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Daycare Center and Family Home Forum>Toddler With Injured Lip Question
Unregistered 10:01 AM 05-18-2011
Hi - I have a 2 year old girl in my care who yesterday fell at home. Her mom text me last night saying that she cut her inside top lip pretty bad and soaked 3 washrags with blood. I asked if they took her to the dr which they hadnt. The bleeding stopped so they thought she was ok. This morning they drop her off and tell me that they are taking her to the dr today because it still looks really bad. She said her breath smells like blood and that top gum part is ripped inside. Also she has a history of chewing on the inside of her cheek during the night time leaving it raw in the morning with blood on her pillow.

She has done the mouth chewing here at nap time too. Her parents dont think its a big deal but now that she has this lip injury they are FINALLY taking her to the dr today. Whats strange though is when they dropped her off this morning (Im still trying to figure out WHY they brought her anyway) she has a big white headed blister on her chin below her bottom lip that she said showed up a couple hours after the fall. So now she has chewed up cheeks inside, a ripped upper inner lip and a nasty pus filled sore under her chin.

Has anyone ever seen anything like this? I told her she most likely needs antibiotics and to find out how to prevent her from chewing the inside of her mouth as well. OH and shes NOT eating either since the accident. The dad is picking her up at 1130am to get her to her dr appt. Still not sure WHY they brought her in the first place.
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Unregistered 01:56 PM 05-18-2011
Okay - so the mom just called me to notify me that the girl as hand foot mouth disease!!! Im so freaked out now! Im trying to find a link on here with any info on it. Has anyone else had experience with this before?

Luckily she was out monday & tuesday. She came today for just 2 hours and left for the dr. She didnt play with anyone or any toys because she was so out of it. But she did sit at the picnic table with 2 others and have lunch.

I just bleached everything and am washing all blankets and sheets and pillows. any other advice would be So appreciated!!!
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jen2651 02:14 PM 05-18-2011
perhaps the white headed thing is where her bottom teeth went through her lip...keep us updated!
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Michael 04:50 PM 05-18-2011
Originally Posted by Unregistered:
Okay - so the mom just called me to notify me that the girl as hand foot mouth disease!!! Im so freaked out now! Im trying to find a link on here with any info on it. Has anyone else had experience with this before?

Luckily she was out monday & tuesday. She came today for just 2 hours and left for the dr. She didnt play with anyone or any toys because she was so out of it. But she did sit at the picnic table with 2 others and have lunch.

I just bleached everything and am washing all blankets and sheets and pillows. any other advice would be So appreciated!!!
Here is an earlier thread: https://www.daycare.com/forum/showthread.php?t=21746

I will look for more.

Here is another: https://www.daycare.com/forum/showthread.php?t=21219
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meganlavonnesmommy 05:24 AM 05-19-2011
HFM is no joke. It's highly contagious, and miserable for the kid. My son had it a few years ago and it was awful. He was a crying crabby mess for 10 days, wouldnt eat or drink, was miserable. His sores were on the insides of his mouth, so he had problems eating or drinking.

I would wash/bleach everything you can and lysol spray or upholstery clean everything else. And definately make sure they dont return without a drs note saying when she isnt contagious. The sores need to be crusted over and no longer open or oozing at the very least.
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nannyde 05:55 AM 05-19-2011
I've had it in my day care once and it was horrible. The cleaning was horrible.
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Mrs.Ky 06:15 AM 05-19-2011
hand foot and mouth is the WORST. It went threw my daycare about 5 years ago a dcg brang it in then it spread like wildfire threw my 2 kids, my other daycare kids, my neighbors 3 kids across the street, and her daycare kids they all played together didnt know she had it till it was to late my middle child was 3 at the time he cried for days and wouldnt eat I was pulling my hair out had to close daycare for a week and disinfect everything. the dcg needs to stay gone from your daycare at the least 5 days.
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SilverSabre25 06:18 AM 05-19-2011
HFM is the only illness of which I live in fear. It's highly contagious, long-lasting, and can reinfect its victims.

Good luck! Unfortunately, eveyone's probably already been exposed...
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juliebug 06:37 AM 05-19-2011
ugh it is horrible the one time we had it i closed for a week and we finally got raid of it for good! i was cleaning and bleaching but it was still just getting passed around!
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Kaddidle Care 07:20 AM 05-19-2011
We've had one or two cases but it's not been a huge problem. Just bleach your toys and surfaces and her cot if you can. Extra bleaching in the bathroom as coxsackie is from poor bathroom habits for the most part. Make sure your children are using soap when washing their hands. Send her bedding home to be washed. Try to remember what she touched and bleach everything that can be bleached.

