Is my child too sick for school?

By Sara Hanau, a contributing writer for Sharp Health News and a senior digital producer for Sharp HealthCare.

It was a Friday when my son was diagnosed with hand, foot and mouth disease. By Monday, he was cleared for day care. As any working mom will tell you, this was relieving beyond measure - my child was on the mend and I wouldn't be buried in unread emails due to missed work. But I did wonder, was it too soon? What if he needed a little extra TLC? And what about the health of the other kids?

As it turns out, my son's contagious period was over - and it happened when his symptoms were easy to miss. Mix that with a child's new, untested immune system, and school and day care become breeding grounds for sickness.

"Common illness is a part of childhood," says Dr. Michal Goldberg, a board-certified
pediatrician with Sharp Rees-Stealy Medical Group. "We want our kids to be exposed to peers and to social interactions. That is how they learn and develop. Inevitably, exposure to other children means that they will be exposed to germs as well."

But sick kids need time to heal, and contagious kids can be dangerous to their peers. So where do you draw the line? "It's a judgment call," says Dr. Goldberg. "Parents need to do the best they can with the information that is available at the time."

To help, she offers three basic guidelines. Keep a child home if:

• She or he is contagious to others

• She or he has a fever

• She or he does not feel well enough to be able to meaningfully participate in the day

Seems easy enough, right? But for a mom like me, who wishes her child came with operating instructions, I need a little more help. "I believe in empowering families to make that judgment call," says Dr. Goldberg, "but with guidance from their doctor as needed."

She offers the following advice for the most common childhood ailments:

• Cold - Children with a cold, who are not feverish, may return to school if they are otherwise well.

• Fever - Children should generally stay home if they have had a fever within the past 24 hours. Babies under 3 months of age with a fever should be evaluated by their doctor.

• Vomiting - If your child has vomited more than twice in the past 24 hours, or if she has vomited once and you feel she may be contagious, she should remain home from school.

• Diarrhea - Children with slightly looser stool do not necessarily need to stay home, as this is a common finding with viral illness. However, children with frequent diarrhea, or diarrhea that cannot be contained in a diaper, are likely contagious to their peers and should stay home.

• Strep throat - Children with strep throat should be treated with antibiotics for a full 24 hours prior to returning to school or day care.

• Pink eye - Children with pink eye (aka bacterial conjunctivitis) may return to day care or school after they have been treated for a minimum of 24 hours with antibiotic eye drops.

• Rashes - Most rashes are not contagious. Exceptions include impetigo, rash with fever, chickenpox, and hand, foot and mouth disease.

• Ear infection - Ear infections are not contagious.

• Hand, foot and mouth disease - Children with hand, foot and mouth disease should not return to school in the early days of illness when they have a lot of drooling and open blisters or mouth sores. Once your child is fever-free for 24 hours, feels well enough to participate in class, and no longer has many open blisters or excessive drooling, he should be able to return to school.

• Chickenpox - Children with chickenpox should not return to day care or school until all of their lesions have crusted over.

As kids grow, parents sometimes bend these rules because they are worried about work coverage or a test that their child might miss. Dr. Goldberg warns against this.

"I empathize with their frustrations," she says. "I am a parent, too. But if kids are contagious, they're contagious. And at the end of the day, parents really do know when to keep their kids home."