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Dr Shapiro completed his undergraduate education at UC San Diego earning a B S in Biochemistry and Cell Biology and a B A in Political Science He furthered his education at UCLA where he earned a Masters Degree in Public…
FAST FACTS
Every day I am asked by parents about whether their ill child must be keep home from school or daycare. And while I sympathize with the implications of keeping a child home from school...lost work, lost school time, the reasons for keeping a child out of school are basically three-fold: a child cannot perform the routine activities comfortably or a child's illness requires more care from the staff than they are able to provide or there exists a good likelihood of infecting others. In the United States, each individual state may issue its own guidelines even if medical evidence does not justify a child's exclusion. And while I believe common sense can often be used to determine whether a child should be excluded from school, I do appreciate having current scientific evidence available when dealing with some of the grey areas. Therefore, I share with you all the evidence-based guidelines from the American Academy of Pediatrics (AAP) as they appear in Managing Infectious Diseases in Child Care and Schools.
Tuberculosis: until an appropriate authority certifies the child is receiving appropriate therapy. I suspect any and every county health department will always be involved as this should be a reportable condition and tracking of this illness is critical for public health safety.
Impetigo (bacterial skin infection): until 24 hours after treatment has been initiated. I actually base my decision on the extent of the infection and if it's not located in an area where others would be exposed, I see no reason keeping a child out of school. And in regard to the lesions associated with MRSA, there is no formal recommendation to keep a child out of school unless there is also fever, pain, or any behavioral change.
Chickenpox: until all sores have dried and crusted over (about 7 days). But since many children are vaccinated to varicella/chicken pox, we are not seeing the typical chicken pox of hundreds of lesions these days. In fact, about once a month or so I will see a child, who has been previously been vaccinated, walk-in with about 30 lesions or so. And because these do not typically crust over, the above rule does not apply with the current mindset that these children do not need to be kept out of school because the chance of spread is minimal.
Measles: until 4 days after an onset of rash. 1 word-vaccine.
Rubella: until 6 days after an onset of rash. Please see measles.
Mumps: until 9 days after an onset of parotid gland swelling. But please keep in mind that it is important to realize parotid gland swelling can be caused by a variety of reasons...both infectious and non-infectious. Also, please see rubella.
Hepatitis A: until 1 week after onset of illness or jaundice or as directed by the health department. Another reportable disease in my county.
Fever: when there are also behavioral changes or other symptoms such as sore throat, rash, vomiting, diarrhea, earache. My rule of thumb is the older the child is, the more lenient I become. I have a difficult time rationalizing keeping a high school student out of school if he/she has an important test and, of course, feels able to attend school.
Diarrhea: when there are frequent, runny, watery stools. This follows the common sense theme I mentioned above.
Blood in the stool: when not explained by dietary change (e.g. milk protein colitis), medication, or constipation/hard stools. Frankly, I think it's important a parent discuss with the child's physician whenever blood is noted in the stool.
Vomiting: if 2 or more times in a 24 hour period. Follows a general rule of thumb I have about watching where the symptoms go. One time vomit, I usually don't get too concerned.
Body rash with fever: if fever has resolved, then most often not a concern although there are exceptions...see above, chicken pox.
Sore throat: with fever and swollen glands or mouth sores with drooling. Your child should be seen with these symptoms.
Severe coughing: with the child getting red or blue in the face or making the whooping sound (often heard with pertussis). Any concerning cough or shortness of breath or difficulty breathing should warrant an immediate trip to the office.
Persistent abdominal pain: when lasting greater than 2 hours. I tend to think the child will be letting the teacher or school nurse know before two hours has been reached.
Now for those who have been wondering about specific illnesses/diseases, please feel free to respond and I'll be sure to clarify any questions you may have.
Dr. Jeremy
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Displaying comments 16-1 of 16
Got a Question?
As far as fevers, not necessarily a reason to keep a child out unless other symptoms...affecting behavior or ability to function normally in class. Granted, each state may have a different take here, but it comes down to some common sense, if your child doesn't look good, school is not the place to be. Unfortunately, each state (and schools for that matter) creates its own guidelines.
If your child has a medically documented anxiety disorder, she is eligible under FEDERAL SPECIAL EDUCATION LAW for a 504 Plan.
Get a note from the doctor and call a meeting with the school.
They will have to accomodate her. This can mean excusing absences, reducing homework, allowing late assignments etc. One accomodation we got was allowing my daughter to leave class if she started to panic.
I have three children with anxiety disorder and ADHD.
If my daugter needs to stay home, I allow it.
I make the school deal with it.
It's the law.
I can help you navigate the system if needed.
Zen
My child gets sick easily and I keep her home if she needs to be kept home.
She also has an anxiety disorder and I have told the school.
Today's schools will hassle you over absences and tardies even if medically related.
All they seem to care about is their attendance based funding and test scores.
My daughter was so stressed out on Friday (due to testing) that I kept her home so she could catch up on homework (which she still has during testing) and rest.
The amount of homework given to kids has increased dramatically and seems to serve no useful purpose if the child is being already being taught during the school day.
Teachers purposefully give kids homework/projects that they cannot do without parental involvement in order to force what THEY judge to be the most important interaction between parent and child.
This is regardless of the fact that most parents are working 50 hours or more and are exhausted or like myself, in very poor health.
I would rather cuddle up with my child and watch a movie or play a game than do last nights homeowrk on how to pluralize words.
A lot of the time we just do whatever we can do to knock the homework out. It is not a learning experience, it's a lesson in compliance.
504 plans and IEP's are not followed either.
The whole situation just stinks for kids and parents and teachers in the current system.
Finally, working parents often cannot afford to keep kids home from school when employers have increasingly strict attendance policies, espcially service industries.
Target, Macy's, Old Navy etc all have point systems for tardiness and absences where you get fired after so many points no matter what, even with a doctor's note.
I just want to yank my kids out of school.
Zen
Any advice?
Frankly, I wish other parents would keep their sick kids home so they will stop infecting mine!
As soon as treatment begins, ok to return to school.
Other people might think I am crazy, but I think some children may need a "mental health day" once each term. I never let my kids to take off on the day of a big test, but honestly, in the long run, in 20 years will it matter that a child missed one day of school? Yes, I had to miss work, but I would rather miss work in order to prevent my kid from getting sick from being over-stressed.
My thinking was that if I didn't teach my kids that it's okay to take care of themselves like this when they need to, where else will they learn it? One teacher found out that my child wasn't really "sick," and said I was teaching them to "be lazy."
Your thoughts?
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