Should my child stay home from school?

Every parent has been there. It’s 20 minutes before the bus arrives, and your child starts complaining of a stomach ache. They feel slightly warm to the touch. Should you keep them home from school for the day? What if they’ve been on an antibiotic for nearly a full day? We asked Barbara Sagoe, MD, PPG – Pediatrics, to help parents get some answers.

Viral vs. bacterial infections

A virus causes a viral infection and bacterial infections are caused by bacteria. This is very simplified though. Both bacteria and viruses are microorganism, but viruses tend to be much smaller than bacteria, and they both cause a variety of diseases. Most common colds, for example, are caused by viruses, as are other infections such as HIV, influenza, viral gastroenteritis, chicken pox and measles.

Some bacterial infections include strep throat, some sinus infections, pneumonia and cellulitis. Sometimes bacteria can complicate a viral illness like the common cold, which is mostly caused by viruses.  Most bacteria can live and reproduce outside of a host cell, but viruses require a living cell to be able to grow and multiply.

Which is contagious?

While both are contagious, viral infections tend to spread faster than bacterial infections. Even though viruses need a host cell to multiply, once they find one, they can literally take over that host’s cells very rapidly because of how they reproduce. Bacteria on the other hand reproduce much slower compared to viruses.

How long is a child contagious?

Once a child contracts an infectious disease, they go through stages:

First, there is the incubation period, which is the period when the child comes into contact with the infectious agent, until the onset of symptoms of the disease. This period can last from a day or two, to months or years, depending on the pathogen.

From this stage, the child may or may not progress to the next stage of the disease, which is the prodromal period, when the onset of symptoms of disease occurs. This is also the period of the illness when these symptoms progress and become severe.

This is followed by the period of decline, during which the number of pathogens in the body begins to decrease and the symptoms of the illness also begins to improve, a result of the immune system working on the pathogen.

This is followed by the period of convalescence, where the child or individual returns to normal.

A person can be contagious in any of these stages of illness, depending on the disease process in question. As an example, a lot of the viral rashes, such as measles, are infectious from the incubation period right up to one week before the onset of rash. This compared to the common cold, flu or strep, where the patient is most contagious during the prodromal period. Then there are other infections, such as GI infections, where the patient can still be contagious even during the period of decline or remission, such as the case of typhoid Mary, if you are familiar with that story.

Symptoms that signal a sick day

Identifying when to keep a child home can differ depending on the age, the disease and the developmental stage of the child. For instance, diarrhea is most often caused by viruses, thus the decision to send to school or not really depends on how the child can manage the diarrhea and their overall health. You might want to consider keeping them home if the symptoms will disrupt their day. However, younger children may need to stay home because they may be more prone to accidents and have poor hand hygiene, which could lead to an increased likelihood of transmission.

If the child is not eating or drinking well, they are dehydrated, vomiting, unable to keep fluids down and/or have a fever, then you will definitely need to keep them home.

Children who attend school or child care facilities often experience upper respiratory tract infections (URI). It is a good idea to keep your child home if the URI is accompanied with lethargy, poor oral intake, respiratory distress or difficulty in breathing. A child does not need to stay home if they have a URI without the presence of any of the aforementioned accompanying symptoms.

Fever

When it comes to a fever, a lot of schools already have policies governing this in place. Most schools will request that parents keep a child home if they have a fever of 100.4 or more, and return after being fever-free for 24 hours. That policy is safe, as the presence of the fever can be a sign of a disease brewing. And they may be shedding microorganisms. 

Ideally, however, if a child has a fever, but is otherwise acting well, then no restrictions are generally necessary. A temperature below 100.4 is technically not considered a fever, and a child does not need to be kept home from school.

Guidelines around antibiotics  

For most common childhood illnesses, such as strep throat and conjunctivitis, the child can return to school after 24 hours of taking the antibiotic. This is not so for other infections, such as certain pneumonias or even pertussis, where the child may be required to complete the course of the antibiotic before returning to school. Having said that, there are other factors to consider in order to have the child return to school, such as their general well-being, fever, etc.

Pink eye

If a child is diagnosed with bacterial conjunctivitis, they can return to school after 24 hours of antibiotics. If it is viral, then it has to run its course and there is nothing anyone can do about it. The child can be sent back to school on that same day.  Viral conjunctivitis can take up to two weeks to fully resolve. Allergic conjunctivitis is not contagious and the child can go to school the same day.

Cough

The cough alone is not a reason to keep the child home. The child can be sent to school with good cough hygiene. However, a child will need to stay home if they are coughing with associated fever, having difficulty breathing or distress, significant wheezing, lethargy or poor oral intake, which can lead to dehydration.

As a general rule, if your child has had some issues with upper respiratory symptoms, then you should continue to monitor them for concerning symptoms. If the child is on antibiotics, then make sure that they complete the course. Remember, you should always reach out to your primary care physician or pediatrician if you have concerns or questions around the child’s condition.

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