Child With Hand, Foot and Mouth Disease, Measles or Chickenpox in the Philippines: Isolation, School Clearance and Protecting the Household

Day one: stay home, see the doctor, tell the school

Until a doctor has seen them, treat a child with fever and rash as contagious. The order of action on the first day is as follows.

• No school and no crowded places. That includes the school bus, after-school classes, playgrounds and mall play areas. For many of these illnesses the contagious period begins as symptoms first appear.
• Book the paediatrician. When you phone, say at once that the child has fever and rash and you suspect an infectious illness. Some clinics and hospitals arrange a separate waiting area or entrance to protect other children. Note when the fever started, the highest reading, where the rash first appeared and how it spread. Take clear photographs and bring the vaccination record.
• Inform the school. Message the adviser or school nurse with the symptoms and the fact that the child is being seen, then follow up with the diagnosis. The school needs this to watch classmates, notify other parents and arrange cleaning.
• Think about contacts. Was another child in the class or neighbourhood ill in the past week or two? Any playground visits or parties? This helps the doctor.

Hand, foot and mouth disease, measles and chickenpox overlap in how they look, and parents can rarely tell them apart early. Their isolation requirements and complication risks differ, so do not diagnose by comparing pictures online. The Philippines also has dengue and other illnesses that present with fever and rash but are managed quite differently, which is another reason the distinction belongs to a doctor.

On the way to the clinic, use your own car or a private ride where you can, put a suitable mask on the child and avoid crowded public transport.

When not to wait for an appointment

Most children with hand, foot and mouth disease or chickenpox recover with care at home, but a small number develop complications. If any of the following appears, skip the outpatient booking and go to a hospital emergency room.

• A change in alertness. Unusual sleepiness, difficulty waking, slow responses, or irritability and crying that cannot be soothed.
• Neurological signs. Seizures, jerking or weakness of the limbs, unsteady walking, frequent startling, severe headache or a stiff neck.
• Breathing trouble. Fast or laboured breathing, bluish lips or a persistent severe cough.
• Dehydration. Refusing nearly all fluids because of mouth pain, no urine for many hours, crying without tears or very dry lips.
• Fever that will not settle or returns. A very high temperature that responds poorly, or a fever that comes back after several days without one.
• An unusual rash. Spots that look like bleeding under the skin and do not fade when pressed, or blisters surrounded by spreading redness or pus.
• Young infants. A very young baby with fever and rash should always be seen promptly.

For judging a night-time fever, see where to go when a child has a high fever or seizure at midnight, and for after-hours options see where to get care at night in the Philippines. On arrival, tell triage the child may have an infectious illness so the hospital can place you appropriately.

These points help a parent decide whether to go now. They are not diagnostic criteria. When unsure, make the extra trip. Whether to admit, which tests to run and which medicines to use are decisions for the doctor examining your child in person.

Looking after the child during home isolation

After the diagnosis the doctor will say how long to stay home and when to return for review. During that time a parent's job is mostly comfort, fluids and observation.

• Fluids come first. A child with blisters or ulcers in the mouth may refuse to drink because it hurts. Offer small, frequent amounts of cool liquids that are neither sour nor hot, and soft, lukewarm food. If the child is passing urine and reasonably alert, eating less for a few days is not a cause for alarm.
• Fever and itch. Which medicine, what dose and how often must follow the doctor's prescription exactly. Do not scale down an adult medicine and do not use another child's leftovers. Some common adult medicines are unsuitable for children, so confirm with the doctor or pharmacist. For buying medicine see the guide to pharmacies in the Philippines.
• Skin care. Trim fingernails, dress the child in loose cotton and discourage scratching blisters open. Bathing is fine with lukewarm water; pat dry gently.
• Rest and company. Sick children are clingy. Allow more picture books or cartoons than usual and relax the normal house rules.
• A daily log. Temperature, fluid intake, number of wet nappies or toilet visits, changes in the rash and general alertness. Showing this at review is far more accurate than describing from memory.

Do not take the child to the condominium pool, a playground or a friend's home during isolation, even when they seem lively again. Whether the rash has crusted or cleared enough, and whether the child is still contagious, is for the doctor to judge at review. If a nanny helps with care, explain the illness and precautions clearly and check whether she has had the disease or the relevant vaccine herself.

