When to Keep Your Child Home From School

Children should attend school every day and may attend school with mild or improving symptoms.  This guidance, based on CDPH recommendations, will help you decide whether your child is too sick to attend school.

If your child has symptoms that prevent them from participating meaningfully in school please keep your child at home.  Otherwise follow the symptom guidance below to decide whether they can attend school. A doctor’s note is generally not required to return to school.

• Masking is recommended for cold and cough symptoms 
• Encourage frequent hand washing.

If your child has been diagnosed by a doctor with a specific illness, or develops similar symptoms after an exposure to a communicable disease, follow instructions from your doctor or the health department for when your child may return to school (for example, Strep Throat or Norovirus.)  Please report diagnosed illnesses to your school office.

Overall, not feeling well

Stay home if any new illness or symptom prevents your child from doing routine activities.  Return to school when feeling better and able to participate in school.

Abdominal pain/ stomach ache

Definition: Pain experienced anywhere between the chest and groin; pain may be continuous or may come and go.

May attend school unless the child has one of the following:

• Pain is severe enough that child has difficulty participating in routine activities
• Pain starts after an injury
• Bloody or black stools
• Diarrhea (see Diarrhea)
• Vomiting (see Vomiting)
• No urine for 8 hours (dry diaper, or ask older children if they have urinated since they woke up)
• Fever (see “Fever” for return guidance)

Cough and cold symptoms

Definition: May include runny/stuffy nose, sore throat, sneezing, congestion, body aches, and/or cough, typically lasting up to 7–10 days.

May attend school unless the child has one of the following:

• Fever (see “Fever” for return guidance)
• Difficulty with or rapid rate of breathing (see “Difficult or noisy breathing”)
• Cough is severe or child cannot catch breath after coughing
• For a cough suspected to be associated with asthma: coughing that cannot be controlled by the medications that the child care or school has been instructed to use

Note: Recommend wearing a mask if returning to school with mild symptoms.

Diarrhea

Definition: Stools that are more frequent (typically at least two more than normal) or less formed than usual for that child AND not associated with a change in diet. 

May attend* school unless the child has one of the following:

• Stool not contained in the diaper or toilet (when toilet-trained)
• Stool looks like it contains blood or mucus, or appears like sticky black tar
• Yellow skin/eyes (jaundice)
• Diarrhea that occurs during an outbreak, and exclusion is recommended by the local health department

*Note: Encourage frequent handwashing.  If the child has been diagnosed with a specific infection follow the advice of the child’s health care professional. If there is concern for an outbreak (more persons with diarrhea than would be expected in the setting for that time of year), Health Services will contact the local health department for guidance.

Difficult or noisy breathing

Definition: Wheezing (high-pitched sounds) that can be heard when a child breathes in or out, chest retractions (see below) OR extra effort is required to breathe. Seek medical attention for new symptoms such as wheezing or breathing difficulties.

May attend school unless the child has one of the following:

• Wheezing that is new for the child or cannot be controlled by medications the child care/school has been instructed to use for known conditions (e.g., asthma plan)
• Skin or lips seem purple, blue, or grey. Call 9-1-1.
• Fever (see “Fever” for return guidance)
• Behavior changes
• Very rapid breathing or increased effort to breathe, such as chest retractions (space between ribs sinks with each breath), belly breathing (belly goes up and down with breathing) 
• Breathing problem that causes child to have pursed lips, difficulty speaking, or difficulty feeding

Note: Seek medical attention for new symptoms such as wheezing or breathing difficulties.

Earache

Definition: Pain (dull, sharp, or burning sensation) experienced inside the ear.

May attend school unless the child has one of the following:

• Fever (see “Fever” for return guidance)
• Behavior changes
• Pain pr​​events participation in routine activities

​​Eye irritation, pink eye, or drainage

Definition: Red or pink appearance to the white part of the eyeball. Child’s eye may also be itchy, have crusted/matted eyelashes, more watering than normal, or yellow/white drainage.

May attend school unless the child has one of the following:

• Problems seeing (vision changes)
• An injury to the eye involving forceful impact to or penetration of the eye
• Pain or discomfort the child cannot tolerate

Note: Encourage frequent handwashing. Pink eye (i.e., conjunctivitis) is inflammation of a layer that covers much of the eyeball. It is most often caused by a virus, and children with viral pink eye typically get better after 5-6 days without antibiotics. Eye irritation can also result from allergies or ch​​emical exposures (e.g., air pollution, smoke, or swimming in chlorinated pool water).  Staying home from school is not necessary. 

Fever

​Definition: An oral (under the tongue), temporal (forehead), rectal, or axillary (underarm) temperature above 100.4°F (38°C). Axillary (underarm) measurements should be used only if other options are not available. Follow instructions for the specific thermometer, including directions for use, cleaning and covers (if applicable). If a temperature is close to 100.4°F, repeat to confirm the result. 

May NOT attend school until: 

• At least 24 hours have passed since a fever of 100.4 degrees Fahrenheit or higher has resolved without the use of fever-reducing medication e.g., Tylenol®, Advil®, Motrin® (acetaminophen or ibuprofen) 
  
  – AND
   
• Other symptoms are improving and the child can participate comfortably in school.