Make sure you get a note from the Dr. that states when she can return.
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Crystal 07:37 AM 05-19-2011
Here is a child care fact sheet for HFM.....you do not need to exclude the child from care:

http://www.ucsfchildcarehealth.org/p...Mouth_0509.pdf
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nannyde 07:52 AM 05-19-2011
Originally Posted by Crystal:
Here is a child care fact sheet for HFM.....you do not need to exclude the child from care:

http://www.ucsfchildcarehealth.org/p...Mouth_0509.pdf
I don't agree with this.

http://www.mayoclinic.com/health/han...ION=prevention

Isolate contagious people. Because hand-foot-and-mouth disease is highly contagious, people with the illness should limit their exposure to others while they have active signs and symptoms. Keep children with hand-foot-and-mouth disease out of child care or school until fever is gone and mouth sores have healed. If you have the illness, stay home from work.

Hand-foot-and-mouth disease is usually a minor illness causing only a few days of fever and relatively mild signs and symptoms. However, a rare and sometimes serious form of the coxsackievirus can involve the brain and cause other complications:

Viral meningitis. This is an infection and inflammation of the membranes (meninges) and cerebrospinal fluid surrounding the brain and spinal cord. Viral meningitis is usually mild and often clears on its own.Encephalitis. This severe and potentially life-threatening disease involves brain inflammation caused by a virus. Encephalitis is rare.

Children usually develop immunity to hand-foot-and-mouth disease as they get older by building antibodies after exposure to the virus that causes the disease. However, it's possible for adolescents and adults to get the disease.
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nannyde 08:34 AM 05-19-2011
Originally Posted by Crystal:
Here is a child care fact sheet for HFM.....you do not need to exclude the child from care:

http://www.ucsfchildcarehealth.org/p...Mouth_0509.pdf
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.
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Mom_of_two 08:37 AM 05-19-2011
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!!
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Unregistered 09:08 AM 05-19-2011
Yes the girl is staying home until all blisters have healed and gone. I called the mom last night to ask her if they did some type of swab test to determine 100% that it is HFMD. She said the dr did not because he said it was so mild. She has a blister on the side of her tongue and the one on her chin and thats it. She also did not get a drs note!!!

I reminded her that she will need to get her re-checked BEFORE she will return here and that per my own policy she cant come back until its completely healed and gone. If she had a fever on this last Monday and the blister showed up Tuesday night - how long should I keep her out? I think the mom thinks as soon as the blister is healed its okay but I read online that they are still contagious for awhile. I keep reading 7 days of being contagious... Any advice on that part? And of course she will HAVE to bring a drs note saying that shes all good before I'd even consider her returning.

Im glad in a way that this girl had the lip injury because otherwise I wonder if the parents would have ever taken her to the dr and found out she has this HFMD. They are the type of parents that wait forever to get things checked out.
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Unregistered 10:03 AM 05-19-2011
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!
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Unregistered 10:22 AM 05-19-2011
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!
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Crystal 11:52 AM 05-19-2011
Originally Posted by nannyde:
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.
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Crystal 11:52 AM 05-19-2011
Originally Posted by Mom_of_two:
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.
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Crystal 11:54 AM 05-19-2011
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.
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Country Kids 01:31 PM 05-19-2011
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.
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jen2651 02:14 PM 05-19-2011
Originally Posted by 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.
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!?!
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Symphony 03:39 PM 05-19-2011
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.
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nannyde 03:50 PM 05-19-2011
Originally Posted by Crystal:
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 "suckers". 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.
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Kaddidle Care 06:06 PM 05-19-2011
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.
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nannyde 06:33 PM 05-19-2011
Originally Posted by 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.
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.
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Unregistered 07:22 PM 05-19-2011
Originally Posted by 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.
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!
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Crystal 08:27 PM 05-19-2011
I have found that Head Start uses Quat cleaner:

http://solutions.3m.com/wps/portal/3...beQB2XRP1WS8gl

Do you know anything about that one Nan?
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nannyde 05:30 AM 05-20-2011
Originally Posted by Crystal:
I have found that Head Start uses Quat cleaner:

http://solutions.3m.com/wps/portal/3...beQB2XRP1WS8gl

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.
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