Making the call to keep a child home from school is never an easy one and now COVID has made that decision even more difficult. If they’re a little stuffy, should they stay home? What if they coughed?! Is it allergies? A cold? COVID?! It’s enough to make any parent or caregiver’s head spin.
“We know that there are many benefits beyond just education in having kids attend school in person, but to safely do that, parents and caregivers need to be aware of what to look for, when to keep kids home and when it’s OK to send them back,” says Dr. Jenna Wheeler, a pediatric critical care physician at Orlando Health Arnold Palmer Hospital for Children. “Beyond COVID, we’re entering flu and respiratory virus season, and it’s important to help prevent the spread of all of these illnesses.”
General recommendations for returning to school after illness*
Not sure when a child should head back into school after they’ve been ill? Here are some general guidelines and recommendations (followed by more detailed information) from Dr. Sara Siddiqui, a pediatrician and clinical assistant professor in the Department of Pediatrics at NYU Langone’s Hassenfeld Children’s Hospital in New York and Dr. Brandon Smith, general academic pediatrics fellow in the Department of Pediatrics at Johns Hopkins in Baltimore, as well as Wheeler:
|Symptoms||Keep kids home until they:|
|Fever||Have tested negative for COVID and are fever-free without fever-reducing medicine for 24 hours.|
|Cold or cough||Have been symptom-free, particularly if there’s a fever, for 24 hours.|
|Vomiting||Feel better, and it’s been 24 hours since the last vomiting episode.|
|Diarrhea||Haven’t had diarrhea in 24 hours and are feeling better. (If a specific cause of the diarrhea has been diagnosed, they may need to stay out of school longer.)|
|Rash or hives||Have been fever-free for 24 hours and are released by their pediatrician, as it depends on rash type.|
|COVID-19||Have quarantined until all symptoms have resolved and 10 days have passed since the onset of symptoms or positive test.|
When to keep your child home from school
According to Siddiqui, the following are reasons to keep a child home from school:
- A temperature above 100.4 F.
- A cough that is persistent.
- A rash that is spreading.
- Lesions on the skin that are open or infected.
- Blisters that are spreading.
- Loss of taste or smell.
- Stomach pain.
- Sore throat.
- Any unexplained symptom that is new and persistent.
“When unsure, call the pediatrician for advice on how to proceed and whether or not a child needs to be evaluated in the office,” Siddiqui adds.
Additionally, it’s smart to check kids for symptoms every day — even if they seem fine. “We recommend parents screen their children each day before sending them to school,” says Wheeler. “They should ensure that their child does not have a fever, cough, new loss of taste or smell, nausea, vomiting, diarrhea or a runny nose, as these can all be symptoms of COVID-19.”
Have a younger child? Here’s when to keep kids home from day care.
Can a child go to school with a fever?
No. Children should not go to school with a fever. “A fever indicates that the body’s immune system is fighting off an illness and could be when a person is actively infectious and contagious,” Siddiqui explains. “Kids should stay home until the fever has been resolved for 24 hours without fever-reducing medication.”
PULL QUOTE: “A fever indicates that the body’s immune system is fighting off an illness and could be when a person is actively infectious and contagious.” — Dr. Sara Siddiqui, pediatrician
Can a child go to school with a cough or cold?
According to Smith, kids may be able to go to school with a cold or cough — but it depends on a number of things. “In addition to taking the school’s policies into account, parents should also consider how long a child has had the cough, if they have other symptoms and if they’ve seen a doctor to evaluate the cause,” Smith says. “However, if you’re concerned that your child may have a new cold or viral infection, it’s best to keep them home. Especially during the pandemic, we want to do all we can to limit children from passing viruses around to each other and their teachers.”
In some areas, kids with symptoms may need to be tested for COVID in order to go to school. “A persistent cough or congestion should be evaluated by a medical provider to ensure that the child is not contagious,” Siddiqui says. “Testing for SARS-CoV2 may be necessary to determine if a child may return to school. Allergies can be very common this time of year, but the only way to know for sure is to have testing done.”
Once a child with congestion or a cough has received a negative test result, Wheeler says they should be “improving, fever-free and feel well enough to attend school again.”
Can a child go to school after throwing up?
“If your child has been vomiting, in general, they should stay out of school until the vomiting is better and no longer an issue,” Smith says. More specifically, Wheeler adds that the child should be able to “stay well hydrated and be back to eating.”
Can a child go to school with diarrhea?
If “diarrhea is accompanied with fever or vomiting” then a child needs to be feeling better and fever-free before returning to school, according to Siddiqui.
However, Smith notes one distinction,“If the cause of diarrhea is from a bacteria or parasite, the child may need to stay out of school longer,” he says, adding that the only way to know for sure is to speak with the child’s pediatrician.
Can a child go to school with a rash or hives?
If a child wakes up with a rash, it’s smart to get them checked out by their pediatrician, as there are a number of things that can be going on. “Some rashes are caused by a viral infection and may not be contagious when the rash is present — this would need to be determined by the medical provider,” says Siddiqui. “Hives are usually caused by an allergic reaction and also would need different treatments. In general, once the rash or hives have been cleared to not be contagious, then the child may return to school.”
Is it COVID?
Unfortunately, COVID-19 can mimic a number of other viral illnesses, so the only way to rule it out is by getting a test. That said, Smith notes that the following can be symptoms of COVID in kids:
- Sore throat.
- Body aches and pains.
- Loss of taste and smell. “These seem to be very specific indicators to get tested for COVID,” Smith says. “But children may or may not present with this symptom.”
“If a child tests positive for COVID, then they need to stay home until all symptoms have resolved and 10 days have passed since the onset of symptoms or positive test,” Siddiqui explains. “If the positive test is a result of an exposure and the child is not symptomatic, the CDC recommendations are to stay home, observe for symptoms and return in 10 days.”
Siddiqui also adds that the rest of the household contacts should be tested as well on day 3-5 of exposure. However, “if household contacts are vaccinated, they do not need to quarantine but need to observe for symptoms and then be tested for COVID if any symptoms are present.”
The bottom line
“At the end of the day, parents know their children best,” Wheeler says. “If there are any concerns about them being ill or coming down with a sickness, keep them home and check in with their doctor for any further evaluation or care and to help answer questions about school attendance.”