No Exclusion If They Feel Well

According to NHS guidance, children with hand, foot and mouth disease do not need to stay off school or nursery, as long as they feel well enough to attend.

Not "once the spots have healed." Not "after 5 days." If they feel well, they can go in.

The reasoning is the same as for conjunctivitis. HFMD is most contagious before symptoms appear. By the time you notice the spots, your child has already been spreading it for a day or two. Excluding them at this point doesn't stop transmission.

But many nurseries and some schools still ask children to stay home until the blisters have dried up. Check your setting's illness policy.

Nursery vs School Policies

Nurseries tend to be stricter than schools about HFMD. This is partly because the children are younger and more likely to spread it (nappy changes, shared toys, everything goes in mouths). And partly because nurseries worry about parental complaints if an outbreak happens.

Some nurseries require 48 hours after the last new blister appeared. Others want all blisters to be fully dried and crusted. A few follow NHS guidance and allow children back as soon as they feel well.

Schools usually follow NHS guidance more closely. If your child feels well and can take part in lessons, they can attend even with visible blisters.

Check your specific nursery or school policy. It should be in the parent handbook or on the website. If it's not clear, ring the office.

How Long Does It Last?

The spots usually appear 3-5 days after infection. New blisters may appear for a few days. Then they dry up and crust over.

The blisters typically last 7-10 days in total. Mouth ulcers heal within a week. By day 10, most children are back to normal.

Your child is most contagious in the first few days of illness, especially before the rash appears. They remain contagious while the blisters are present, and for several weeks afterwards (the virus is still in their poo).

This is why exclusion policies don't really work. By the time everyone stops being contagious, half term has been and gone.

Treating HFMD at Home

There's no treatment for hand, foot and mouth disease. It just has to run its course. But you can make your child more comfortable:

Pain relief: Paracetamol or ibuprofen for mouth pain and fever. Follow the dosage instructions for their age.
Soft foods: The mouth ulcers hurt. Offer soft, bland foods (yoghurt, mashed potato, ice lollies). Avoid acidic or salty foods (citrus, tomato, crisps).
Cool drinks: Sipping water or milk helps soothe the mouth. Use a straw if it's too painful to drink from a cup.
Avoid dehydration: Children with mouth ulcers may refuse to drink. Keep offering small amounts frequently. If they're not weeing much or seem very tired, call your GP.
Don't pop the blisters. Let them dry up naturally. Popping them increases infection risk.

When to Call the GP

Most cases of HFMD are mild and don't need medical treatment. But call your GP or NHS 111 if:

Your child is refusing to drink and showing signs of dehydration
They have a very high fever (39°C or above) that won't come down
The blisters are infected (red, hot, swollen, oozing pus)
Your child is unusually drowsy or floppy
They have a severe headache or stiff neck
You're pregnant and you've been exposed to HFMD (small risk to unborn baby)

Can Adults Get It?

Yes. Adults can catch hand, foot and mouth disease from their children. It's less common in adults, but it happens.

Adult symptoms are usually milder. You might just get a few mouth ulcers and feel a bit rough for a few days. Or you might get the full blistery hands and feet experience.

If you're pregnant and you get HFMD, call your midwife. There's a small risk of complications, especially if you catch it close to your due date.

Preventing Spread

You can't completely prevent HFMD from spreading in a household with young children. But you can reduce the risk:

Wash hands frequently. Especially after nappy changes, before eating, and after touching blisters.
Don't share cups, cutlery, or towels.
Wipe down toys and surfaces that the infected child has touched.
Keep blisters covered where possible (socks, long sleeves) to reduce contact spread.
Dispose of nappies carefully. The virus is in their poo for weeks after symptoms clear.

Will They Get It Again?

Possibly. There are multiple strains of the viruses that cause HFMD. Having it once gives immunity to that strain, but not to the others.

Most children get it once or twice in early childhood, then don't get it again. But it's not a one-and-done illness like chickenpox.

The School-Age Surprise

Hand, foot and mouth is often described as a "disease of under-5s." It is most common in that age group. But older children get it too.

My daughter brought it home from nursery at age 3. My son caught it at age 7 from a classmate. Both times it looked worse than it was. Alarming blisters, grumpy child, then fine within a week.

Schools don't always send warning letters about HFMD the way they do for chickenpox or scarlet fever. It's seen as less serious. But it's worth knowing the signs, especially if your child suddenly refuses breakfast and has red dots on their palms.

I built My School Agent to reduce the cognitive load of parenting school-age children. When your child is off sick and you're juggling work calls, laundry, and trying to remember if today was PE kit day for their sibling, you don't have headspace left for tracking what homework they missed or when the next school trip is. The app handles that. You handle the ice lollies.