When to Keep a Sick Child Home from School

From the Show: Healthy Children
Summary: If your child wakes up feeling unwell, you’ll need to decide if they should stay home from school.
Air Date: 2/25/15
Duration: 10
Host: Melanie Cole, MS
Guest Bio: Corinn Cross, MD
dr cori crossDr. Corinn Cross was born and raised in New Jersey. She attended Barnard College where she graduated cum laude and majored in philosophy. She went on to attend the University of Medicine and Dentistry of New Jersey in Newark, NJ, where she was selected for the Alpha Omega Alpha Honor Society. Dr. Cross did her internship and residency in pediatrics at Children's Hospital Los Angeles. Dr. Cross has continued to work at CHLA as a general pediatrics attending. Dr. Cross is actively involved in her local AAP, Chapter 2, where she is an obesity champion. She is co-founder of the Fit to Play and Learn Obesity Prevention curriculum. Through a collaboration between AAP Chapter 2 and the L.A. Unified School District this curriculum is being used to educate at-risk students and their parents on the risks of obesity and to help them to lead healthier lives. Dr. Cross is an AAP Spokesperson and speaks to children throughout the L.A. school district about obesity, healthy lifestyles and the benefits of walking to school.Dr. Cross is a member of the Executive Board for the AAP's Council on Communications and Media. She is the Editor of the Council on Communications and Media's blog.
When to Keep a Sick Child Home from School
Your child's not feeling well... so, how do you decide if they should stay home from school or "buck up" and go?

Keep him home if he has a fever, rash, or eye discharge, or if he’s vomiting, has diarrhea or a disruptive cough.

If your child has minor symptoms such as a runny nose or a slight headache, you can send her to school. But, make sure both she and her school's administration have the correct phone number to reach you during the day in case other symptoms develop and she needs to return home.

Additionally, you should consider whether your child is energetic enough to actively participate in class, as well as if he or she may be contagious to other children.

Dr. Corinn Cross discusses when to send your kids to school and when keep them home for some good old rest and recovery.

RadioMD Presents:Healthy Children | Original Air Date: February 25, 2015
Host: Melanie Cole, MS
Guest: Corinn Cross, MD

Hear it from the doctor with expert guests from the American Academy of Pediatrics. It’s Healthy Children. Now, our favorite mom, Melanie Cole, MS.

MELANIE: Well, I went through this just recently.

When do you keep your sick child home from school if they just tell you they don’t feel well? Do they get to stay home from school? If they’re coughing? If they’re sneezing? If they have a fever? I mean, what really signifies keeping a child home because it places a demand both on a parent and for caregivers. You know it’s kind of difficult when you have to keep them home.

So, my guest today is Dr. Corinn Cross, pediatrician and spokesman for the American Academy of Pediatrics.

Welcome to the show, Dr. Cross.

When do we know that it’s okay to keep our kids home and when do we say, “Hey, guys. Suck it up and go to school.”

DR. CROSS: So, I think as a parent, you’re right. It’s really difficult when all of a sudden, we just have to change plans mid-morning and try to figure out what we’re going to do with a kid who we think may or may not need to stay home from school. So, what you first have to think about is, “Is your child well enough to participate in class?” I think that’s a big thing. For kids, if they’re in school, they’re expected to perform. So, if they’re not going to be able to participate, if they’re falling asleep because they’ve been up all night vomiting, even if they’re not vomiting in the morning, it’s still probably a good idea to keep them home. So, you want to make sure that if you’re going to send your kid to school that they are really well enough to be able to maybe take that pop quiz they’re going to get or whatever. If they’re a younger grade, you can always maybe send them and say, “Call me if they seem to be falling asleep and they don’t seem to be doing well.” So, it’s something that you want to be communicating with the teacher about if they’re a younger kid and older kids, obviously, can do that themselves.

Next, you want to think about, “Are they contagious to another child?” So, you don’t want to be sending your kid to school so that they get the whole rest of the class and the teacher sick. That’s just not fair to other kids. So, are they well enough to participate? Are they contagious? And then, there are some things that you have to think about. Do they have a fever? Have they had diarrhea? Have they had vomiting? All of those things that parents think about.

MELANIE: So, let’s start with if they’re vomiting and they’ve had a fever, and the school says 24 hours. They had strep throat and they haven’t been on their antibiotics for 24 hours. Okay, those are all reasons.

But now, just the basic sniffles, sneezing or coughing. So you said, “if they can’t participate in class” but what if they can participate—just maybe not to their fullest energy level? Can you give them Motrin and shove them on their way so that at least their symptoms are managed? Maybe they feel a little better, give them a good breakfast. I mean, you know, what do you do?

DR. CROSS: It really does depend on how sick they are. So, you’re absolutely right. Most schools have policies that if your child has a 101 fever or higher that they need to be fever free for 24 hours. The same with diarrhea and vomiting. They want them symptom free for 24 hours. And they want to make sure that if they’ve been started on antibiotics either for pink eye or for strep throat, that they’ve been on that for 24 hours as well. But, you’re talking about if they have a cold. So if they have a headache, you’re going to give them some Motrin for that achiness—not for a fever because that’s not right—but if you give it to them for the achiness, of course. You can give them some Motrin. If they’re older, you can give them some of the DayQuil. We don’t use the over the counter cold medicines for younger kids, but for older kids, that’s absolutely fine and if they seem up to it, then, yes, they can go. Some of these colds, they linger for 5, 6 days. You can’t have them home for that long, so that’s completely understandable. When we’re talking about the littler kids, you don’t want to send them to school if they can’t wipe their own nose and it’s copious discharge. That’s just not fair to the teacher. But, for older kids, of course, if they can go to school and they can manage through and muster through with a little bit of Motrin, then I think it’s absolutely fine to send them. Really, they can’t stay home for the whole length of that illness, but they need to stay home when they actually are very sick and contagious.

