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Quick reference medical handouts used by Pediatric offices

When to send your child back to school

Should you send your child to school or keep them home is a question facing many parents at the breakfast table when their usually exuberant, hungry child sits listlessly ignoring their food. Since it is important to provide as healthy a school environment as possible for all students and staff, here are some guidelines to help parents struggling with his dilemma.

Cat scratch disease

This illness is usually spread by bacteria from the cat’s saliva into a child’s open skin and not by person to person contact. Therefore, the child may attend school.


As long as there is no fever or discomfort, a child with a cold may go to school as long as they are not too uncomfortable to function in school. Instruct the youngster on the proper use of tissues for coughing, sneezing, and nose blowing. They should also be taught good hand washing techniques, since research has shown that more colds are spread via contaminated hands than by infected droplets in the air. Alcohol wipes can be used to reduce spread from hands or contaminated objects (toys, etc.)


The child may return to school once all the chicken pox lesions are crusted over. Since the child was contagious up to two days before the rash started, most of their classmates were already exposed.


Loose stools have many causes; a child should not attend school until the bowel movements have normal consistency. This reduces the chance of leakage or contaminating the child’s hands. Certainly, youngsters still in diapers who have watery loose stools that cannot be contained in the diaper should stay home. In addition, youngsters with diarrhea that contains blood or mucus should be kept home until their physician evaluates them. Children with Escherichia coli 0157:H7 or Shigella infections should be kept home until diarrhea resolves and two stool cultures are negative for the organisms.


Never ignore an earache. Keep your child home and contact your physician. If there is ear discharge, even without pain, notify the doctor, as this generally means a ruptured eardrum ( a draining ear is not contagious).


The first question to answer here is “what is fever?” Most experts agree that any temperature below 100.8 degrees is normal (for babies under four months of age, any temperature demands medical attention). Temperature should be normal for 24 hours before sending a child to school. For example, if a youngster has a fever 100.8 degrees or higher during the night, he or she should probably not attend school in the morning, even if the temperature is normal. Temperatures are lower in the morning and the fever may occur again in the afternoon. Temperature is  also influenced by activity, diet, and environment. Fever in itself is not contagious. Its presence simply means that parents should look at their youngster more closely for other signs or symptoms.

Fifth Disease

By the time the lacey red or "slapped cheek" rash is visible, the affected child is no longer infectious. Therefore, they can return to school and exclusion from class is unnecessary.

Hand-Foot-Mouth Disease.

This illness is non-serious, but is especially uncomfortable. While exclusion from school is not necessary, the child should be kept at home if they have an elevated temperature or the mouth sores make them too uncomfortable to attend school

Head Lice 

Head lice pass from child to child on clothing, bed linens, combs, brushes, and hats, but the louse does not jump from one child to another. The child may return to school when the treatment is completed. Often, the child is then examined by the school nurse or designated personnel for signs of an active infection. Although medical experts feel a child should not be denied school attendance because of the presence of nits, it nay be the policy of your child's school system, private school, or day care center, that the youngster be nit free.
Hepatitis A child with Hepatitis A should remain home for one week after the start of the illness.  Most school districts require a physician's note before a child with either Hepatitis A, B, or C, is permitted back in class. Some children with hepatitis can be asymptomatic and still be contagious. 


Children with impetigo requiring antibiotics may return to school 24 hours after they have begin taking the antibiotics, While many infectious disease experts do not believe the impetigo sores need to be covered, most school systems and day care centers do require the lesions be covered. be covered.

Infectious Mononucleosis

The child may return to school once cleared by their physician. Despite many myths to the contrary, the virus that causes “mono” has an extremely low communicability Absence from school varies among teenagers with mono and depends on how much energy they have to attend class. For example, some teens may tolerate attending school full time, while others may need to be off for several weeks.


Child may return to school four days after the onset of the rash. Since most kids are required to be immunized against measles, a child who has been diagnosed with this condition probably has another reason for the rash and is therefore not contagious.


When a child has a condition necessitating they return to school while still on antibiotics, parents should check with the school regarding administering medication. Trained school personnel (most schools don't have nurses) will administer medication only to those students who have a signed authorization form on file at the school. Most require that all medication must be in the original container. Prescription medications need only the parent's signature since the physician's prescription is the labeled pharmacy container. Over-the-counter medications require both the parent's and physician's signatures. Both signatures are also required if the student is carrying and self-administering their own medication. Parents should be encouraged to work with their physician to schedule medication administration before and after school, if possible.


Child should remain home until 9 days after the beginning of parotid gland swelling. Since most kids are required to be immunized against mumps, a child who has been diagnosed with this condition probably has another reason for the swelling and is therefore not contagious.

Pink Eye

If the child is old enough to be responsible about hand washing (usually school age), exclusion from school or activities is not necessary. If the youngster is a toddler or pre-schooler, it is probably best to keep them at home for a couple of days until either the condition clears on its own or a physician has looked at it and states it is not contagious. Unfortunately, how long a child is excluded from daycare or school is often dictated more by the day care’s individual policy than by sound medical science.


A child with this parasitic condition need not be excluded from school, but good hand washing, particularly after using the restroom, should be required. Since pinworms exit at night, the child is most contagious in the morning, so good hand washing at school first thing is a good idea.
Rash A rash is usually a sign of a viral illness. It may also be a reaction to a medication or chemical (plant, detergents). If your child has an unusual rash or it is associated with a fever, it is probably best to keep your child at home until you have had a chance to discuss the condition with your youngster’s physician.  Most viral rashes are not contagious, so parents should use their own common sense. For example, if your child has an allergic rash and is taking an antihistamine to prevent itching, it might be a good idea to keep the youngster home since these medications tend to make kids sleepy.
Ringworm The Committee on Infectious Diseases of the American Academy of Pediatrics has stated that children receiving treatment for ringworm may attend school. Haircuts, shaving of the head, or wearing a cap during treatment are not necessary (parents should check with their child's school or day care center, since many require the lesions to be covered). It is impractical to keep children out of school for the 4-8 weeks it takes to completely eradicate the infection.
Roseola Students with any rash and fever should not return to school until their fever is gone. It is believed that children are contagious from a few days before the fever until onset of the rash.
Scarlet Fever and Strep Throat A child diagnosed with strep throat may return to school 24 hours after the youngster has been on antibiotic therapy. 
Tuberculosis Children with tuberculosis infection or disease can attend school or childcare if they are receiving therapy. Most schools require a letter from the childs physician indicating that the youngster is no longer contagious.
Vomiting If a child vomits during the night, it is probably not a good idea to send them to school or day care in the morning. What he or she needs is rest and either a liquid or soft diet.

Whooping Cough

Child should remain home until they have been on antibiotics (erythromycin) for five days. Since most kids are required to be immunized against whooping cough, a child who has been diagnosed with this condition may actually have another reason for the cough and is therefore not contagious.

Signs indicating that your child is in the early stages of a health problem may include changes in behavior, mood, activity, and loss of appetite. Parents should always let their instincts be their guide. If you are uncertain about sending your child to school on any given day, it is probably best to keep the youngster home and observe him or her for further symptoms. It is always a good idea for parents to check with their child's school nurse or daycare center to find out their individual policies on illness. These policies differ and could affect your decision as a parent. One final word: it is a good idea for everyone to wash their hands routinely, especially if they have a communicable disease, in order to keep themselves healthier as well as those around them.


Prepared with the help and assistance of Diana H. Dameron, BSN, MPH, Supervisor, School Health Services, Pinellas County Schools, Florida, and Jack Hutto, M.D., chief, Infectious Disease Department, All Childrens Hospital St Petersburg, Florida.









As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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