By: Dr. Brian Gannon
It’s 7 a.m. on Monday and your little angel had a restless night, but now she feels hot. The doctor’s office has not yet opened and you have to decide whether it’s ok for her to go to school. You cannot afford to miss work and have nobody else to watch her. What’s a parent to do?
We all face this problem with our children, but parents can make better, more informed decisions about school absences if they know a little about the reasons and concepts behind keeping kids out of school when they are sick.
There are two basic reasons that determine when a child should be kept out of school or any other group setting: either the child has a contagious disease, the spread of which would be prevented by keeping the child isolated, OR the child requires more individual attention than the setting would allow in order for him to benefit from being there. Examples of the first include fever of 101 or higher, throwing up, and certain specific infections like chickenpox or Strep throat. Examples of the second include the wheezing child who may need breathing treatments or other one-to-one care, or the child who is coughing so much that she cannot enjoy being at school or focus on her work.
Let’s review the rules our local school system follows: regardless of the reason for staying home, the parent by herself can only excuse 5 absences for illness; after that the school requires a doctor’s note in order for the absence to be excused. We recommend that parents keep in contact with their doctors’ offices so that we stay aware of when you are keeping the child home and why. Many pediatricians will not excuse an absence if the parent never told the office about the illness.
The school system has options for handling the child with a serious illness or injury that requires a prolonged or excessive number of days out. The key is being open with both your child’s doctor and school, so all of you decide as a team when it is safe for the child to return, or if the child needs home-bound school services.
As discussed earlier, the two clearest situations are fever and vomiting. If a child has fever of 101 or higher, he must stay out of school for 24 hours after the fever goes down. Most children with illness-related vomiting must stay home for 24 hours after the last episode. The exception would be the child with carsickness or other noninfectious long-term vomiting, but this is a great example of keeping your school and doctor in contact with each other.
For any other single symptom, some judgment is required. Most coughing illnesses do not by themselves justify the child staying home. The child is already contagious with these illnesses before showing symptoms, so keeping the child home does not prevent spreading the infection to other children. But if your child is breathing really fast, using extra muscles in the neck or belly to breathe, or has fever, then he should be seen by a doctor to see if he needs urgent treatment.
When a child has loose stools, there are some key points which would require a clinic visit: blood or mucus in stools or severe cramping, for example. If the child is still in diapers (daycare) and the stool is contained in the diaper, she may go to child care. But if she is having accidents outside the diaper or cannot make to the potty if toilet-trained, then she should stay home until these conditions are met. Once the diarrhea is controlled, she should return; it is not appropriate to keep the child out until completely normal, because this may take 2-3 weeks, even with a minor illness.
Pinkeye is another controversial topic. These children should stay home if having fever or other non-eye related symptoms. But if the eye is red and otherwise asymptomatic then really that child can go to school, because this is often a short, noninfectious problem. If the child does stay home for this, call or see the doctor, so the office can decide when the child may return, and they will provide a note.
No parent should have to make complex medical decisions when it comes to school excuses. But parents, school nurses, and front office staff are all faced with these issues every day. Feel free to use your pediatrician and school nurse to help when you are not sure what to do. We all want to prevent unnecessary absences, and the more we understand these rules, the better your child’s school experience will be.