When Can My Child Go Back to School or Daycare?

As parents, most of us ask this question from time to time. Roughly two-thirds of American children under 5 years old attend daycare, and almost all children 5 and over attend school out of their homes. Keeping kids home from school or daycare due to illness is difficult for kids and their parents. Not only are the children sick, but they are missing their education (and time with their friends), and their parents are missing work and other responsibilities. The goal is to keep kids healthy. We want to minimize missed school and daycare, but also minimize the spread of illness in these places so that more kids don’t get sick and have to stay home.

Children get a lot of different illnesses during their childhood years. Some illnesses are not contagious (like ear infections, asthma or allergies), while some are (like flu, strep throat and chickenpox). Some illnesses that are not contagious still make kids miss school due to pain or other symptoms, while some illnesses that are contagious – like the common cold – do not require exclusion from school or daycare (more on this later). It is often hard for schools, daycares and parents to decide what should keep a kid home from school or daycare and what should not.

Many decisions about exclusion can be made using two simple rules. Children should stay home if he or she:

1)      Is unable to participate comfortably in school/daycare activities

2)      Needs more care from school/daycare staff than they can provide

The more difficult decisions come when a child is not too ill to participate, but poses a risk of spreading harmful/dangerous infection to others. Schools and daycares should follow guidelines from each state to help determine when a kid should stay home from daycare or school. These guidelines should be created using advice from your child’s pediatrician; the American Academy of Pediatrics (AAP) has written guidelines about this subject.

Sometimes kids are excluded because of specific symptoms that may be contagious. The following is a list of some symptoms that will likely result in exclusion:

• Fever and acting sick
• Diarrhea more than once
• Vomiting more than once
• Rash and acting sick or fever

Let’s take a closer look at each of these symptoms.

Fever: The state of Missouri defines fever as:

100.4 F rectal/ear

99.5 F oral

99.1 F axillary

Many pediatricians define fever as 100.4 F no matter how it is measured. Fever is caused by many conditions, some of which are contagious and some are not. Kids can get a fever if they get overheated or exercise strenuously. The AAP recommends that schools and daycares only check temperatures in kids who look or act sick. If excluded, a kid with fever can return when his or her fever is gone and is acting well. It is not necessary that a kid with a fever see a doctor before returning to school or daycare.

Diarrhea: Diarrhea is sometimes contagious and sometimes not. Kids can return when their diarrhea is contained in their diaper or they are not having accidents. All kids with bloody diarrhea must be cleared by their pediatrician before returning.

Vomiting: Vomiting is sometimes contagious and sometimes not. Kids may return once they stop vomiting.

Rash: It is hard to decide which rashes should cause exclusion and which shouldn’t. Fever or discomfort with rash might be cause for exclusion. Rashes that are draining should be covered with a bandage or result in exclusion. Your pediatrician can identify a rash if your child gets one and help decide when to return to school/daycare.

Some other conditions are worth mentioning, including:

Colds: Kids in daycare get 8-10 colds per year, while kids in school get 4-6 each year, on average. Colds are contagious before, during and after kids have symptoms, but colds are not dangerous illnesses to healthy kids. Therefore, kids should not be excluded for colds. The amount of missed school and work if kids were routinely excluded for colds would be very high.

Pinkeye: Some pinkeye is contagious and some is not. Except in very rare cases, pinkeye resolves without treatment. The state of Missouri still recommends that kids with eye redness AND drainage start antibiotic eye drops, but they can return immediately after starting drops. The AAP recommends that kids not be excluded for pinkeye no matter what the cause, and regardless of whether or not kids start eye drops.

Head Lice: Lice are not caused by poor hygiene and happen to kids everywhere. They can spread from direct head-to-head contact, but will not fly or jump across the room to infect your child. Lice are harmless. Kids with lice may remain in school until the end of the school day and may return the next day if treated for lice overnight. Policies that require all eggs or “nits” to be removed before return do not decrease spread of lice and should not be recommended.

A last point to make about keeping kids home from school or daycare is about vaccines. Many illnesses like chickenpox, measles and meningitis, that used to be commonly spread in schools and daycares, are now almost never seen because of the success of the vaccines that prevent them. Influenza vaccine prevents a lot of exclusion every year – but kids have to get it yearly. Vaccines are a very important part of keeping our kids healthy and in school and daycare.

For more information about this topic, visit www.essehealth.com.

By Dr. Randall Sterkel, Esse Health Pediatrician