Is Your Child Too Sick for School?

Early in the morning it is often difficult to make a decision about whether or not your child is sick enough to stay home from school.  With minor symptoms, you often cannot tell whether they are going to get better or worse during the course of the day.

 When you send your child to school, make sure that your child's school nurse knows how to reach you during the day, and that there is a back-up plan and phone number on file if the school nurse cannot reach you. Feel free to contact your child's school nurse anytime.

 The main reasons for keeping your child home are:

• They are too sick to be comfortable at school.

• They might spread a contagious disease to other children.

As a rule of thumb a child should stay home if they have:

• A fever (an oral temperature of 100.4 or greater is considered a fever)

• Vomited

• Diarrhea

• A very frequent cough

• Persistent pain (ear, stomach, etc.)

• A widespread rash

Most of these problems need to be discussed with your child's healthcare provider to determine if an office visit is needed. (If your child has frequent complaints of pain that cause school absence, you should consider the possibility that your child is intentionally avoiding school. Bring this to the attention of the child's doctor or nurse practitioner before a great deal of school has been missed.)

On the other hand, children who don't have a fever and only have a mild cough, runny nose or other cold symptoms can be sent to school without any harm to themselves or others. The following guidelines may help in your decision process:

1.  A runny nose is the way many children respond to pollen, dust or a cold virus.  Minor cold or allergy symptoms should not be a reason to miss school. Many healthy children have as many as six colds per year, especially in the early school years. If the mucous has color, you may want to call your doctor or nurse practitioner.

2.  Coughing, especially if it is persistent during the day, can indicate a worsening of cold or allergy symptoms. It may be a sign of a secondary infection (e.g., sinusitis, pneumonia), which may require medical treatment. It may also indicate mild asthma. If your child's cough is worse than you might expect with a common cold, you need to consult your child's doctor or nurse practitioner. You should do so immediately if the child is not acting normal, has a fever or has any difficulty breathing.

3.  Diarrhea and vomiting make children very uncomfortable.  A single episode of watery diarrhea probably warrants not going to school. It could be very embarrassing and uncomfortable for your child to have another episode while in school. If diarrhea or vomiting are frequent or are accompanied by fever, rash or general weakness, consult your child's doctor or nurse practitioner and keep the child out of school for 24 hours with no vomiting, diarrhea or fever without the use of fever-reducing medications.

4.  Strep throat and scarlet fever are two highly contagious conditions caused by the same bacterial infection.  They usually arrive with a sudden complaint of sore throat and fever and often stomachache and headache.  With scarlet fever, a rash usually appears within 12 to 48 hours.  A child with these symptoms should see his doctor or nurse practitioner for diagnosis and treatment and should remain out of school until they are without fever and has been on antibiotics for 24 hours.

5.  Pinkeye, or conjunctivitis, can be caused by a virus, bacteria or allergy.  The first two are very contagious. The eye will be reddened, and a cloudy or yellow discharge is usually present.  The eye may be sensitive to light. Consult with your child's doctor to see if antibiotic eye drops are needed.  Again, your child should stay home until symptoms subside and they have been on antibiotic eye drops at least 24 hours or until the doctor or nurse practitioner recommends your child return to school.

6.  Middle ear infections can cause great discomfort and often fever, but are not contagious to others. Your child should see their doctor or nurse practitioner for diagnosis and treatment and should stay at home if they have a fever or pain.

7.  Flu is a contagious virus that usually occurs in the winter months. Symptoms include body aches, high fever, chills, congestion, sore throat and, in some children, vomiting.  Your child should stay home until these symptoms improve. Consult your child's doctor or nurse practitioner for treatment suggestions to make your child more comfortable.

8.  Impetigo is a staph or strep infection that creates a red, oozing blister-like area that can appear anywhere on the body or face.  A honey-colored crust may appear on the area.  It can be passed to others by direct contact. Consult you child's doctor or nurse practitioner for treatment and length of time your child should remain out of school, especially if the area cannot be covered.

9.  Chickenpox is a highly contagious viral illness.  It causes fever and an itchy rash, which spreads quickly all over the body, changing from red bumps to blister-like lesions, then scabs.  Your child needs to stay home until all bumps are scabbed and no new bumps have appeared for two days. Your child is contagious at least two days before the rash starts, so you need to let the school and playmates know and consult your child's doctor or nurse practitioner for treatment of symptoms.  A vaccine is available for children who have not yet had chickenpox and is required for kindergarten. The vaccine will also be required again for all sixth graders who have not yet had chickenpox.

10.  Scabies and lice brought into a school can quickly produce an epidemic of itching and scratching.  Scabies are tiny insects that burrow into the skin and cause severe itching. Lice are tiny wingless insects, like ticks, that thrive on the warm scalps of children and cause itching. Both should be treated immediately, with advice from your child's doctor or nurse practitioner. Children need to stay home from school until head lice are dead and until nits or eggs are removed with a special fine comb. Head checks should continue for 10 to 14 days. Caution your child against sharing combs, brushes, hats or other clothing.  In the case of scabies, children should stay home for 24 hours after treatment.

All of these illnesses can be spread easily, both in school and in the family.  Keep in mind that hand washing is the single most important thing you can do and teach your child to do to help prevent the spread of infections.

Whenever there is a doubt in your mind about sending your child to school, consult your child's doctor or nurse practitioner before doing so.  A phone consultation may be all that is necessary, or your child's doctor or nurse practitioner may need to see the child in the office.

2023 KDE Health Services Reference Guide

School Nurse Resource Manual 

A Guide To Practice 

Ninth Edition

Evidence-based policies and procedures for safe student care