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When can my child return to school? Part Two – Need to stay home from school


Of course, this information is general and should only be used for informational purposes. Please follow the guidance of your health care provider regarding the particular needs of your child.

My child is sick, when should they stay home?

For the safety of the child, and the child’s classmates, parents should keep their child at home until their child is no longer contagious to avoid spreading the illness to his or her classmates. Most parents know how a cold or the stomach flu cycles through a classroom multiple times. This may occur because a sick or infected child returns to class too soon and spreads the disease to other classmates.

The key to understanding when a child can return to school is related to the contagiousness of his or her illness. Different illnesses have different lengths of time in which it can be spread to other individuals. Also, treatment can shorten the length of time a child is contagious.

The following information can be helpful to guide parents regarding particular childhood illnesses.

Gastrointestinal Illnesses

Diarrhea is defined as 3 or more loose or watery stools per day. Nausea, vomiting, or cramping may accompany diarrhea. Occasionally, diarrhea may be accompanied by fever.

Diarrhea is spread person-to-person via fecal-oral route. Most causes of diarrhea are never identified.

Good hand washing and personal hygiene are important in the prevention and control of diarrhea. Children who have not mastered good hand washing technique or who cannot maintain good personal hygiene should not be sent to school until their diarrhea has been resolved for 24 hours.  

Children who have vomited two or more times in a 24-hour period should remain home from school. Children can return once they have been vomit/diarrhea free for 24 hours.

If your child has been diagnosed with an enteric pathogen as the cause of their diarrhea, please follow the recommendations of the health care provider.

Strep Throat

Signs and symptoms of strep throat include fever, sore throat, swollen lymph nodes, and perhaps pus spots or red spots on the back of the throat. However, a diagnosis can only be made with a culture of the throat.  

The incubation period of the disease is 1-3 days. Strep is most often spread by direct contact with nasal or throat secretions (e.g. kissing or drinks) or by droplet transmission (e.g. a big sneeze or cough).

A diagnosis of strep throat requires antibiotic treatment to avoid complications (e.g. scarlet fever). It is imperative that the antibiotic treatment be given as directed and fully completed to avoid complications. Children with a diagnosis of strep throat should stay home until 24 hours of antibiotic therapy have been completed.

Colds and upper respiratory infections

Most colds and respiratory infections are bothersome due to head or chest congestion, coughs, sneezes, headache, stuffed noses, body aches, sore throats, and general malaise. These symptoms may prompt children to remain at home until they feel well enough to engage in their normal activities.

However, when colds or respiratory infections are accompanied by fever, inability to eat or drink because of a sore throat, or inability to sleep due to coughing and/or blocked noses, or tremendous head pain related to sinus pressure, children may need to be evaluated by a health care professional before returning to school.

If children are fever free, have a good appetite and are drinking freely, and are able to engage in their normal daily activities without becoming fatigued, they may return to school. Reminding them to do good hand washing and to rest when tired can help them recover faster.

Skin issues

Skin is the largest organ of the human body and is quite complex. The myriad of skin disorders makes is impossible to address all possible infections. However, a few guidelines can help parents make wise choices when skin issues arise.

Varicella (chickenpox)

Signs and symptoms of varicella generally start as a fever, general malaise, sore throat and/or a loss of appetite. Then a rash appears that evolves to have small, bumps that are fluid filled which eventually rupture and scab over. The rash occurs in stages around the body so it is common that a child has areas of red rash, areas of raised, fluid-filled bumps, and areas of scabs simultaneously.

The incubation period is around 14 days. A child is contagious from 48 hours before the rash appears until all the scabs have dried and no new fluid-filled bumps are developing. Varicella is spread through contact with the fluid in the bumps.

The varicella vaccine has reduced how many children have the illness. Children who do have the disease and do not have any complications may return to school 24 hours after all the fluid-filled bumps have ruptured and scabbed over. In total, this takes about 6 days from the start of the rash.

Please note, children who have not had the illness and who are not vaccinated may need to self-exclude from school if other children actively have the disease. Please seek advice from the child’s health care provider if your child falls into this category.

Conjunctivitis (Pink Eye)

Conjunctivitis normally begins with eye redness and clear or cloudy discharge. The eye may be matted closed in the morning due to this discharge. Some children also report itching, burning, pain, or a gritty feeling in the eye.

Conjunctivitis is highly contagious and has an incubation period of 24 to 72 hours. Infection is spread from direct contact with the eye discharge or from an infected surface (e.g. door handle, countertop).

Infected children should not share towels with other people and parents should reinforce good hand washing to prevent spreading the infection to others. Placing paper towels in the restroom can help prevent spreading the disease among family members. If you would like to learn more about proper hand washing techniques and how to help children prevent from spreading their illness to others, please read my blog post on illness prevention When can my child return to school? Part 1- Prevention and Okay-to-go.

Illnesses are a common reason for children to miss school. Understanding the need for missing school, to protect both the ill child as well as his or her classmates, can help parents make informed decisions.

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Thursday, 22 August 2019

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