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The Informed Parent

Your Child Is Sick. So Can He Go To School? The Updated Guidelines On When To Exclude Ill Children

by Lori A. Livingston, M.D., F.A.A.P.
Published on Mar. 30, 2009

No parent WANTS to send their sick child to day care or school, but all parents know that sometimes you HAVE to. If all sick children had to stay home, parents would likely almost never get to work and kids would miss much of their education.

So when should you absolutely keep your child home with an illness?

For these reasons:

  • Tuberculosis, until a health care provider certifies that the child is getting proper treatment and can return.
  • Impetigo, until 24 hours after treatment has been started.
  • Chickenpox, until all sores have dried and crusted (usually one week).
  • Mumps, until 9 days after the onset of parotid gland swelling.
  • Hepatitis A Virus, until one week after the onset of illness.
  • Measles, until 4 days after the onset of rash.
  • Rubella, until one week after the onset of rash.
  • Fever, only if accompanied by behavior changes or other symptoms like sore throat, rash, vomiting, earache, etc.
  • Diarrhea, if frequent, runny and watery stools.
  • Blood in Stool, if not explained by diet changes, medication or hard stools.
  • Vomiting, if 2 or more times in a 24 hours period.
  • Body Rash with Fever
  • Sore Throat with Fever, and swollen glands or mouth sores with drooling.
  • Severe coughing, with the child turning red or blue in the face.
  • Persistent abdominal pain, if more than 2 hours or intermittent pain with other signs like fever or vomiting.
  • Signs of Possible Severe Illness, such as irritability, unusual tiredness, or neediness that compromises caregivers’ ability to care for others.
  • Uncontrolled coughing or wheezing, continuous crying or difficulty breathing.

When can your child go to school with an illness?

A good rule of thumb is that a child should stay home if the illness prevents him from participating comfortably in activities. Or a child should be excluded from day care if the illness results in greater care than the staff can provide.

We know that most viruses are spread by children who seem well, which means that exposure to other children happens BEFORE the school can call to have the child picked up. Preventing a child’s attendance will not significantly reduce the chance of spreading of the illness. The best way to prevent the spread of infection in group care is hand and surface hygiene, not sending children home. However, many exclusion guidelines vary from state-to-state and school-to-school, meaning your child’s day care or school may have their own rules for sending ill children home.

If you are unsure of whether to keep your child home, contact the day care or school for guidance, or contact your pediatrician for advice.

Resource:  Infectious Diseases in Children, February 2009

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