​​Headache, stiff or painful neck

Definition:  Pain experienced in any part of the head ranging from sharp to dull; may occur along with other symptoms.

May attend school unless the child has one of the following:

• Concussion symptoms: Pain occurs after a fall or other injury to the head and is severe or associated with vomiting, vision changes, behavior change, or confusion.
• Possible infection: Stiff neck, headache and fever can be symptoms of meningitis, a potentially serious infection. Meningitis can also cause sensitivity to light, vomiting, and/or confusion. A stiff neck is most concerning if the child can’t look at their belly button (putting chin to chest) due to pain or the BACK of the neck is painful (not soreness in the sides) along with the other symptoms above.

Get immediate medical attention for either of the above conditions or ​Call 911.

Rash or itching

Definition:  An area of the skin that has changes in color or texture and may look inflamed or irritated. The skin may be darker than or lighter than normal or red or purple. It may be warm, scaly, bumpy, dry, itchy, swollen, or painful. It may also crack or blister.

May attend school unless the child has one of the following:

• Oozing, open wound or infection that cannot be covered and is in an area that might come in contact with others.
• Skin that looks bruised without a known injury or in an unusual location.
• Rapidly spreading dark red or purple rash (may indicate a rare but severe bacterial infection; usually accompanied by fever). 
• Tender, red area of skin, rapidly increasing in size or tenderness.
• Associated symptoms of a serious allergic reaction (rash with throat closing, abdominal pain, vomiting, or wheezing).  Call 9-1-1
• Fever (see Fever for return guidance)
• There is concern for a disease like chickenpox or measles. If this is the case, the child should see a healthcare provider and Health Services should contact the local health department.
• Note: For diagnosed conditions, follow the advice of the healthcare provider. For conditions such as lice, impetigo, ringworm, scabies, and pinworms, no waiting period is typically necessary after starting treatment and the child may return after the appropriate treatment is started.

​​​Sore throat (pharyngitis) and/or mouth sores

Definition:  Sore throat includes pain or irritation of the throat often resulting from a viral or bacterial infection (e.g., cold, flu, strep throat). May feel worse when swallowing.

Mouth sores include white patches on the tongue, gums and/or inner cheeks (oral thrush/yeast infection); white/red spots in the mouth, blisters on lips or inside mouth; or painful ulcers inside cheeks or on gums (canker sores).

May attend school unless the child has one of the following:

• Inability to swallow
• Fever (see “Fever” for return guidance)
• Breathing difficulties
• Excessive drooling or muffled voice. Call 9-1-1

Note: Recommend wearing a mask if returning to school with mild symptoms. Most children with sore throat have viral infections. If a child is diagnosed with strep throat, they should receive antibiotics for at least 12 hours before returning.

Vomiting

Definition: Forceful expelling of stomach contents out of the mouth 2 times or more in 24 hours. 

May attend school unless the child has one of the following:

• Vomiting has occurred 2 or more times in 24 hours.
• Fever (see “Fever” for return guidance).
• Concern for a serious allergic reaction, such as hives appearing with vomiting – Call 911
• Vomit appears green or bloody – Call 911
• Child has not urinated in the past 8 hours (i.e., has dry diapers, or ask older children).
• Recent head injury – get medical attention or call 911
• Looks or acts very ill.

Note: Not all vomiting is due to an infection (e.g., motion sickness, overeating).  If there is concern for an outbreak, more persons with vomiting than would be expected in the setting for that time of year, call Health Services.   If norovirus is suspected, children should not return until 48 hours after symptoms have resolved.

This guidance does NOT:

Does NOT eliminate the possibility of spreading disease in child care or school settings. This guidance is part of a broader strategy to limit the spread of disease. Other preventive measures include, but are not limited to, optimizing indoor air quality, cleaning surfaces, and promoting individual actions that help protect children and staff (e.g., staying up to date on vaccines, washing hands, wearing facemasks) as appropriate.

Does NOT replace the advice of licensed healthcare professionals (such as school nurses) performing individualized assessments.

Does NOT replace or revise guidance provided in an individual child’s care plan for known conditions, as provided to the child care or school by the child’s healthcare provider.

Does NOT replace or revise guidance specified in a child’s individualized education program (IEP), Section 504 plan, or individualized family service plan (IFSP).

Does NOT provide recommendations on how to manage specific diagnoses (e.g., pertussis, hepatitis A). To manage specific diagnoses, follow guidance provided by a child’s healthcare provider, local health department, the California Department of Public Health (CDPH), and/or the Centers for Disease Control and Prevention (CDC). 

This guidance is limited to the evaluation of symptoms suspected to be from infection (e.g., caused by a virus or bacteria). Please remember to consider non-infectious causes for symptoms in any individual child, such as allergies or other chronic conditions.

For more information see:

Considerations When a Child has Symptoms of Illness in Child Care or School, Oct 2, 2023

For questions or concerns about this guidance for your student please contact your school office, your School Nurse or call Health Services at 916-643-9412.