Question of the year! We parents are all great at knowing when our children are sick, but the lines get blurry about when our kids are well enough to go back. This is a difficult topic because not every pediatric illness is the same and not every symptom will always present in the typical fashion. Plus, most of the common illnesses we see in pediatric outpatient medicine are contagious so of course, we support limiting the spread if we can!
I think the easiest way to think of this is by breaking down the symptoms, but also knowing what your child’s school/daycare/camp policies are and if a physician’s note is required to return. As always, strict hand washing, counselling on limiting the spread of germs by sneezing and coughing away from the face or into the elbow, and no sharing of drinks or liquids is recommended while feeling unwell.
With a fever: Children can generally return after being fever-free on their own for 24 hours- that means without the help of medications like Tylenol or Motrin.
Runny nose/cough/congestion: This is a combination of symptoms that often falls under the umbrella term of the common cold, and there are multiple viruses that cause this! So your child can easily have these symptoms a few times a year. Return to school depends on your child’s activity levels. If they feel overall comfortable and are acting at baseline despite these symptoms, they are generally safe to go to school.
Sore throat: Here, return to school depends on corresponding symptoms. If there’s a fever involved and the diagnosis is, for example, Strep, we usually wait 24 hours after antibiotics are started. If the sore throat is due to a virus, it depends on how well your child is feeling, presence of fever, etc. (see above)
Pink eye: If the cause is bacterial, the child can return after initiating antibiotic eye drops. If the cause is viral, it is still highly contagious, but there’s not much we can do besides measured listed above (hand washing and limiting touching the eyes) to decrease the risk of spread. If the pink eye is due to allergies, it generally affects both eyes and are safe to return to school.
Ear infections: Ear infections aren’t contagious so as long as your child is comfortable and fever free, he or she can return to school.
Vomiting- Children should have at least 24 hours free of vomiting before returning to school. Sometimes, appetite might still not be what it was at baseline, but make sure hydration is adequate.
Diarrhea- This usually goes hand in hand with vomiting symptoms but may begin after the vomiting has subsided and generally lasts a few days as it takes a few days for stools to normalize. The biggest rate limiting step here is hand hygiene so with an older child or daycare staff, hopefully this isn’t an issue! And you want to make sure that your child isn’t going to the bathroom so often that they are uncomfortable.
Pneumonia- If your child is having difficulty breathing or maintaining normal activity levels without significant fatigue, then he or she needs to stay home. If there are other factors like wheezing, antibiotic usage, or accompanying symptoms such as fever or belly pain, this complicates the situation and each individual case varies.
In fact, none of these are clear cut cookie cutter answers but instead, a guide. Notice, how I didn’t even broach the topic of rashes because that would be impossible to give input on since there’s such a wide spectrum! That’s where the art of medicine comes into play and how your pediatrician can help you. Some illnesses are unique and a personalized care approach matter, in my opinion. Don’t trust your medical care to just anyone but to someone with the right credentials and expertise in managing pediatric patients-especially if there is a concern about vaccine preventable diseases like chicken pox, measles, rubella, whooping cough, etc. Your pediatrician should be up to date on the best protocols and treatment plans. One my biggest reasons to create this blog is parental education and empowerment with the right tools to make sound decisions. Remember, being a parent is never easy and throwing a sick child in the mix makes everything so much more difficult. That’s why if you’re ever concerned, feel free to reach out to your pediatrician for help or advice if you’re not sure whether your child needs a sick day or can return to school!
Of course, this is for information purposes only and should not be construed as personal medical advice or diagnosis. It is the responsibility of the parent/guardian to seek appropriate medical attention when they are concerned about their child, including asking their healthcare provider about any clarification that may apply to their own child’s needs.
This post is meant to educate and should not replace the medical judgement of a licensed healthcare provider who is evaluating the patient.