We’ve all been there. You wake up and are rushing around to get everyone ready for the day when out of nowhere your child utters the dreaded words, “Mommy/Daddy, I don’t feel good.”

Your brain goes into hyperdrive as you go through all the options. “Maybe it’s not that bad. Maybe once she is up and going, she’ll feel better.” Or perhaps, “He does have a cough and seems a little sluggish, but I really need to get to work.” Or even, “His temperature is 99.9F. Perhaps I’ll give him ibuprofen and hopefully, he’ll feel better after he gets to school.” It tough. I’ve been there.

Studies Show You are Not Alone

In 2017, The University of Michigan C.S. Mott Children’s Hospital completed a National Poll on Children’s Health and let me assure you, you are not alone in the murkiness regarding when to keep your child home. “Parents frequently rate health-related factors – concern about the illness getting worse if the child went to school (60%) and not wanting the child’s classmates to get sick (47%) – as very important in deciding to keep a sick child home from school.”

Per the survey, symptoms also make a difference. “Most parents (80%) are not likely to send a child to school with diarrhea, but have less agreement about vomiting (58%) or a slight fever but acting normally (49%). Few parents say they are not likely to send a child with red watery eyes but no fever (16%), or a runny nose, dry cough and no fever (12%). Some low ranking additional factors included parents missing work or having difficulty finding someone to stay home and care for their sick child."

So, when should you keep your child home from school and when should they come back? While sometimes it’s very cut and dry, other times it feels like a complex puzzle. Hopefully, I can help shed some light on the matter. Keep in mind, when referring to a “child”, I am referring to students of all ages. These are even great guidelines for adults too!

Factors to Consider When Deciding Whether to Keep Your Child Home

• Remember that going to school is a child’s work. Will he or she be able to comfortably participate in activities? Will whatever is ailing him or her distract them or classmates from completing school work?
• Is the illness contagious or does your child need more care than the staff can give without affecting the health and safety of other children? Even though it may only be a low-grade fever and they are feeling fine, they might still be contagious. While early childhood students, in particular, are still learning how not to spread germs, even middle schoolers sometimes don’t think twice about sharing food or drink.

Nine Symptoms to Help You Make Your Decision

Symptoms play a major role in deciding whether or not to send your child to school. Consider the following when making your decision. This is a list of the more commonly seen ailments. 

1. Fever - If your child’s fever is 100F (37.7C) or higher, it is school policy to keep your child at home, even if they seem okay otherwise. Even though you may be able to treat the fever, and usually make your child feel better temporarily, the cause of the fever (and the risk of passing it to others) is still there. If you are really struggling with it, consider how would you feel if someone sent their child to school with a fever and then your child came down with a fever a few days later. Once your child has been fever-free for 24 hours without the aid of medication, he or she may return to school.
2. Vomiting - While this should be very straight forward, sometimes it seems tough. Perhaps your child woke up in the wee hours of the night, vomited once or twice, but seems fine in the morning and is now running around the house completely out of control. I get it, but please keep them home. After 24 hours of not vomiting without the assistance of medication, they are welcome back at school.
3. Cough/Cold - Colds come in all shapes and sizes. Some are mild with a runny nose and an occasional cough. Others have frequent persistent coughing, headache, sneezing and a severe runny nose. Again, think about how it may affect their day. Can they concentrate and participate in activities? How might it affect others around them? If your child is at a point where all that’s left of an illness is a persistent cough, please get in touch with the school nurse. You may be able to keep cough medicine in the nurse’s office to be administered during the day. This will help keep your child comfortable at school and lessen distractions overall.
4. Diarrhea - Need I say more? Keep them home until they are 24 hours free without medication. Sending your child to school with this is not fair to your child, other students, and school staff.
5. Hand, Foot, Mouth Disease - Children should be home while they have a fever, trouble swallowing, sores oozing, and/or are too sick to complete normal school activities. Your child may return to school once sores have dried up and your child is fever-free for 24 hours without medication. If there is only a small area left with oozing sores that can be completely covered with a dressing and clothing, get in touch with your school nurse to have a discussion regarding this.
6. Sore Throat - If it’s minor, students can come to school. If the sore throat is accompanied by fever and/or a headache, please keep them home. If it is strep throat, they may return to school after 24 hours on an antibiotic and are fever-free without a fever reducer.
7. Pinkeye or Conjunctivitis - This can be caused by bacteria, a virus, or an allergy. Bacterial and viral conjunctivitis are very contagious. The eye becomes reddened with cloudy or yellow drainage and there is possible light sensitivity. This usually warrants a trip to the doctor’s office. Your child should stay home until symptoms subside, particularly any drainage, and has been on antibiotic eye drops for 24 hours or the doctor says it is okay to return to school.
8. Rashes – Rashes sometimes cover the entire body, while others may only be in one area. Either way, they may be a sign of contagious illnesses such as, but not limited to, impetigo or chickenpox. Keep your child home until they have been diagnosed. Then they may return after symptoms are gone and/or a doctor gives the okay to return to school.
9. Flu - Keep your child home, please! Symptoms include body aches, fever, chills, congestion, sore throat, and in some children, vomiting. Your child should stay home until these symptoms improve and they have been fever-free, with no vomiting for 24 hours.

Establish Healthy Habits

Healthy habits are essential in the quest to prevent germs from spreading. It’s important to introduce these habits when children are young, remind them often, and set an example as well.

• Teach children to cough or sneeze into a tissue, then take it a step further by having them wash their hands after throwing it out. If out in public, teach them to cough or sneeze into the crook of their elbow.
• If you or your child coughs or sneezes into your hands or blows nose into a tissue, wash hands for at least 20 seconds. Pre-schoolers can sing the Happy Birthday song while washing hands, which is about 20 seconds. Kindergarten and 1st graders can sing the ABC’s while washing hands and for anyone older, well, count to 20!
• Avoid touching your eyes, nose, or mouth to prevent the spread of viruses. If you do, take a moment to wash your hands.
• Teach children to not share food, utensils, beverages or anything that might be contaminated with germs.
• Clean surfaces that may be contaminated with germs with household disinfectant cleaners.

Best Decisions

We all have good intentions and it’s easy to second guess oneself after making the decision to send or not send a child with symptoms to school. In a press conference, Gary Freed, MD, M.P.H., co-director of the C.S. Mott poll said, “It can be difficult to predict if a child will feel worse after going to school or how long symptoms of minor illnesses will last, so parents are often basing decisions on their best guess.” Several examples have been given in this article, but in pinch remember, if your child has a fever, might be contagious or would have difficulty participating in school, keep him or her home. 

Jackie Scheel, RN

School Nurse

nurse@stanleyclark.org