Dear Pediatrician: How Do I Know If My Kid Is Too Sick For School? - Forbes

Editor's Note: In "Dear Pediatrician," Dr. Natasha Burgert answers questions about babies, children and young adults for Forbes Health. Have a question? Email her at dearpediatrician@forbesadvisor.com.

Dear Pediatrician,

Since September, it feels as though my kid has been at home sick for more days than he's been at school. On most of these days, his symptoms clearly mean he cannot go to school, but sometimes I'm not so sure. I don't want to get any of his classmates or teachers sick, but he can't stay home forever. Are there some guidelines you can share so I really know when my kid is too sick for school?

Sincerely,
A tired mom

Tired Mom, you're not alone. The current illness season has been brutal for parents and kids alike. Visits to the doctor and school and parental absenteeism from work have been at record levels. And when illnesses seem back-to-back, it's tricky to determine when it's safe and appropriate to send them back to the classroom or daycare.

Keeping kids home when they're contagious with illness is a critical way to reduce the spread of sickness to others. In addition, many viral illnesses suppress the immune system, making recovering kids more susceptible to new illnesses if they return to the classroom too quickly.

Sick kids are not good learners. Not only are sick kids potentially spreading illness to others, their day is not effective or productive. Humans are meant to rest and recover as the body fights disease. A busy classroom setting is not conducive to this important work.

Most childhood illnesses follow a fairly predictable pattern. Kids often begin their period of contagiousness one to two days prior to symptom onset and decrease the risk of spreading illness to others over time. Knowing these patterns is how we can determine when kids should be staying home from school or daycare.

Based on my knowledge and experience as a pediatrician, a child must stay home from school with the following symptoms:

• Temperature over 100.4 Fahrenheit in the previous 24 hours
• Vomiting in the last 24 hours
• Diarrhea lasting more than a few hours
• Excessive coughing that is disruptive to others, or change in breathing patterns
• Untreated eye infection
• Severe headache or sore throat, especially if with fever
• Sharp, severe or persistent abdominal pain
• Known positive for COVID-19
• Known positive for influenza

A trip to the pediatrician's office is often recommended for kids who have a fever along with any focal pain (like ear or throat), or a known exposure to a contagious disease that may require treatment. In addition, if kids have severe symptoms of any type or the illness is lasting longer than expected, a doctor visit is warranted. And, of course, anytime you're worried about your child, we expect you to visit or call the office.

Think about returning to class when your child's symptoms are improving. For most kids, these are the factors that I would look for before sending them back to school:

• Fever-free for at least 24 hours without any fever-reducing medication
• Regular eating habits, especially after any vomiting or diarrhea
• Return to regular sleeping habits, and a good night of sleep the night prior to returning to school
• Runny nose and cough that is not disruptive and easily manageable
• Return of a normal level of energy and playfulness that will allow for a productive day in the classroom

If you visit the pediatrician and get a diagnosis, certain childhood infections have their own return-to-school rules. The time frames below are based on correct diagnosis and treatment plans.

• Strep throat. Kids with strep pharyngitis commonly experience sudden sore throat, fever, nausea and headache without additional respiratory symptoms. Doctors can diagnose strep throat by testing a sample of throat secretions, or throat swab. If positive, antibiotic treatment is required. Kids can return to school 12 hours after beginning antibiotics, as long as symptoms have improved.
• RSV. Children with respiratory syncytial virus, or RSV, will have fever, respiratory symptoms and a wheezy cough. RSV is spread from person to person like the common cold, and most kids are infectious for about one week after the start of symptoms (however, the American Academy of Pediatrics notes that kids with weakened immune systems can be contagious for up to four weeks, even if they aren't showing symptoms). Kids can return to school when the fever is gone, appetite and sleep has improved and breathing is stable. RSV can make kids cough for many weeks, so a cough alone should not keep kids at home.
• Pink eye. Childhood eye infections are most commonly viral. However, in case the infection is bacterial and to prevent bacterial complications, eye drops are often prescribed. Kids are able to go back to school as soon as antibiotic eye drops are started or with physician approval.
• Hand, foot and mouth disease. This viral infection causes small blisters and ulcerations to form in the mouth, around the nose and lips and on the palms and soles. Children can return to daycare and school when all the ulcers have scabbed over, fever is resolved and they are feeling well.
• Croup. This barking cough is not a disease itself, but a symptom of many viral infections. Once the symptoms of the primary infection have resolved or have met the return-to-school criteria for a specific illness, they may return to school.
• Influenza. The flu is a highly contagious viral infection that can be prevented with a yearly vaccine. Kids often have sudden high fever, fatigue, respiratory symptoms, sore throat and headache. Kids should stay home from school until they are fever-free for 24 hours without medications, eating normally, fatigue has resolved and they are feeling better. The cough from flu may persist for a few weeks, but that symptom alone should not keep kids home from school.
• Stomach flu. Most stomach bugs that cause vomiting and diarrhea last one to two days, but many kids will have intermittent vomiting for a few days as they try to return to their normal diet. Kids can return to school when they have not vomited for at least 24 hours and returned to a normal diet. In addition, diarrhea should be improved and they should be feeling back to normal before returning to class.
• COVID-19. Severe COVID-19 disease is vaccine preventable for all people over the age of 6 months. If a child is positive for COVID-19, they should stay home for five days from the beginning of symptoms or date of positive test. They can return to school on day six, if their symptoms have improved and if they are able to reliably wear a mask through day 10. If they are still unwell or cannot wear a mask, they should remain home for a total of 10 days.
• Lice and scabies. These skin infestations are annoying and persistent, but cause little harm to individuals. Children may return to school after appropriate over-the-counter or prescription treatments have started, even if nits remain.

For any of the above diseases, and other common childhood illnesses, symptoms may linger after the contagiousness period. In addition, kids may have very mild symptoms with certain illnesses and are able to attend school through this time.

Generally speaking, it's okay to send your child to school with:

• Improving cough without fever
• Runny nose without fever
• Non-contagious rashes
• Looser, infrequent stools
• Mild headache or tummy upset
• Rash without fever
• Ear infection
• Eyes with yellow or green drainage without fever

If you're unsure if your child should go to school, it's always wise to check in with your pediatrician. A phone call to their office may be able to offer more specific suggestions based on the illnesses that are being seen in your community. Alternatively, a quick office visit can confirm or rule out a contagious illness, helping to make a smart and safe decision for your family.

"Dear Pediatrician" is for informational purposes only and should not substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your child's pediatrician or other qualified health providers with any questions about a medical condition. By submitting your letter, you're agreeing to let Forbes Health use it in part or in whole, and we may edit the letter for length and clarity.

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