September 17, 2013

Ask: When should I keep my sick child home from school?

Your kid has the sniffles and a slight fever. Is that enough to keep him home from school? UNC pediatrician Mike Steiner gives us the scoop.

Q. When should my child stay home from school due to illness?


A. This is a great question, and one that comes up frequently. Generally, medical professionals and schools are in agreement about when kids can be back in school and when they shouldn’t be, but occasionally there are conflicts.  It’s nice that most public schools have a financial incentive to want students to be in school as much as possible, so it’s rare for them to keep kids out when doctors say they can go back to school. However, many day care centers for young children have very restrictive "sick" policies that can be frustrating for parents.


There are a few things that are important to remember when deciding whether your child is well enough to go to school.  First of all, whatever he or she caught was likely caught at school. Secondly, many viral infections are infectious BEFORE they are symptomatic, so spreading has often already occurred.  Lastly, if children are really sick, they will have a hard time learning, so that is the ultimate time when it’s obvious that they should stay home.


There are a few infections where it is absolutely clear that children should be at home, such as active tuberculosis not treated or in early treatment, pertussis during the infectious period and chicken pox. But there are a variety of illnesses/infections for which the schools generally require a physician’s note or clearance that generally are OK for children to go back to school. For example, "pink eye" has a horrible reputation, but in reality it is just a minor bacterial or viral infection and can be easily controlled with good hand washing.  Additionally, even lice is very difficult to pass between children despite the reputation. The newest guidelines from the American Academy of Pediatrics does not recommend "no-nit" policies in schools. No-nit policies exclude kids even when just live or dead eggs are seen on the hair.


As a general rule, please keep your children home whenever they feel too badly or are too sick to learn.  Secondly, if they currently have a fever, we usually recommend that they stay home. However, even some doctors have admitted to loading their kids up with Tylenol or Motrin right before school starts and crossing their fingers that they can make it through the day.  Finally, children should stay home for the first day or two of a severe viral infection like influenza. Luckily, for most infectious illnesses that require isolation, children will feel badly and clearly won’t be able to attend school,  so it makes decisions much easier.  


As a related issue, if your child has a chronic illness that makes him more likely to catch serious illnesses, please talk to your doctor about when he should or shouldn’t attend school and how you can lower his risk of infections.


If you have a question about your child's health or happiness, ask Dr. Steiner or any of our experts by sending email to

Dr. Mike Steiner is a pediatrician in the division of General Pediatrics and Adolescent Medicine at UNC and North Carolina Children’s Hospital, a group of health-care professionals dedicated to improving the health of children and adolescents through clinical care, research, education and advocacy. The group includes over 35 physicians, practitioners, nurses and other health-care professionals. We supervise the care of children with general medical problems at N.C. Children’s Hospital, including hospitalized children, the newborn nursery, primary care clinic and a complex care and diagnostic clinic that also sees patients at the N.C. Children’s Specialty Clinic located on the Rex Healthcare campus in Raleigh.


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