MELANIE: Okay. So, they can’t, obviously, as you say, stay home. Then, what do you do for them? If they, Dr. Cross, stay home because they really just aren’t up to it and you think, “Okay, they’re not going to be learning much. They’re not going to be able to think very well.” And then, they’re home and 2 hours later, you’re like, “Okay. They’re bored and they seem to be feeling fine.” Do you take them to school? Do you let them miss that day?

DR. CROSS: It depends on the age and what they’re actually missing. So, if they seem to be better by lunch time and you know that there is something that they’re preparing for, that they really should be in there for, like if they’re in AP History and the lectures are important. If they’re getting ready for those AP tests, yes, then they can go in midday.

If they’re in 2nd grade and they’re missing, I don’t know, something that’s really not going to make a long-term difference, then you might be able to keep them home. It also depends on you. It depends on you. Keeping your child home is hugely inconvenient for a lot of parents who are working. So, you really have to have a backup plan and before the kids get sick, say, “Okay. What do I do if they get sick? Is it okay with my employer if I work from home? Do I have a neighbor or a babysitter or a relative who can watch the child?” So, those are things that you have to have figured out a little bit in advance and a lot of times, you have to call an audible and figure out what you’re going to do when the situation arises.

MELANIE: How is threatening if they stay home, you’re going to take them to the doctor?

DR. CROSS: Well, that’s another good point. So, a lot of schools if you do keep them home will want a doctor’s note to return to school. So, you do have to know your school’s policy because often, if you are keeping them home, you’re going to need a note to return to school.

MELANIE: Okay. And those cold symptoms: sneezing, the icky stuff coming out of their nose. You know, teachers could look sideways at you if you send your kid to school that way because clearly, they’re contagious, but it’s just a cold.

DR. CROSS: True. So, it depends, again, on their age. The older kids, they tend to let that go more often because kids know to wash their hands; they know to cover their mouth when they cough; they can wipe their own noses. For the younger kids, you really do have to think, “Am I going to get this whole class sick? Do I want every other parent to go through this?” And sometimes you do have to be socially minded and inconvenience yourself so that you don’t get the rest of the class sick. That is part of going to school. That’s part of the responsibilities of parents to make sure that they’re not going to get the rest of the class and the teacher sick.

For older kids, again, they can handle not getting other people sick a little bit better, but if they truly are just hacking up a storm, you have to keep them home. I think it also comes down to communicating with that teacher. Particularly in the school-aged kids, the kids less than high school, most people have their teachers’ email address. You can email them and say, “So and so’s been a little under the weather. They were sick this weekend. They’re looking better today. I’m sending them. If you feel uncomfortable, please contact me, but also know they’re probably not up to taking a pop quiz.” That sort of thing and maybe they could have a little extra time for homework because they’re probably going to need to sleep tonight.

You know, you can communicate with the teacher. They are people, too, and often if you talk to them about what’s going on, they’re a lot more understanding.

MELANIE: Now, fevers—99. Do you keep a child home for anything over 98.6 or whatever? Or, is 99 not enough? Does it have to be over 101? And then, if it’s fine for the middle of the afternoon until the night, can you send them to school the next day? What’s the rule on fevers?

DR. CROSS: Absolutely. So, low-grade fevers. That’s okay. If it’s 101, then you can consider it a fever. But, if they had 101 yesterday and they wake up this morning and their fever’s 99, they can go to school if they look good to you. I mean, I think that’s completely fair. If they’re starting to get sick and their temperature is 99 then it’s 100, then it’s 100.9, you’re like “Hmmm. Maybe I can send them. Maybe I can’t.” Well, no. If it’s the beginning of the illness and you’re watching it creep up, then you’re probably better off keeping them home because you’re only going to get a phone call an hour and a half later when they say, “Your child has a 102 fever. Please come get them.” But, if you’re on the tail end of it, and you know they were sick yesterday and this morning they wake up with a very low-grade fever, usually they’re good to go. Usually, they’re over the hump.

MELANIE: It’s great advice, Dr. Cross. So, wrap it up for us. You have about a minute left. Wrap up when to keep your child home, your best advice if a parent were to call you and say, “When do I keep my child home?” What would you tell them?

DR. CROSS: I would say keep them home when they are too sick to actually get anything out of going to school. Keep them home when you’re really certain that they’re contagious and it’s not just the right thing to send them to school and get everybody else sick. Keep them home if they’ve had a fever of 101 or higher in the last 24 hours; if they have diarrhea or vomiting in the last 24 hours; if they have a really serious and severe cough and copious discharge coming out of their nose. That’s just not fair to send them to school. Keep them home if they’ve started antibiotics and they haven’t been on that for 24 hours. They need to be on that for 24 hours. Pink eye, again, 24 hours of treatment. Other than that, if they just have the run of the mill cold for the winter, then you can send them and communicate with their teacher that if they look like they’re getting worse during the day, to please contact you.

MELANIE: That’s great advice because parents go through this every single day all over this country. Do I send my child to school? Think of all the things that Dr. Cross has told you today and if you missed any of them, listen again on demand or on the go at

Share this one with your friends because I’m sure they’re asking the same questions we are.

This is Melanie Cole for Heathy Children right here on RadioMD.

Thanks for listening and stay well.
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