When to Keep Your Child Home From School
Illustration by Paige McLaughlin for Verywell Health
Fact checked by Nick Blackmer
Key Takeaways
Experts say a fever, persistent cough, runny nose, vomiting, diarrhea, and red, crusty eyes are all signs you need to keep your child home from school.
Each school district also has its own policies about sick days for kids, so make sure you know what the rules are.
The Centers for Disease Control and Prevention (CDC) does not recommend keeping your child home if they have lice.
Back-to-school season is also “back to cold, flu, and other not-so-fun bugs” season. If you’re a parent, you probably aren’t looking forward to the first morning your child wakes up not feeling well and you have to decide if they should stay home from school or not.
Adding to the confusion is that your school district, state, and even the part of the country where you live may have totally different policies that guide parents on when kids have to be kept home from school if they’re sick.
Here’s what experts say about the signs and symptoms that mean your child needs to take a sick day from school and their other activities, as well as when they need a trip to the pediatrician.
Related: Avoiding Illness When Your Family Is Sick
Sick Day: Signs and Symptoms
After getting through a global pandemic, a lot of us feel more confident about spotting the signs of an infectious respiratory disease and know how important it is to take steps to try to prevent its spread. Maybe you’re already used to getting your family’s flu shots in the fall, and you’ve worked hard to make sure everyone knows to always wash their hands and sneeze into the crook of their elbow.
You can do your best to try to keep germs out of your home, but colds, the flu, and other ailments are likely to find their way in eventually. And then you’ll have to decide if a sick day is warranted.
“I recommend keeping your child at home for fever, significant coughing, vomiting, and/or diarrhea,” Lauren Strelitz, MD, a pediatrician at Bayside Medical Group at Stanford Medicine Children’s Health, told Verywell.
According to Andrew Bernstein, MD, a clinical assistant professor of pediatrics at Northwestern University Feinberg School of Medicine, fever, a bad runny nose, and cough are the symptoms that keep kids out of school the most.
Bernstein said that headaches and stomachaches are also common in kids, but “may be caused by anxiety, dehydration, vision issues, constipation, acid reflux, and food sensitivities” rather than a contagious illness.
It sounds simple, but caregivers have to juggle a lot of competing feelings and priorities when they’re trying to decide whether to let a child who isn’t feeling well go to school or not.
Related: Fevers in Common Childhood Illnesses
Fever
A fever is a body temperature over 100.4 degrees. Experts recommend that you keep your child home from school until they are fever-free for 24 hours without taking any medication like Tylenol or ibuprofen that brings a fever down.
Positive COVID Test
If your child tests positive for COVID, keep them at home—even if they don’t feel sick. You’ll also want to call their school to let them know about the positive test.
The current guidelines from the Centers for Disease Control and Prevention (CDC) state that you need to isolate for five days after COVID symptoms start or you get a positive test.
You can usually end isolation after five days if your symptoms are getting better and you’ve been fever-free for 24 hours without taking fever-reducing medication. However, you’ll need to check with your child’s school to find out what the policy is for coming back after COVID.
Related: What to Do If You Test Positive for COVID
Persistent Cough
Coughing spreads germs and can be distracting for a child and their classmates. Keep your child at home if they have a persistent cough that’s causing mucus (a productive cough) or shortness of breath.
Here are a few common contagious cough culprits in kids:
Upper respiratory infections (e.g., colds, the flu)
Lower respiratory infection (e.g., bronchitis, pneumonia)
There are also several common causes of cough in children that are not contagious:
Seasonal allergies
Asthma
Post-nasal drip
Related: Should I Worry About My Kid's Cough?
Uncontrollable Runny Nose
If your child’s nose is dripping nonstop or they frequently need to blow their nose, they’ve probably got a cold or another respiratory virus. If your child is constantly using tissues, those little germ balls are going to get spread around the classroom—and so will the illness.
Keep your child home if they:
Are having trouble breathing
Have consistent drainage from their nose
Have discolored mucus
Related: Why Runny Noses Happen
Vomiting
Kids throw up at school for a lot of reasons that are not contagious—nerves, a snack that doesn’t agree with them, playing too hard at recess after lunch, a weird tickle in their throat that makes them gag.
But if a child vomits and also has stomach pain, fever, diarrhea, or just an overall “yucky” feeling, they probably have a bug and need to go home. Keep your child out of school until they have not thrown up or had a fever for 24 hours without taking any medication.
Diarrhea
If you’ve ever been stuck at work or out on an errand when diarrhea strikes, you know that being anywhere other than the comfort (and privacy) of your own home when you’re dealing with it is miserable. For kids, having diarrhea at school can be even worse because they may have a harder time controlling it.
Diarrhea in children caused by gastrointestinal infections is contagious and tends to spread through your child’s class (and subsequently your family).
There are also non-contagious causes of diarrhea in kids such as:
If your child has diarrhea, let them stay home until they’ve been symptom-free for at least 24 hours, and make sure they stay hydrated (especially if they’re also vomiting).
Related: How to Help Your Kid Stay Hydrated When They Have Vomiting and Diarrhea
Sore Throat
If your child has a sore throat, they could have anything from allergies to a cold to strep throat. It might be hard to say for sure what the cause is, but you’ll know to keep them home from school if their sore throat is accompanied by:
Trouble swallowing
A fever, runny nose, and/or cough
Red/swollen tonsils
Swollen lymph nodes on their neck
COVID, RSV, and the Flu
Flu season is expected to coincide with rising cases of COVID and respiratory syncytial virus (RSV). These respiratory illnesses can share many of the same symptoms, including:
Runny nose
Sore throat
Cough
Muscle aches
Fatigue
Fever
However, there are a few differences, too:
RSV can also have symptoms like shortness of breath and wheezing
The flu can come with symptoms like body aches, vomiting, and diarrhea
COVID can have symptoms like a loss of taste or smell
There are vaccines available for all three viruses, which will hopefully reduce the number of people who get seriously sick. An updated COVID vaccine and flu vaccine are available for everyone 6 months and older, and there are RSV vaccines for people who are pregnant (to protect infants in the first six months of life) and for older adults. There are also monoclonal antibodies, which mimic natural antibodies created by the immune system, for infants and for certain children up to 24 months old who are at high risk for severe RSV disease.
