Body Wise

Sick, but Too Sick for School?

by Tina Gallagher

You wake your child for school in the morning. He utters the phrase every parent dreads hearing: “Mom, I don’t feel good.”

His temperature is normal, but he’s sniffling, coughing and complaining of a sore throat. Should you get him up and send him off to school?

Health officials recommend parents keep children home if they exhibit any of the three main symptoms of illness — fever, vomiting or diarrhea. But often illnesses aren’t that black and white. “There are a lot of gray areas, but because temperature is an objective piece of information, it is a useful guide for parents in determining if their child can return to school. Usually I recommend 24 hours of no fever (off medications such as ibuprofen or acetaminophen) for the child to return to school,” says Cheryl Hausman, MD, a pediatrician at The Children’s Hospital of Philadelphia.

Fever Is a Symptom,
not a Sickness

It’s only natural to be concerned when your child’s temperature goes up. But not all fevers are a cause for worry. In fact, many fevers don’t need treatment.

By activating your child’s immune system, a fever can actually shorten your child’s illness. Normal temperature is not a specific number. Instead normal temperature usually ranges from 97° to 100.4° Fahrenheit. Body temperature also varies according to time of day, age, and physical activity.

Pediatricians do not consider a fever significant unless it rises above 100.4°. Treatment is rarely required for a child older than three months who has a mild fever but no other symptoms. But if other symptoms appear along with the fever, you should call your pediatrician.

For children younger than three months even a mild fever means you should call your pediatrician right away

From the American Academy of Pediatrics radio series A Minute for Kids.

Colds are mildly contagious, but not necessarily a reason to keep your child home. “Chances are pretty good that the school setting was the place the child was infected. Usually if the child’s symptoms will not be disruptive in the classroom, and the child feels up to it, it is fine for the child to return to school,” says Dr. Hausman.

If your child is feeling sluggish or seems to be “getting sick,” keeping her out of school usually isn’t necessary either. Some parents believe that putting a halt to a child’s activities will keep a mild illness from turning into something more serious, but that isn’t always true.

According to Dr. Hausman, “Rest is always important when an illness is beginning. However, there is no evidence that it will prevent something more serious. Many illnesses are viral in nature and once in motion will run their course. Having said that, maintaining decreased stress, promoting good nutrition and getting rest can often benefit your child during these early stages of illness.”

So when should your youngster absolutely be kept home from school? Here’s Dr. Hausman’s prescription for parents:

Fever. If your child’s temperature is 101 degrees or higher, keep him home. He should be fever-free for 24 hours without medicine before returning to school.

Treating Diarrhea

Most children with mild diarrhea can continue to eat a normal diet including formula or milk. Breastfeeding can continue. If your baby seems bloated or gassy after drinking cow’s milk or formula, call your pediatrician to discuss a temporary change in diet. Special fluids for mild illness are not usually necessary.

Special Fluids
Children with moderate diarrhea may need special fluids. These fluids, called electrolyte solutions, have been designed to replace water and salts lost during diarrhea. Do not try to prepare these special fluids yourself.

Use only commercially available fluids — brand-name and generic brands are equally effective. Your pediatrician or pharmacist can suggest products.

If your child is not vomiting, these fluids can be used in very generous amounts until the child starts making normal amounts of urine again.


• Watch for signs of dehydration which occur when a child loses too much fluid and becomes dried out. Symptoms of dehydration include a decrease in urination, no tears when baby cries, high fever, dry mouth, weight loss, extreme thirst, listlessness, and sunken eyes.

• Keep your pediatrician informed if there is any significant change in how your child is behaving. Call the doctor if your child has blood in his stool or develops a high fever (more than 102°F or 39°C).

• Continue to feed your child if she is not vomiting. You may have to give your child smaller amounts of food than normal or give her foods that do not further upset her stomach.

• Use diarrhea replacement fluids that are specifically made for diarrhea if your child is thirsty.


• Try to make special salt and fluid combinations at home unless your pediatrician instructs you and you have the proper instruments.

• Prevent the child from eating if she is hungry.

•Use boiled milk or salty broth and soups.

• Use “anti-diarrhea” medicines unless prescribed by your pediatrician

From the American Academy of Pediatrics Parenting Corner

Diarrhea or Vomiting: Keep your child home until the symptoms have passed, and for 24 hours after the last episode. Give plenty of fluids to avoid dehydration
Sore Throat. A minor sore throat is usually not a problem, but if your child has been complaining of a severe sore throat for more than one day, it could be strep, even if no fever is present. Take her to her doctor, who might advise a strep test.

Earache. This is usually a sign of an ear infection, so your child should see a doctor for treatment.

Conjunctivitis (Pink Eye). This disease is highly contagious and uncomfortable. If your child’s eye is itching, burning and producing a whitish discharge, call the doctor immediately. Most schools require a doctor’s note before allowing the child to return to school from a bout of pink eye.

Rash. A child with a skin rash should see a doctor to identify it. The rash might be caused by one of several infectious diseases, such as chicken pox, measles or impetigo.

Not all children exhibit obvious symptoms at the onset of an illness. Sometimes, it’s just a matter of the child not feeling well.

When this is the case, parents must use their own judgment. You know your child better than anyone else, so if your instincts tell you he’s too sick to go to school, by all means, keep him home.

If you think your child is using illness as a means to skip class, then pack his backpack and send him on his way. When in doubt, don’t be afraid to contact your physician for guidance.

Tina Gallagher is a freelance writer.