Know When to Stay Home From School

by Dr. Zach King, M.D.

The new school year is fast approaching and many families are scheduling well child visits before school starts. The well child visits are some of most fun appointments that I have and I believe to be the most important.

Unfortunately though, our children are not always well. With school starting, sick visits will be on the rise. This raises the question, “When my child gets sick, when do I keep them out of school, and at what point should I schedule an appointment to see the doctor?”

You should keep your child at home for a couple of generally accepted reasons.:

The first is fever of 100.4 degrees or above.

In most cases, they need to be fever free for more than 24 hours before returning to school.

Unless your child has a specific sign or symptom associated with the fever, we usually recommend treating the fevers with ibuprofen and/or Tylenol for a couple days before making an appointment with your physician.

There are several reasons for this. Most illnesses are caused by viruses that will “run its course” in under a week and do not require antibiotics.

Another reason to watch and wait for a couple days after onset of fever is that it can take a couple of days for many of the signs and symptoms to develop. Your physician is able to make a much more accurate diagnosis if they have a little more history and physical findings that may have not been there the day or two before.

A question I commonly get regarding fever is, “What specific degree do I need to go to the doctor or ER?”

I don’t recommend fixating on any specific number. Instead, I suggest that if you can’t get the fever to come down after giving Tylenol or ibuprofen AND your child looks really sick, then it is reasonable to go to the doctor.

A second common reason to keep your child out of school is vomiting or diarrhea.

If your child begins vomiting, stop allowing them to eat solid food and dairy products, and switch them to clear liquids only. No soft drinks or juices.

If he or she is under 1 year of age, use Pedialyte instead of plain water. If your child cannot keep anything down, you can give him or her anti-nausea medicine (for example, Phenergan or Zofran).

The main concern with these types of illnesses is dehydration. Signs of dehydration would be decreased urine output, dry mouth, and decreased energy or lethargy.

If there are any other of these signs, it is time to make an appointment because your child may need IV fluids to get re-hydrated. Once your child has not had any vomiting or diarrhea for 24 hours, it is usually safe to go back to school.

Pink eye (conjunctivitis) is definitely a reason to be seen by your doctor.

Pink eye is a bacterial infection on the surface of the eye that causes it to become reddish pink. Therefore, by definition, if the eye is not pink…it is not pink eye. Classic conjunctivitis is a reddish pink eye and a greenish yellow matting that is worse after being asleep but will also return frequently throughout the day even after wiping it clean. Pink eye is very contagious initially but is treated fairly quickly by antibiotic eye drops or ointments. Usually 24-48 hours after starting treatment the contagiousness is no longer a concern, the eye is looking better, and the child may return to school.

There are many types of illnesses and ways to get sick. As a parent, it can be overwhelming to know what to do when your child becomes sick. I always tell my families that when all else fails, trust your gut. If you think your child is really sick and needs to see a doctor, go see your doctor. I would much rather give a diagnosis of reassurance than that of a serious illness any day!