Related: Where Is RSV Spreading?
Eye Discharge
If your child has red itchy eyes, your first thought might be seasonal allergies. But it could also be an eye infection like conjunctivitis (also known as highly contagious “pink eye”). While allergies usually affect both eyes at the same time, an eye infection tends to start in one eye and may spread to the other.
As a rule of thumb, keep your child home if they have:
Noticeably red or pink eyes
Eyelid swelling
Eye discharge
A feeling like there’s something in the eye
Crust on the eyes when they wake up
Increased tear production
Sensitivity to light
If your pediatrician diagnoses your child with an eye infection like pink eye, they may get a course of antibiotics to treat it if it’s caused by bacteria. You’ll want to check with their school, but you can usually expect to let them go back to school 24 hours after they start antibiotics.
Related: How to Tell If Your Kid Has Pink Eye
Body Rash
“Children get many rashes,” said Strelitz. “Unless it is from something highly contagious, such as scabies, measles, or chickenpox, there aren’t any specific rashes for which they would need to stay at home.”
A body rash has a lot of non-contagious causes like allergies, eczema, or irritation from something in their environment. But there are also some causes of body rashes that are contagious:
Scarlet fever: This condition causes a bright red rash that can develop along with a case of strep throat. A child can usually return to school 24 hours after antibiotics are started as long as they don’t have a fever.
Impetigo: This is a common bacterial infection of the skin. A child can usually return to school 24 hours after starting antibiotics. If they still have any open sores, they should be covered.
Ringworm: This is a common fungal infection on the skin. There are medications that can treat it, and a child can usually go back to school within 24 hours of starting treatment.
Hand, foot, and mouth disease: A mild (but still contagious) viral infection that causes sores on the mouth, feet, and hands. A child can usually return to school when they are fever-free for 24 hours without medication and the sores have either healed or can be covered up.
Related: The Most Common Rashes in Kids
Head Injury
It’s not a contagious thing, but if your child gets a head injury playing a sport or in gym class, they should be kept home from school. You’ll also be advised to keep a close eye on them and get medical attention if they have:
Loss of consciousness
Confusion
Nausea or vomiting
Change in personality
Bleeding
Change in alertness
Uneven pupils
Headache
Dizziness
Ringing in the ears
Sleepiness
If your child has a concussion, they’ll need to follow the return-to-school/sports protocol from their pediatrician. Usually, this means they can go back to school after:
24–48 hours of cognitive rest
Their symptoms have improved
They can tolerate 30–45 minutes of instruction
Their provider says they can go back to school/sports/regular activities
Related: What Are Return-to-Play Guidelines for Concussions?
What About Lice?
Head lice, a tiny insect that feeds off blood on the scalp, is a fear of many parents of school-aged children.
Head lice is itchy and annoying to deal with, but it does not carry or spread disease. Contrary to what decades of classroom “lice checks” might have led you to believe, it’s also pretty rare for lice to be spread at school.
In fact, the CDC does not recommend children with lice be excluded from school, and it does not recommend those mass lice screenings anymore.
“A child with lice should not stay at home, or even be sent home early,” said Strelitz. “They should be treated the night it is diagnosed with permethrin shampoo. A nit comb should also be used to thoroughly brush the hair to remove the eggs. The treatment should then be repeated on day 9 or 10 after diagnosis.”
If you think your child has lice, you should tell the school and get in touch with their pediatrician about the steps. There are several over-the-counter (OTC) and prescription treatments for lice that are safe and effective, such as:
Pyrethrins (OTC)
Sklice (OTC)
Ovide (prescription)
Natroba (prescription)
Stromectol (prescription)
AirAllé (heat-based treatment done at a lice clinic)
Related: How to Avoid Head Lice
When to Take Your Child to the Pediatrician
The symptoms of a mild cold will usually get better after a couple of days. However, if your child’s symptoms do not improve or get worse, it is time to call their pediatrician.
You should also call your child’s provider right away if they have:
Stiff neck and fever and other viral symptoms
A fever above 104
Lethargic after vomiting and diarrhea
Symptoms are getting worse
Having trouble breathing
Fever persists for longer than 3 days
Red crusty eyes
Mysterious rash or sores
Symptoms of concussion
Severe sore throat with redness and white spots on the throat
Government and school-based guidelines will differ, but you can often rely on your parental intuition and common sense when it comes to deciding to keep your child home from school for a day or two if they’re not feeling well.
“Parents know their child best and have a great sense of when their child is sick, anxious, or has other reasons they might not want to go to school,” said Strelitz.
Before you send them back, make sure they have the basics of infection prevention down. That means knowing how to wash their hands properly and cover their coughs and sneezes. As a parent, you’ll want to make sure you’re giving them the tools they need to avoid giving others germs, too. For example, having them mask up for the trip to the pediatrician.
What This Means For You
For an obvious infectious illness, the decision to keep a child home from school is pretty clear. But if you’re not sure, consider whether your child’s symptoms would make it hard for them to focus or disrupt their classmates.
Read Next: Signs Your Child Needs to See Their Pediatrician
Read the original article on Verywell Health.
