Hand, Foot & Mouth vs Scarlet Fever: Irish Crèche Guide

As November sets in and Irish crèches keep windows cracked for ventilation while heating cranks up, seasonal childhood illnesses peak. Among the most common—and alarming-looking—infections circulating in toddler and preschool rooms across Ireland are Hand, Foot and Mouth Disease (HFMD) and Scarlet Fever (caused by Group A Streptococcus or Strep A). Both conditions spread rapidly in group childcare environments through close contact, shared toys, and respiratory droplets.

Understanding how to tell them apart, when your child must stay home, and how Health Protection Surveillance Centre (HPSC) and Health Service Executive (HSE) exclusion policies work will save you stress, missed work scrambles, and unnecessary trips to the GP.

Note: This article is for informational purposes only and does not constitute medical advice. If you are concerned about your child’s health, always contact your GP, out-of-hours GP service (such as D-Doc, ShannonDoc, SouthDoc, or Caredoc), or call 999/112 in an emergency.

Quick summary

• Hand, Foot and Mouth (HFMD): A common, highly contagious viral infection (Coxsackievirus) causing mouth ulcers and red spots/blisters on hands, feet, and the nappy area. Antibiotics do not work.
• Scarlet Fever (Strep A): A bacterial infection requiring prescription antibiotics. Classic signs include high fever, swollen neck glands, sore throat, "strawberry tongue", and a fine, pink-red rash that feels like rough sandpaper.
• Exclusion rules: For Scarlet Fever, children can return 24 hours after their first dose of antibiotics (if feeling well and fever-free). For HFMD, the HSE states children do not need to stay home until every blister scabs over, but must stay home until they are fever-free, feeling well enough to participate, and drooling has stopped. Many crèches have stricter internal policies.
• Reporting to crèche: Always inform your childcare provider immediately upon diagnosis so they can alert other room parents and monitor for outbreaks.
• Hydration is key: Painful mouth blisters in HFMD can lead to dehydration quickly; offer cold milk, yoghurt, ice lollies, and regular fluids.

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Hand, Foot and Mouth vs. Scarlet Fever: Key Differences

While both conditions present with a rash and fever in early childhood, their causes, treatments, and risks are completely different.

Feature	Hand, Foot and Mouth Disease (HFMD)	Scarlet Fever (Strep A)
Cause	Viral (usually Coxsackievirus A16 or Enterovirus 71)	Bacterial (Group A Streptococcus)
Typical Age	Most common under 5 (babies, wobblers, toddlers)	Most common in children aged 2 to 10 years
Rash Appearance	Red spots developing into small, grey-centred blisters on palms, soles, buttocks, and nappy area	Fine, pink-red rash across chest and tummy that spreads; feels like rough sandpaper
Mouth Symptoms	Painful red spots on tongue and inside cheeks that turn into ulcers	Very red, swollen throat; white coating on tongue that peels to reveal a bright red "strawberry tongue"
Medical Treatment	Symptom relief only (paracetamol, ibuprofen, hydration); antibiotics do not help	Prescription antibiotics (usually a 10-day course of penicillin or amoxicillin)
HSE Exclusion Period	Stay home until child feels well and fever has resolved; do not need to wait for all blisters to clear	Return 24 hours after starting antibiotics, provided fever is gone and child feels well

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1. Hand, Foot and Mouth Disease: What to Expect

Hand, Foot and Mouth Disease has nothing to do with foot-and-mouth disease in cattle. It is an extremely common childhood virus that sweeps through Irish crèches every autumn and winter.

Symptoms and Progression

1. Days 1–2: Starts with a mild fever, loss of appetite, sore throat, and general irritability. Toddlers may suddenly refuse snacks or lunch.
2. Days 2–3: Painful mouth ulcers appear on the tongue, gums, and inside the cheeks. Your child may drool heavily or cry when swallowing.
3. Days 3–5: Small red spots appear on the palms of the hands and the soles of the feet. These frequently appear around the mouth, knees, and nappy area (often mistaken for severe nappy rash). In many cases, these spots develop into fluid-filled blisters.

HSE Exclusion Policy for HFMD

According to official HSE and HPSC guidelines (Management of Infectious Disease in Childcare Facilities and Other Childcare Settings), exclusion is not strictly required until the last blister clears, provided the child feels well and has no fever.

However, your crèche's specific infection control policy may be stricter. Many providers ask that children stay at home if:

• They have an active fever (above 38°C).
• They have painful, open mouth ulcers causing excessive drooling (which spreads the virus rapidly on shared equipment).
• The child is visibly miserable, clinging, and unable to take part in crèche activities.

Always check your crèche parent handbook. If you use a registered childminder, discuss their illness policy directly before drop-off.

