How Sick Is Too Sick for School?

Feb. 22, 2007— -- It's a familiar scene for every parent of a child in elementary school.

The lethargic, shuffling steps into the kitchen. Coughs and complaints of a sore throat and the hint of a feverish forehead.

Deciding whether or not to send your kid to school can sometimes be a tough call. After all, it's not always easy to distinguish simple theatrics from true illness.

Worse, a diagnosis and decision must often be made in the few spare moments after breakfast — and before an angry call from your boss.

Fortunately, there are a few rules of thumb that you can follow when determining whether a child is up to the task of a full day at school. And pediatricians say a mild case of sore throat or the sniffles is not necessarily a mandate to keep kids at home.

The Fever Factor

Determining whether or not a child has a fever offers a fairly reliable way of judging whether or not a child is truly too sick to go to school. Additionally, it is one of the few symptoms that can actually be quantified.

"States often have requirements regarding the exact temperature at which children need to be sent home, especially in early childhood and child care settings," says Dr. Laura Jana, pediatrician and owner of a 200-child private child care center in Omaha, Neb.

"We use above 100.2 at my school, but I have seen as low as 100 and up to 101 as the cutoff."

The time of day during which a child is experiencing a fever can also make a difference.

Dr. Carden Johnston, past president of the American Academy of Pediatrics, says fevers usually run a bit higher in the evening than they do in the morning. So a high temperature in the evening may abate overnight.

However, a high temperature in the morning will likely only get worse as the day progresses, so parents should consider keeping kids home in this case.

"If it is the first day of the illness and the temperature is over 101, they should stay home," Johnston says. "If it is the third day or later, and the child has been acting well during the day, but has a 101 in the evening, I would let them go to school."

Other Symptoms to Monitor

A fever isn't the only symptom to track when it comes to judging a kid's ability to attend school. Vomiting, diarrhea, rashes and a host of other indicators can also mean the difference between a desk at school or the couch at home.

Vomiting and diarrhea, aside from adding a significant "ick" factor for classmates and teachers, can also be a tremendous source of discomfort for children if severe or uncontrolled. In these cases, a day at home may be the best option.

"If the child is vomiting, it is inconvenient for the teacher and the other classmates, so they stay home," Johnston says.

If mild and controllable, however, a bit of diarrhea may not be a big problem.

"In elementary age children, [diarrhea] isn't as much of an issue if it doesn't interfere with their ability to remain in the classroom and if they aren't sick enough to potentially have accidents, have to run to the bathroom, or be in pain," Jana says.

Rashes, particularly those that cannot be readily explained, may also be cause to keep your kid at home -- and perhaps even require a doctor's opinion.

And children with severe cases of conjunctivitis -- commonly known as pink eye -- should also be kept home from school. However, pediatricians note that mild cases of this affliction may not warrant a day off.

When Can Kids Return to the Classroom?

Many parents may also wonder when it is safe for their child to go back to school after recovering from their illness.

"The answer to that one is a little bit trickier," says ABC News medical editor Dr. Tim Johnson. "In general, nobody would recommend that a child goes back to school unless they have been fever-free for 24 hours, and some would even say 48 hours."

Jana says a full day of fever-free downtime is probably sufficient to safeguard the child's health, as well as that of his or her peers.

"It is fairly standard that children are required to be fever-free for 24 hours before returning, which I repeatedly explain is a useful method of limiting the spread of infection during the febrile period when children are thought to be most contagious," she says.

Johnston agrees. "When the fever is gone for 24 hours, the contagiousness is greatly diminished."

The 24-hour rule may prove to be more than sufficient for vomiting, Johnston says.

"Vomiting is a temporary nuisance most of the time," he says. "So if the child feels OK and has not vomited since midnight, I will allow them to go [the next morning]."

Parents Must Trust Instincts

In most cases, however, the decision of whether or not to send a sick kid to school will not be clear-cut. In these cases, parents must ask themselves certain questions to help them decide.

Will the illness prevent the child's participation in normal school activities? Also, will the child's illness place an unusual burden on the staff?

A third and very important question to consider is whether or not the illness that the child has poses a risk to other children and adults.

Parents must also keep in mind that those complaints of abdominal pain could be from a food-borne illness -- or they could just be due to anxiety over the prospect of going to school.

But in these situations, it may be better to err on the side of caution.

"Parents have to be willing to trust their instincts," Johnson says. "Even when their child is not having any objective signs of illness, if they think that the child is different from how they normally are, they need to trust their instincts and keep the child at home until they figure out what's wrong.

"Just because a kid does not have a fever does not necessarily mean that they are well."

Johnson says some signs that you should keep your kid at home are a high fever, significant coughing, an unexplained rash or pink eye, and uncontrolled vomiting or diarrhea.

Parents should also be aware of symptoms that suggest the child should be brought to a doctor. If the child cannot touch his chin to his chest, it could be a sign of meningitis, a serious infection that warrants immediate medical attention.