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father holding his young son and checking for a fever

Signs your child is too sick to go to school

It can be difficult to know when your child should stay home from school, especially during the pandemic. Patrick Phelan, M.D., a Piedmont pediatrician, shares advice for parents concerned about their children’s health.

Signs of COVID-19 in children

“Children often experience few symptoms with COVID-19, and those symptoms can overlap with less worrisome viral infections,” says Dr. Phelan. “If your child has any of the more common symptoms of COVID-19, such as fever, dry cough, headache or body aches, you should contact your child’s doctor for instructions or evaluation.”

If your child tests positive for COVID-19, Dr. Phelan says they should remain at home until all the following are true:

  • 10 days have passed since the onset of symptoms.

  • There has been no fever for 24 hours (and no use of fever-reducing medicines in that time).

  • All other symptoms have been improving.

Signs your child should stay home from school

In general, if your child is experiencing symptoms that will make it difficult for them to participate effectively in school or distract other students, you should keep them home, he says.

These symptoms include:

  • Fever

  • Pain (such as headaches, body aches and earaches)

  • Cough of any type

  • Sneezing

  • Pinkeye

  • Fatigue

Coughing and sneezing not caused by allergies are the most common ways children (and adults) spread illness to others.

For the following symptoms, you should consider the severity and other factors before sending your child to school:

  • Sore throat. “Sore throats can be due to causes that are not contagious, such as allergies or just a dry throat,” says Dr. Phelan. “The parent must look at these symptoms in context. If the sore throat is severe, if there is a known exposure to strep or if the lymph nodes are swollen, keep the child home and get them evaluated.”

  • Runny nose. “If they have a runny nose and are sneezing with a sore throat, you may want to try an OTC allergy medicine or a saltwater gargle first,” he says.

  • Stomachache. “If the stomachache is severe, localized or has nausea associated with it, contact your child’s doctor,” says Dr. Phelan. “Less severe stomachaches are often transient and improve with eating breakfast.”

“In general, if your child looks sick to you and you have concerns, they should probably take the day off,” he says. “I find that parents are pretty astute in determining when their child needs time off or requires an evaluation by their physician.”

When your child can return to school after illness

The clearest sign your child can return to school is an improvement in symptoms. Here are some other guidelines from Dr. Phelan:

  • Fever should be absent for 24 hours before returning to school.

  • Pinkeye, once evaluated, can be treated with antibiotics if it’s caused by a bacterial infection. Allow 24 hours before your child returns to school.

  • Some viral infections may require several days off. Your child’s physician can instruct you on this.

  • Strep throat, once treated for 24 hours, is no longer a risk to other students.

When to call your child’s pediatrician

Here are the signs you should contact your child’s pediatrician:

  • Fever lasting more than three days in children older than 2 or fever without any other symptoms that lasts more than one or two days

  • Fever above 104 degrees at any age

  • Signs of dehydration, such as decreased activity, dry mouth and sunken eyes

  • Vomiting dark green bile

  • Projectile vomiting in newborns

  • Vomiting accompanied by abdominal pain or severe headache

  • Cold symptoms that get worse after three to five days or don’t improve after 10 to 14 days

  • Cold symptoms accompanied by wheezing, chest pain, trouble breathing or constant cough

  • New fever a few days after they develop a cough

  • Uncharacteristic fatigue or irritability

  • Weight loss

It’s normal for a cough to last up to three weeks, but you should notice an improvement in symptoms during that time, he adds.

When to seek emergency care for your child

Call 911 or visit the emergency department if your child has any of the following symptoms:

  • Trouble breathing

  • Severe allergic reaction (trouble breathing or swallowing, vomiting, or drooling)

  • Ongoing pain (like a stomachache, headache or body aches) that isn’t relieved by at-home care and that limits their activity

  • Pain during urination

  • Testicular pain

  • Head injuries, especially if your child lost consciousness or may have a concussion

  • Cuts and scrapes that may require stitches, particularly if they won’t stop bleeding or are deep or gaping

  • Severe headache, especially if accompanied by neck stiffness, fever, vomiting or irritability

  • Coughing up blood

  • Bloody diarrhea

  • Vomiting blood

  • Seizures, particularly if your child doesn’t have a seizure disorder

“If you’re ever in doubt, call your child’s physician,” says Dr. Phelan. 

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