Home Care Tips

• Pain management: Give liquid paracetamol (Calpol/Paralink) or ibuprofen (Nurofen) at correct age-based dosages to relieve mouth pain before meal times.
• Hydration: Avoid citrus juices, salty foods, or acidic fruit that sting mouth ulcers. Offer chilled water, full-fat milk, smooth yoghurts, cooled porridge, or plain ice lollies.
• Skin peeling: Several weeks after recovering, you might notice your child's fingernails or toenails peeling or even shedding, alongside peeling skin on fingertips and toes. This is a harmless, normal post-viral reaction.

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2. Scarlet Fever & Strep A: Recognition & Treatment

Scarlet Fever is caused by bacteria known as Group A Streptococcus (GAS). While it sounds Victorian, it remains a standard childhood illness in Ireland that peaks between November and April. Strep A bacteria usually cause a mild sore throat ("strep throat") or impetigo, but when the bacteria produce a specific toxin, it results in Scarlet Fever.

Symptoms to Watch For

• Sudden high fever and chills (often 38.5°C or higher).
• Severe sore throat with swollen, tender glands in the neck.
• The "Sandpaper" Rash: Typically starts 12 to 48 hours after the fever on the chest and tummy, spreading to the neck and limbs. It looks like a sunburn with tiny pinpoint bumps and feels rough to the touch, like fine sandpaper.
• Flushed cheeks with pale skin around the mouth.
• Strawberry Tongue: The tongue starts with a white coating that peels off over 2–4 days, leaving it bright red, swollen, and covered in tiny raised bumps.

When to See the GP

If you suspect Scarlet Fever, see your GP promptly. Unlike viral infections, Scarlet Fever requires a full course of oral antibiotics (typically penicillin or amoxicillin).

Antibiotics are vital for two reasons:

1. They significantly speed up recovery and prevent complications such as ear infections, sinusitis, pneumonia, or rheumatic fever.
2. They render your child non-contagious within 24 hours.

HSE Exclusion Policy for Scarlet Fever

The HSE rule is clear: children must be excluded from crèche or school until 24 hours after their first dose of antibiotics, provided they are also fever-free and feel well enough to return. If antibiotics are not taken, the child remains contagious for up to 2 to 3 weeks and cannot return during that window.

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When to Seek Urgent Medical Care

Most cases of both illnesses resolve smoothly at home, but complications can arise. Contact your GP or out-of-hours service immediately if your baby or child:

• Is under 3 months old with a temperature of 38°C or higher.
• Shows signs of dehydration: no wet nappy for 8–12 hours, dry lips, sunken eyes, no tears when crying, or extreme lethargy.
• Breathes faster than normal, grunts, or shows chest retractions (skin sucking in beneath the ribs or throat).
• Has a rash that does not fade when you roll a clear glass against it (a non-blanching rash).
• Is unusually drowsy, floppy, difficult to wake, or inconsolable.

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Crèche Outbreak Policies & Hygiene

Childcare rooms are built for social development: toddlers share building blocks, explore sensory trays, and often mouth communal toys. Consequently, winter bugs spread fast.

Notification Rules for Crèches

Under the Child Care Act 1991 (Early Years Services) Regulations 2016 monitored by Tusla, early learning services have clear infection control obligations:

• Parental communication: When two or more cases of an infectious illness occur in a room, crèche managers generally issue an alert email or notification on your parent portal (e.g., ChildPaths, Little Vista).
• Public health notification: Services report unusual clusters or larger outbreaks of scarlet fever/strep A to their local HSE Department of Public Health for guidance.

Deep Cleaning Protocols

When an outbreak occurs, crèches implement enhanced cleaning:

• Soft toys and fabric cushions are removed or washed at high temperatures.
• Plastic toys, table surfaces, door handles, and nappy changing stations are sanitized with hospital-grade disinfectant several times daily.
• Hand hygiene routines before snack time and after outdoor play are strictly reinforced.

If you are exploring childcare options or moving facilities, you can search Tusla-registered settings across Ireland on Crechely to read inspection reports and assess provider standards.

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Managing Missed Crèche Days and Work

Having a child excluded for several days in mid-November creates real logistical headaches for working parents.

1. Check Your Force Majeure Rights: Under Irish employment law, parents are entitled to paid Force Majeure leave of up to 3 days in any 12 consecutive months (or 5 days in 36 months) for urgent family illness emergencies.
2. Protecting Your NCS Subsidy: If your child misses crèche due to HFMD or Scarlet Fever, your National Childcare Scheme subsidy will not be cut off immediately. Tusla and the Scheme Administrator allow for typical childhood sick days without penalty. If illness stretches beyond continuous absence thresholds, an explanatory GP note provided to your crèche manager protects your registered hours and subsidy funding. Check subsidy impact using our NCS calculator.
3. Plan Childminder Backup Wisely: Remember that if your child is contagious, registered childminders must also protect the other mindees in their home. Relying on family or flexible remote working rosters is usually the safest option until the infectious window passes.

By recognising the symptoms early, consulting your GP when bacterial signs show, and adhering to HSE exclusion timelines, you help your child recover comfortably while keeping vulnerable room buddies safe.

Frequently asked questions