Your child awakens on a school morning grumbling that "my tummy hurts," or with a warm forehead and flushed cheeks, or another -- probably minor -- health complaint. Or he has an odd rash or a few leftover nits (eggs) from that summer-camp case of head lice.
Is he healthy enough to pack off to class or too sick for school?
Chances are you've faced similar situations at least occasionally. Seventy-five percent of parents report that their children had at least one sick day in the prior year, according to a January 2017 survey from the C.S. Mott Children's Hospital at the University of Michigan.
"That decision often has to be made on the spot before the school bus arrives, but it can be based on more than just a flip of the coin," says Marvin M. Lipman, M.D., Consumer Reports' former chief medical adviser. "There are some commonsense guidelines that can help you decide what to do."
In some cases, of course, it's pretty clear when kids are too sick for school -- for example, if your child has been up all night vomiting, or has a fever.
But in others, your conclusion may depend largely on whether you think your child can make it through a day in the classroom, says Dr. Susan Aronson, a spokesperson for the American Academy of Pediatrics and retired clinical professor of pediatrics at the University of Pennsylvania School of Medicine.
Additional concerns that may factor into your decision on whether he's too sick for school, according to the C.S. Mott poll, are whether the demands of the school day may worsen your child's illness (cited by 60 percent of parents surveyed) and whether your youngster may spread his or her germs to classmates (named by almost half).
If you're sometimes uncertain about when your kids are too sick for school and when it's fine send them, here's a look at how to make that call for five common conditions. Before you continue reading though, it's important to note that the school administrators we talked to do not fully agree with the AAP.
Kelly Worley-Giddens owns and runs Bartram Academy, a pre-school in St. Johns County. She said, "We do extra things to keep kids healthy like cleaning door knobs, spraying sippy cups, chairs and tables. We also do extra hand washing. If we have a case or two of a sick child in that class, we will even do extra cleaning in that room while the class is on the playground throughout the day to lessen the spread."
Worley-Giddens says they also notify parents with kids in that class and ask them that if they see any symptoms in their child, to please keep them home to lesson the spread. She says that if it's something that is contagious, she does not want to risk spreading the illness to other students, teachers or their families at home.
Here's what the AAP suggests, according to a Consumer Reports article:
If your youngster is free of fever, she can generally attend school, even if she has a runny nose or coughs from time to time.
However, if she seems too sick to participate in the day's activities, or you think her needs might compromise the teacher's ability to care for the rest of the children, she should stay home, Aronson says. In this case, a day of rest (and plenty of liquids) will probably allow her to head back to school the next day in better spirits.
For a sore throat accompanied by a headache and/or fever, consult your child's pediatrician. Most wintertime sore throats are due to viruses, but up to 30 percent of cases in children between 5 and 15 are strep throat -- a highly contagious bacterial infection that requires treatment.
If the doctor confirms strep, your child is unlikely to be contagious after two doses of a prescribed antibiotic. The AAP also recommends that children with strep stay home from day care until they've had two doses of an antibiotic 12 hours apart. (Check with your school on local rules; most require that youngsters with strep be on antibiotics for a full 24 hours before returning to class.)
Vomiting and Diarrhea
If your child vomited or had diarrhea once during the night but otherwise seems fine—he ate a normal breakfast and is fever-free -- it's reasonable to send him off to school.
But if he had diarrhea or vomited more than once, or his stool is unusually frequent or so loose that a diaper can't contain it (for very young children) or could cause "accidents" (for older children), he needs to stay home, Lipman says. These circumstances cause too much work for teachers and make it difficult to maintain good classroom sanitation. (And if he vomits or has diarrhea at school, it's embarrassing and uncomfortable for him, as well.)
Most vomiting and diarrhea from stomach viruses resolve within a day or two. After more significant symptoms ease, if he still has occasional stools that are loose but not watery, you can send him to school.
And to help ward off future gastrointestinal troubles that can make kids too sick for school, remind your youngsters to wash their hands frequently, both at school and at home. Studies have clearly shown that proper hand-washing reduces the likelihood of picking up a virus.
Children in the U.S. miss 3 million days of school a year due to this inflammation of the conjunctiva, a membrane that covers the white part of the eye.
Pink eye, also called conjunctivitis, is often caused by a viral infection such as the common cold but can also be due to bacteria, allergies, or irritation from swimming in a chemically treated pool.
Your child should not have to stay home from school if he has pink eye, Aronson says, but many states require that they do -- ask before your youngster heads out.
If you do need to keep him home, be aware that most children with pink eye get better after five or six days. In the interim, encourage him to wash his hands frequently and not to rub his eyes, to avoid spreading the infection from one eye to the other. These steps from the Centers for Disease Control and Prevention can also help.
You probably think that head lice -- sesame-seed-sized, wingless insects that feed on human blood and cause kids to scratch their heads incessantly -- are a clear signal to keep your child home.
But according to the AAP's 2016 recommendations, healthy children shouldn't be prevented from attending school because of nits (eggs) or even active lice, as long as they're being treated.
"Parents have a strong emotional response when they learn their or another kid has lice, but as long as children keep their heads apart, they are fine," Aronson says. "Lice can be a nuisance, and very itchy, but they don't spread any sort of disease."
In fact, if your school calls to notify you that your little one has head lice, the AAP says it's fine for them to finish the day, go home, get treated, and return to school the following day.
However, you may need to check local policy. Some school districts still require a child to be fully free of nits before returning to school, even though this has not been shown to reduce the spread of lice in the classroom. (See our guide to the most effective way to treat head lice.)
If your child has at least one scaly round patch on his scalp or skin, he may have ringworm, a harmless but contagious fungal skin condition.
It's common in children and can be spread at school by sharing infected hats, combs, or hair barrettes. But while it may be a little itchy, your children can still attend school, according to the AAP.
"As long as it's covered by a shirt or a gauze bandage, there's very little risk of transmission," Aronson says.
If you can't cover it, check with your pediatrician to see whether you need to keep your child home for 24 to 48 hours after starting treatment for ringworm. During treatment (and afterward) don't let your child share combs, brushes, hair clips, barrettes, or hats with others.