Protecting siblings, pregnant women and older relatives

All three illnesses spread readily within a household. Complete separation is rarely possible, but the risk can be lowered.

• Separate items. The sick child has their own towel, dishes, cup and toothbrush, and a separate room and bathroom where the home allows it.
• Wash hands. Use soap and running water before and after caring for the child, after changing nappies and after handling vomit or wiping a nose. The virus behind hand, foot and mouth disease can remain in stool for some time, so keep up careful handwashing after nappy changes and toilet visits for a while after recovery.
• Clean toys and surfaces. Clean and disinfect toys, door handles, tables and toilet seats daily, and put soft toys away for now.
• Ventilate. Measles and chickenpox can spread through the air. Keep rooms aired, bearing in mind that ventilation does not replace isolation.
• Check vaccination records. Take out the other children's records and see whether measles and chickenpox vaccines have been given. If not, or if the record is incomplete, ask the doctor promptly whether and when to vaccinate. See children's vaccination in the Philippines and where to get vaccinated in the Philippines.

Three groups need particular care and should contact their own doctor after exposure without waiting for symptoms: pregnant women, very young infants and anyone with a weakened immune system, such as a relative receiving certain treatments. Chickenpox and measles are often more severe in adults than in children, so parents and nannies who have had neither the illness nor the vaccine should also be alert.

Older relatives with chronic conditions should keep close contact with the sick child to a minimum and let other family members handle the care.

What schools usually require: exclusion, notices and clearance

Schools and preschools in the Philippines normally have a written policy on infectious illness in the parent handbook. Details vary, but the general pattern is this.

• Exclusion after diagnosis. The school will ask that the child stay home until no longer contagious. The length is not a fixed count of days; it follows the doctor's judgement and how the fever and rash resolve.
• Clearance to return. A certificate signed by a licensed doctor is usually required, commonly called a medical clearance, a medical certificate or a fit-to-return note. Ask for it at the review visit. It should state the diagnosis and the date the child may return, with the doctor's signature and licence number.
• The school's notice. The school will generally tell parents in the class that a case of a named illness has occurred, without identifying the child. If privacy worries you, check the wording with the school beforehand.
• Class or school measures. When several cases appear in one class within a short time, the school may suspend in-person sessions for that class or step up disinfection, and health authorities may become involved. Follow the school's notices.
• Missed work. Ask the teacher about assignments and make-up tests. Most schools are flexible.

If the school asks for more than the doctor advised, for example by refusing re-entry despite a clearance, ask calmly for the basis and have the school nurse speak directly with your child's doctor. That usually resolves it. Lasting unequal treatment because of a past infection can be raised through the school's grievance steps.

Preschools and daycares, where children are younger and contact is closer, tend to be stricter; see preschools and daycare in the Philippines. For whether costs fall under school insurance or a family HMO, see what school insurance actually covers.

After recovery, and preparing for next time

Once your child is well there are a few loose ends worth tying, which also set you up for the next illness.

• Keep the records. File copies or photographs of the diagnosis, test results and clearance. A later school transfer, enrolment back home or certain formalities may ask about past infectious illness and vaccinations.
• Complete vaccinations. Ask the paediatrician to go through the record against your child's age. Children arriving from China should bring their Chinese vaccination record, translated into English, so the local doctor can continue the schedule.
• Watch for after-effects. Some children shed fingernails or toenails in the weeks after hand, foot and mouth disease, and they normally grow back by themselves. Raise anything else that concerns you at review.
• Close the loop. Tell the school the child has recovered and let families you recently spent time with know, so they can watch their own children.

Everyday preparation is modest but effective. Save the numbers of the paediatric clinic and nearest emergency room. Keep a thermometer and whatever children's medicines your doctor recommends at home. Read the handbook's section on illness and exclusion. Confirm whether your HMO or insurance covers your child's outpatient and inpatient care. For who can decide and whom to call in different kinds of emergency involving children, see handling emergencies with children in the Philippines.

If you are bringing a child to study in the Philippines and need admission papers, authenticated vaccination records and the parents' residence status arranged together, see Yixing's settling-in support. Yixing is a private consultancy registered with the Philippine SEC (CS202009551) and holds BI Accreditation No. CA-202624381-1. It is not a medical provider. This article describes process only and does not replace a paediatrician's diagnosis or prescribing advice.