Flu, COVID-19 and RSV: When should you keep your child at home?

It's been repeated through the COVID-19 pandemic: Keep your kids at home if they're sick.

And Ohio records of absenteeism at schools for the past few years show parents did.

From the 2020-2021 school year to the 2021-2022 school year, the statewide rate of students missing at least 10% of their instructional time due to absences increased by 6 percentage points to 30.2%. There were other reasons kids were absent, too, which often intersect with symptoms of poverty: unsafe neighborhoods, food insecurity, housing instability and lack of transportation. Chronic absenteeism rose across nearly all grade levels, district types and student subgroups.

And with all the flu, respiratory syncytial virus (commonly called RSV) and COVID-19 threats, parents might be overwhelmed with judging symptoms to decide whether to send their children to school.

If parents fail to keep sick kids home, can − and do − schools intervene?

"I don't really think there is a way that they can enforce it," Madeira parent Amy Groover said. She knows judgement calls can be tricky. One of her three kids "tends to be a little bit of a faker at times," but she has been called in by the school nurse to pick up her other son when he developed a fever at school.

More obvious symptoms, fevers and vomiting, for example, could get a student sent home, she said. But other symptoms, such as coughing, a runny nose or a sore throat? Those are things parents need to keep an eye on.

Groover and her husband, Richard Groover, told The Enquirer they don't test for COVID-19 unless their child has a fever. But they have sent their kids to school wearing masks when they noticed coughing or other low-grade symptoms.

Catherine Beaucham, a parent in the Forest Hills School District with kids in first and eighth grades, said she has always taken a conservative approach to gauging sickness severity but would send her kids to school with minor colds if they otherwise felt OK.

Beaucham, like the Groovers, recognizes that she is fortunate to be able to stay home with her kids when they are sick. There are other parents who can't do the same due to work inflexibility and lack of child care.

Not just about stopping the spread

Angie Maddox, the environmental and school health administrator for Cincinnati Public Schools, said the district works with the Cincinnati Health Department to develop its guidelines and protocols for dealing with sickness. But while the health department recommends receiving a negative COVID-19 test before returning to school, the district's school board has no such policy. CPS, like most other local school districts, doesn't require negative flu or strep tests to return to school, either.

Still, the district encourages its families to check in with their physicians when their kids are sick to determine the best treatment and for advice on how long to keep their sick children out of school.

"We try to remind people that COVID is not the only illness out there," Maddox said. "There are certainly other things that we don't want spreading across to other people."

Minor symptoms "certainly can" fly under the radar, Maddox said. But since the pandemic, she believes school nurses and teachers are all a bit more attentive to kids' health needs. She hopes parents are, too.

"It's not just a matter of not spreading a virus," she said. "Someone needs to stay home so that they, themselves, can heal quicker. If you're coming to work or school and you don't feel well, it could set back your own healing."

What advice do doctors have for parents?

We asked Dr. Robert Frenck, a pediatrician in the Cincinnati Children's Hospital Medical Center Division of Infectious Diseases, for his advice to parents. Frenck is also director of the Vaccine Research Center.

Q: When should you keep your child at home, and if so, why?

Frenck: I would recommend a child not go to school if they are too sick to be able to participate or the parents think the child is contagious with a significant illness that could pose a risk to others at the school. If they have a fever, they should not go to school.

Q: What does "fever-free" really mean?

Frenck: Fever (an oral temperature of over 100 degrees) is an objective marker, and a child should not return to school until he or she has been without a fever – and that includes without administration of medicines to control a fever – for at least 24 hours. Fever is an indicator that the person still is contagious and more likely to transmit the infection to others.

Q: When should you send them to school?

Frenck: No fever for at least 24 hours and feeling well enough to attend. The "well enough to attend" is subjective, but parents know when their child is not feeling well.

Q: Is this a time when parents should be more careful about sending their child to school?

Frenck: Parents are advocates for their children and should do what is the best and safest for their kids. Sometimes, parental decisions are difficult and painful. The best we can do as parents is provide our children with the best chance to stay healthy. One main tool in that toolbox is vaccines.

Q: What about screwing up a kid’s perfect attendance record in school?

Frenck: While school attendance is very important, if a child is sick, he or she should stay home until well enough to return to school.

This article originally appeared on Cincinnati Enquirer: Flu, COVID-19 and RSV: When should parents keep kids at home?