When to Keep Your Sick Child Home from Daycare, Nursery, or School   Frank Barnhill M.D.
 

Contagious illnesses in schools, nurseries and daycare centers are usually passed from child to child by droplets suspended in the air from coughing and sneezing, direct contact with objects that have those droplets or “snot” deposited on them, or from hand contact with contaminated bowel movement. In defense of daycare centers and other schools, it’s virtually impossible to keep a child from coughing or sneezing on other kids or scratching his butt and handling toys before his hands can be washed. That’s why preventing the spread of childhood disease should start at home before the illness goes too far.

Medical reports clearly state that children should not be kept home from school for mild respiratory illnesses such as head colds without fever or a productive cough. However, you should use the following “guidelines” to judge the difference between mild and more severe illnesses.

You should not send your child to school if he or she:

• Has a fever above 100.4 degrees orally or 99.4 degrees rectally (please note that skin and ear digital thermometers are very unreliable!)
  
   
• Is irritable, cries constantly, or seems very sleepy or difficult to awaken
  
   
• Is hard to keep awake and refuses to eat normally
  
   
• Has difficulty breathing or seems to be breathing more rapidly than usual
  
   
• Had diarrhea in the past twelve hours that would run out of a diaper, has a foul infected type odor, or would be so difficult to control that your child could not make it to the toilet without soiling clothing or messing up the bathroom or classroom
  
   
• Has vomited two or more times in the past 24 hours or once in the past eight hours
  
   
• Complains of constant stomach pains or walks stooped over and holding his stomach
  
   
• Has sores in the mouth or is drooling because it hurts to swallow
  
   
• Has a skin rash that includes pus bumps, water blisters, or oozing crusty areas (impetigo), or is associated with fever
  
   
• Has pinkness or redness in the whites of eyes with crusting or drainage of yellow or green pus
  
   
• If skin or whites of eyes become yellow or jaundiced
  
   
• Has untreated head lice, scabies, or strep throat
  
   
• Has an unexplained swollen joint, arm or leg and won’t move the arm or stand on the leg
  
   
• Has a headache for more than twelve hours not relieved by Tylenol
  
   
• Has a croupy or wheezy cough or coughs up a lot of green or yellow phlegm
  
   
• Has a change in behavior or doesn’t act “normal”

There are many other signs of serious illness in children that we have not covered. Our advice is simply to use common sense in deciding whether your child acts “normal enough” to send him or her to school.

Hopefully you can use these rough guidelines to help decide when to keep your sick child home from school or daycare. Since you know your child’s normal appetite, how energetic he is, how often she urinates or poops, and how he or she ordinarily “looks” when not sick, you are the best judge of when to keep them home.

When our kids were in daycare, we developed a feel for when to keep them at home and trusted that other parents would do the same to avoid spreading diseases throughout the entire nursery and daycare population. I’m sure you’ll do the same, since I know that you would not do anything to place someone else’s child at risk of a contagious illness.

For further information, please see articles on “How to choose a daycare provider for your child” and “When can I send my sick kids back to school?”.

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