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When Is My Child Too Sick for School?

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By RANI S. GEREIGE, M.D.

Published: December 7, 2007

"I heard Jenny constantly coughing at 2 o'clock this morning," Jenny's mom told me. "She was burning up with fever. I don't understand — she was just fine last night when she went to bed, maybe a little less active than usual. I gave her fever medication, and she went back to sleep. This morning, she has no fever; she's active and has some mild cold symptoms. I'm not sure what to do. I feel guilty sending her to school, but she wants to go. Shall I keep her home today? I would have to call in to my job."

Knowing when to keep kids home from school is often a tough decision for parents to make. Like Jenny's mom, they struggle to balance their child's well-being with minimizing school absences and missing work.

Now that school is in full force, children share school lunches, play, friendships and, unfortunately, hard-to-control germs. Changes in weather and close contact with others in closed classrooms predispose children of all ages to common illnesses.

Viral infections, such as colds or stomach viruses, spread more easily and are more common than bacterial infections, such as strep throat. Viruses typically get better on their own, without antibiotics, and symptoms may be alleviated by supportive care such as medications for congestion, cough, or runny nose. Here are some tips for when your child needs to stay home from school:

A fever greater than 101.5 degrees (taken orally). A child may experience no symptoms except fever and feeling "under the weather" during the first 24 hours of any viral infection, but this is the period of highest contagiousness. This is why schools frequently establish policies against sending students with a fever to school.

Severe vomiting and/or diarrhea with or without abdominal pain. The child who can't keep anything down needs careful observation for signs of dehydration. You should slowly encourage fluids. However, if your child had a bout of diarrhea the night before and no symptoms in the morning, he or she can attend school.

Severe abdominal pain with fever and poor appetite. A child with a tender abdomen should be closely observed. A doctor's visit is needed to rule out appendicitis if the pain worsens or if your child doubles over with pain.

A sore throat with or without fever. A doctor's visit may be needed to rule out strep throat. If it is not strep, the child can go to school that same day. A child with strep is no longer contagious 24 hours after being treated with antibiotics.

Fever and skin lesions suspicious for chickenpox. If your child is not immunized against chickenpox or was exposed to another child with chickenpox, a doctor should check the rash before your child returns to school.

Fever, severe headache, neck pain and/or stiffness. A physical examination is warranted to make sure these symptoms are not signs of meningitis.

In the end, you know your child best. Children who have no specific symptoms but are lethargic, look drawn out and tired, or have a high fever should be evaluated by a doctor or school nurse. Sometimes even minor illnesses can interfere with learning and require your child to stay home to prevent the further spread of a contagious disease.

Dr. Gereige is associate professor of pediatrics and director of the Primary Care Pediatric Sports Clinic at USF Health.

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