How Sick Is Too Sick For School?

September 25, 2014

Dr. Diana Roukoz, Mercy Kids pediatrician

by Mercy Kids Dr. Diana Roukoz

With new clothes, backpacks and classrooms comes a whole new dilemma for parents. After all, back to school is synonymous with “germ sharing.” If it hasn’t happened yet, it won’t be too long before you’re awakened to the whiny chorus of, “I don’t feel so good,” and the dreaded conundrum of whether or not to send your child to school.

When faced with this, it’s always useful to rely on a few trusted instincts. In general, facing it with a healthy dose of common sense and a genuine concern for the well-being of your child will generally lead to the right decision. The American Academy of Pediatrics suggests using these guidelines to keep your child home:

  1. A fever
  2. Is not well enough to participate in school activities
  3. May be contagious to others

Let’s review a few common scenarios.


If your school-aged child has a temperature of 100.5 F, or greater, he’s considered contagious and should remain home. With a fever, he’s most likely pretty uncomfortable and won’t be able to learn or participate in class (just think how you feel with a fever). Your child should remain home until he’s been fever free for 24 hours.

Cough and Cold Symptoms

Most of the time, upper respiratory infection symptoms are more of a nuisance and don’t necessitate your child staying home (otherwise, schools would be empty!). Colds typically last three to seven days and the age-old adage of “Tincture of Time” is all we can prescribe. If symptoms interfere with her ability to participate in school, such as a cough keeping her up all night, then keep her home for some TLC.

Diarrhea and Vomiting

This seems like a no brainer, right? If your child’s actively having symptoms, then he’s too sick and contagious to go to school. A good rule of thumb is to keep him home until he’s had no more episodes of vomiting or diarrhea for 24 hours. The tricky part comes when he has the persistent, lingering soft stool. Consult your doctor and use his comfort level in deciding.

Sore Throat

If she doesn’t have a fever and can tolerate eating and drinking, she’s more likely okay for school. However, if she’s been diagnosed with strep throat, she’ll need 24-hours worth of antibiotics before returning to school.

Pink (Red) Eyes

If his eyes are red, covered in – or oozing – yellow/green discharge, then you’re likely dealing with a contagious case of conjunctivitis (the dreaded pink eye). Again, he’ll need 24 hours of antibiotics before returning to school. On the other hand, slightly pink eyes with clear/watery discharge is likely allergic and he’s okay to be at school.


I saved the best for last. Rashes are dependent on diagnosis and may require a doctor’s aid in identifying the cause and contagiousness. Some are contagious before the rash appears. Others, like chickenpox and hand, foot and mouth disease, need to be crusted over before your child can return to school.

Parents, remember to simply trust your instincts. I know it may wreak havoc on your already hectic schedules, but your child’s well being comes first. If all else fails, your doctor’s always only a phone call away to help you navigate these difficult decisions.

Diana M. Roukoz, D.O. is a Mercy Kids pediatrician with Mercy Children’s Hospital

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