Two common questions that parents ask their pediatricians are “when can my child return to school” and “how long will I need to stay home with my child?” Understanding how long and under what conditions a child with an infection is contagious is important in preventing spread of disease. Your pediatrician can help educate parents, educators, and daycare providers about infection control practices which help to prevent illness and minimize it from spreading. Following these policies can prevent unnecessary school absences and excessive days off work.
Respiratory infections are spread when children cough and/or sneeze. Aerosolized droplets can be inhaled by nearby children, or more commonly, when the droplet comes to rest on a surface and they touch their hand to their face, nose, or mouth. When covering their cough/sneeze with their hands, they can still spread germs by contaminating surfaces if they don’t wash their hands.
It is better to teach children to sneeze/cough into a tissue, paper towel, or if not available, into the crook of the elbow. Your child should use a 5-step hand washing technique recommended by the Centers for Disease Control and Prevention.
- Wet hands first with clean running water and apply soap
- Rub hands together to lather up and focus on back of hands, between fingers, and under finger nails
- Scrub hands for 20 seconds
- Rinse hands under running water
- Dry hands with a clean towel or let them air dry
If you can’t wash your hands, hand sanitizer is an option.
Children with the following conditions, typically do not need to miss school as long as they feel well and do not have a fever, rash, or severe illness.
- Cold sores/canker sores without excessive drooling
- Croup
- Tick-born diseases (Lyme, Rocky Mountain Spotted Fever)
- Ear infections
- Fifth Disease
- Warts (including Molloscum)
- Mononucleosis
- Rash without fever
- Roseola (after fever is gone)
- Thrush
- Urinary tract infections
A child might need to miss school if they have one of the following:
- Boils, abscesses, cellulitis (staph or strep bacterial skin infections)--If the infected area is open and draining, with fever, or the draining lesion cannot be covered, or drainage is enough to go thru the bandage, contaminating surfaces, which allows for person-to-person contact or spread on a contaminated surface. Good handwashing is important to prevent spread from the child-to-child. Also children should not share personal items such as towels.
- Chicken Pox (Varicella)--School exclusion is appropriate for active cases, and may also exclude at risk, unimmunized children. With uncomplicated infections, children may return to school when rash has crusted or no new lesions are present in 24 hours. This often happens about 6-7 days after the start of the rash.
- Conjunctivitis (Pink Eye)--Both bacterial and viral infections are highly contagious. Spread is via direct contact with eye discharge or from a contaminated surface. Good hand hygiene is vital especially when touching the eyes, nose, or mouth. Exclusion from school for 24 hours of antibiotic eye drops is appropriate to decrease risk of spread of bacterial conjunctivitis, but will not change risk of spread due to a viral cause.
- Diarrhea illness (3 or more large, loose stools per day and may include fever, nausea or vomiting)--It is spread by person-to-person contact via fecal-oral route. Good handwashing and personal hygiene are extremely important in prevention and control of this illness. Most cases are viral. Younger children who are unable to reliably toilet and practice good personal hygiene should stay home until diarrhea has resolved for 24 hours. Older children, able to reliably toilet, practice good personal hygiene, and do not have other symptoms (i.e. fever, vomiting) may go to school unless diarrhea is uncontrollable. Children with vomiting 2 or more times in 24 hours should stay home. Return to school is okay when child has no accidents using the toilet and stool frequency is no more than 2 stools above child’s normal stooling frequency.
- Strep Throat--It’s incubation period is 1-3 days and is spread by large respiratory droplets in an infected child (or carrier), or direct contact with nasal/throat secretions. Children must be excluded from school until they have had 24 hours of antibiotics.
- Head Lice--They are most often spread by direct hair-to-hair contact. They can less commonly be spread by indirect contact with brushes, head gear (i.e. hats, baseball helmets) or bedding. Once children are treated, they should be allowed to return to school. The American Academy of Pediatrics advocates that “no-nit” policies should be discontinued. Lice can only live 24-48 hours off a host, and person-to-person transmission is possible if head lice are present on the host. All close contacts and family members should be checked and treated as well as all bed linen and clothes used in the last 48 hours washed and dried in hot water/hot air cycles.
Infections are a frequent reason for children missing school. Using appropriate prevention and treatment can help prevent children from missing school.
By Michel Danter, Pediatrician
