It’s official. School has started for another year. Along with all that good education, your child is likely to bring home sniffles, a sore throat, and the common cold. More often they head back to school the next day. But when is your child really too sick to go to school?

Jerold Woodhead, MD a pediatric specialist at the University of Iowa Children’s Hospital, gives some advice on when kids should stay home from school:

A sniffle, a cough, or a general “I don’t feel good” from your child, when really is a child too sick to go to school?

If a child has symptoms of an upper respiratory infection like a cough or a sniffle, most of those children can go to school. On the other hand, if the child has fever, if the cough is interrupting daily activities, if the child didn’t sleep well at all the night before and is exhausted in the morning (and the parents would be too, by the way), would probably exclude that child from school just for the comfort level of the child.

In general, when should parents check with their pediatrician about a child’s illness?

If a parent knows the child has an underlying problem that’s triggered by an illness, such as asthma every time she gets a cold, or frequent ear infections, or if the parent knows the child has been exposed to a strep throat carrier or someone who is sick with strep throat, it would be appropriate to call the doctor. In addition, with fever, vomiting, diarrhea, rashes that are unusual, should probably trigger a call.

What are your recommendations on when it’s okay to send the child to school if the child has:

• A slight fever?
  In general, sending a child to school with a temp greater that 101 degrees is not advised. If you’re using a Celsius thermometer, that would be 38° C. A child with a temperature that is slightly elevated—say 99 degrees—is probably OK to go to school as long as that fever is not associated with something like a swollen lymph node, a terrible sore throat, a rash that’s concerning, or a cough that’s problematic.
• A mild cough, runny nose, no fever?
  A child in that situation can go to school as long as the child can control the secretions. In other words, if the child is old enough to know how to blow his nose, if the child can be taught to cough into the elbow rather than into the hands, or if the child knows how to wash hands, all of those should be OK. The younger child—say the kindergartener or even the preschooler—you may need to talk with your specific teacher or provider to find out what they want.
• A bad, hacky cough with significant cold symptoms?
  Again, it depends on the degree it’s disrupting the child’s daily activities or would disrupt the activities of the classroom. Many times the child who is coughing like that has a form of viral-induced asthma that may have been diagnosed previously and that parents know how to take care of using a medication like an albuterol inhaler. On the other hand, if the family has never experienced anything like that before, then it’s probably worthwhile calling somebody and getting the child into the doctor before you send them off to school.
• Either diarrhea or vomiting?
  Most school-age children can control diarrhea if it’s only once or twice a day or if the stool is just loose. When the diarrhea gets to the point where the child is constantly going back and forth to the bathroom, and especially if the diarrhea is so bad that there’s a problem of keeping fluids in the child, the child needs to stay home. Vomiting is more problematic because it’s harder to control, and when a child is vomiting, especially if the child vomited first thing in the morning before school, it’s prudent to keep the child at home until you know how much vomiting is really going to happen.
• A sore throat?
  Sore throats are in many ways like runny noses and slight coughs. They reflect a viral illness in 85 or 95 percent of cases. The severe sore throat may well be associated with strep infection, especially if there’s swollen, tender lymph nodes at the angle of the jaw; and even more so if you know the child has been exposed to somebody with strep. Mononucleosis can cause sore throats in adolescents, but the strep throat and the mononucleosis sore throat are accompanied by fever, often by abdominal pain, and headache. So those kids are pretty ill and most parents are going to keep them home. The slight sore throat without other symptoms is most likely a viral illness and it’s probably OK to send the child to school.
• An earache?
  Earaches are typically caused by bacterial infections, although viruses can cause them. Some children who have trouble with fluid in the middle ear can develop an earache because of pressure. So there’s a degree to which the symptoms of the child dictate how you handle it. A little bit of an earache, it’s certainly OK to send the child to school with a dose of Tylenol or ibuprofen to control the discomfort. If pain is so severe that the child has been up all night, or has a lot of pain, that child needs to be seen by the doctor.
• Pink eye?
  Pink eye is conjunctivitis and conjunctivitis in most children is caused by a viral illness. The younger child, under five or so, often will have a bacterial infection that needs to be treated with antibiotics. The trouble is it’s very difficult to distinguish between the bacterial and the viral infection. There are some tests available to look for a specific kind of viral infection, but they’re not readily used in most offices at present. I think that, depending on how red the eye is, and what kind of symptoms the child has, and how much eye discharge there is, parents are probably going to need to see somebody and find out whether or not the child needs antibiotics. If a bacteria infection is diagnosed in the eye, then the child has to stay home for 24 hours after the dose of antibiotics is started. If you’re taking the child to the doctor at noon on a school day, that means the child is going to be out of school for the remainder of that day, plus the full next day, because you’re not going to send them back on the afternoon of the next day. And by the way, the same goes for strep throat. If you’ve got a diagnosed strep throat with a rapid test or a culture that’s positive, treatment needs to be given for 24 hours before the child can go back to school.
• Rash or poison ivy?
  Let’s start with poison ivy. Poison ivy is an allergic-type reaction to the material that’s in the poison ivy plant. It can’t be transmitted. It’s not something that’s dangerous to other children. But it may certainly cause a child to be very uncomfortable and have, perhaps, rashes that are not very attractive, especially if they’re on the face. And if the rash involves the eyes or the face or is really severe and the child is being treated with steroids or other medicines, that child may need to stay home. But most poison ivy on the hands or legs, doesn’t need to be excluded. Then there are the rashes, and boy we’ve seen a lot of rashes this summer. Almost all of them triggered by the enteral viruses which is a family of viruses that cause all sorts of symptoms and signs. For the most part, by the time the rash appears, the child has already exposed everybody to that infection because most of those viruses are infectious several days before symptoms appear. So you’re going to have to talk to the school and the care provider as to what they would like in terms of sending the child to school. For the most part, though, careful hand washing, watching out for coughing and sneezing, and how you handle Kleenexes, is probably the best way to prevent spread of the viruses that trigger those rashes.

Finally, what is your best advice when a parent is in doubt about sending their child to school when they are sick or not feeling well?

• Know your own child and know how well the child can function in daily activities.
• If you think the child is so sick that sitting in a classroom is going to basically be uncomfortable or nonproductive for the child, then it’s probably better to keep the child at home.
• If your child needs to have Tylenol or ibuprofen, acetaminophen or ibuprofen, every four to six hours—that’s going to be hard to administer at school.
• If your child needs an antibiotic, you need to be sure that that antibiotic has been given at least 24 hours before the child goes back to school.
• If there’s an underlying condition like asthma, or some other problems, you need to know the child and what the recommendations are for that specific child.
• And lastly, just make sure your child is completely immunized.

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Jerold Woodhead, MD

University of Iowa Children’s Hospital