Colds, Flu, Cough: When is a sick child not too sick to go to school?

Sick child with mom on couch.
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Sometimes, its easy to figure out when your child is too sick to go school. With telltale signs like vomiting, a high fever, even pink eye, you know when to keep a little one home.

But after you've both spent a restless night with a scratchy throat, hacking cough, a warm forehead or general malaise, parents of elementary school children may find themselves wondering whether their sick child is or isn't too sick to send to school.

While you don't want to infect an entire classroom, there may be times when your child needs to head for the school bus. And, if you're a working parent, you're left to make a judgment call, which can be difficult.

It's a common question we hear and there's a lot of gray area, says Tad Nowicki, MD, pediatrician who practices at AdventHealth. Sometimes it's hard for people to know what the right answer is.

Below Dr. Nowicki offers advice to help you make a stay-or-go decision before the start of the school day.

Colds
Common colds are the main reason children miss school and adults miss work. Each year in the United States, there are millions of cases of the common cold. Adults average of 2-3 colds per year, and children have even more says the National Institutes of Health.

Colds are so common that if kids stayed home every time they had one they'd never graduate.  Says Dr. Nowicki, make sure your child washes his or her hands and sneezes into an elbow or better yet, a tissue. Teach little ones to avoid sneezing into their hands because they're likely to spread germs by touching something like a doorknob, computer or a friend.

Conjunctivitis a.k.a. Pink Eye
Its the most common eye problem kids can have. Adults, especially parents and teachers who spend a lot of time with kids, can get it too. Pink eye is highly contagious and most cases are caused by a virus, which doesn't respond to an antibiotic. Bacterial conjunctivitis requires an antibiotic; your doctor will be able to determine if this is the case.

Conjunctivitis lasts a short time, usually about a week or less, and then goes away by itself or after treatment. Keep your child home until a doctor gives the OK to return to school.

Coughs
Having a sore throat, cough or mild congestion doesn't necessarily mean your child can't be active and participatory. If your son has a stuffed-up nose but is still running around the house, chances are he's well enough for the classroom. On the other hand, if he's been coughing all night, or his cough is accompanied by phlegm, or he wakes up groggy, he may need to take it easy at home.

Fever
Its parents call on fevers of 100 degrees. Fevers of 101 and higher, however, are usually a sign of illness. Keep him home and don't be too quick to send him back as soon as he appears to rebound. Kids should be fever free without any medication for at least 24 hours before returning to school. Giving them acetaminophen to lower a fever and then sending them off to school isn't right for them, their teachers or their classmates.

Flu
I tell parents to keep kids with flu-like symptoms home for at least 24 hours after they no longer have a fever, or signs of a fever, without the use of fever-reducing medicines, says Dr. Nowicki. 

Rashes
Rashes can be a sign of contagious illnesses like chickenpox, bacterial meningitis, or impetigo (a skin infection). Keep your child home until she's been diagnosed. Even if the rash isn't catchable, you'll put other parents and teachers at ease if you get a doctors note confirming it isn't contagious.

Lack of Energy
Kids who lose their appetite, are clingy or lethargic, complain of pain, or who just don't seem to be acting like themselves should also take a sick day.

Vomiting and Diarrhea
Keep kids home for the duration of a gastrointestinal illness, and for at least an additional 24 hours.

Tips for working parents:
If you're a working parent, below are a few ideas to consider before your child becomes ill:

  • Save some personal days: For days like these, the easiest way out is to use paid time off. Save a few extra hours for child emergencies. If your company doesn't provide PTO, talk to your supervisor in advance about the best plan of action if your child wakes up sick.
  • Have an emergency sitter list: Start a list of family, friends or care providers who could possibly be available at short notice. Keep their phone numbers and availability within reach.
  • Watch for warning signs: Be aware of early warning signs in your child that could predict an oncoming illness. Does your child get a tickle in her throat or a headache? Recognize the signs and tend to these immediately to try to ward off illness.

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