There are a lot of different rules that dictate when kids can go to daycare or school when they are sick.
The actual rules of your daycare or school are the ones that you are likely most familiar with, but there are also recommendations from the American Academy of Pediatrics and the CDC, in addition to state-specific regulations.
Can Your Sick Child Still Go to Daycare or School?
Most people know to stay home when they are sick.
“Stay home when you are sick. If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness. Avoid close contact with people who are sick.”
CDC on Information for Schools & Childcare Providers
But what exactly does it mean to be “sick” and how long are you supposed to stay home and avoid other people?
“Most minor illnesses do not constitute a reason for excluding a child from child care, unless the illness prevents the child from participating in normal activities, as determined by the child care staff, or the illness requires a need for care that is greater than staff can provide.”
Recommendations for Inclusion or Exclusion (Red Book)
In general, your child does not need to be kept home and out of daycare or school if they are able to participate in routine activities, do not need extra care, and have:
- a cold (unless they have a fever) or other upper respiratory infection, even if they have a green or yellow runny nose
- RSV (unless they have a fever)
- croup (unless they have a fever)
- diarrhea that can be contained in a diaper or the child can make it to the bathroom without having an accident, as long as they aren’t having more than 2 stools above their usual or stools that contain blood or mucus
- a rash without fever – most skin rashes won’t keep your kids out of school, like if they have poison ivy, hives, or even molluscum contagiosum and warts
- Fifth disease – interestingly, you aren’t contagious once you have the characteristic Fifth disease rash
- head lice – why not keep kids out of school if they have lice? It doesn’t stop them from spreading. They can get them treated at the end of the day.
- pinworms – like lice, keeping kids out of school with pinworms isn’t going to stop them from spreading, although kids should be treated
- pink eye – if caused by an infection, in general, should be able to stay or return if is improving, but keep in mind that most experts now think that kids with pink eye do not need to be excluded from daycare or school at all
- oral lesions and are able to contain their drool (unless they have a fever), which would include hand foot mouth disease
- skin lesions that can be covered, and if they can’t, then they can return after they have been on antibiotics for 24 hours (impetigo) or have started treatment (ringworm)
- strep throat and have been fever free and on antibiotics for 24 hours
- scabies – if you have started treatment
- a sore throat (unless they have a fever)
Why don’t you have to keep your kids home when they have RSV or many of these other common childhood diseases?
In addition to the fact that some kids would never get to go to daycare or school, since these diseases are so common, many kids continue to be contagious even after their symptoms have gone away. So excluding them doesn’t really keep the illnesses from spreading through the daycare or school.
So why not just send them when they have a fever or really don’t feel well?
In addition to the possibility that they might be a little more contagious at those times, it is because the typical daycare or school isn’t able to provide the one-on-one care that your child would likely need when feeling that sick, as your child probably isn’t going to want to participate in typical group activities.
Policies that are overly strict at excluding children from daycare and school may also lead to antibiotic overuse, as parents rush their kids to the doctor for and push for a quick cure because they need to go back to work.
Exclusion Criteria for Vaccine Preventable Diseases
While the exclusion criteria for many diseases simply extends to when your child is fever free, starts treatment, or feels well enough to return to daycare or school, for many now vaccine-preventable diseases, you will be excluded (quarantined) for much longer:
- hepatitis A virus infection – exclusion for one week after illness starts
- measles – exclusion until four days after start of rash
- mumps – exclusion until five days after start of parotid gland swelling
- pertussis – exclusion until completes five days of antibiotics or has had cough for at least 21 days
- rubella – exclusion until seven days after start of rash
- chicken pox – exclusion until all lesions have crusted
- diphtheria – if survives having respiratory diphtheria, would likely be excluded until finishes treatment and has two negative cultures at least 24 hours apart
- rotavirus – as with other diseases that causes diarrhea, children should be excluded until “stool frequency becomes no more than 2 stools above that child’s normal frequency” as diarrhea is contained in the child’s diaper or they aren’t having accidents
- tetanus – if survives having tetanus, wouldn’t be excluded, as tetanus is not contagious
Unfortunately, kids are often contagious with many of these diseases, especially measles and chicken pox, even before they have obvious symptoms, which is why large outbreaks used to be so common.
Children will often be excluded from daycare or school if they are unvaccinated or not completely vaccinated and they are exposed to a vaccine-preventable disease.
More on Sending Your Sick Child to Daycare or School
- Inclusion/Exclusion/Dismissal of Children
- Infectious Diseases
- Ways to Prevent Diarrheal Illness From Spreading at Child Care and Preschool
- Specific Disease Exclusion Guidelines for Child Care and Preschool
- Infectious Diseases in Childcare Settings and Schools
- AAP – When to Keep Your Child Home from Child Care
- AAP – Recommendations for Inclusion or Exclusion (Red Book)
- AAP – Which children should be excluded from child care due to illness?
- Kids with “pink eye” CAN attend daycare, and other updated school exclusion recommendations
- My daughter has pink eye. How long is pink eye contagious and when can I send her back to school?
- CDC – Information for Schools & Childcare Providers
- CDC – Animals in Schools and Daycare Settings
- Communicable Disease Guide for Schools and Child Care Settings
- Study – The influence of children’s day care on antibiotic seeking: a mixed methods study
- Study – Day-Care Center Exclusion of Sick Children: Comparison of Opinions of Day-Care Staff, Working Mothers, and Pediatricians
- Study – Unnecessary Child Care Exclusions in a State That Endorses National Exclusion Guidelines
- Study – Child Care Center Exclusion Policies and Directors’ Opinions on the Use of Antibiotics
- Study – Daycare attendance and respiratory tract infections: a prospective birth cohort study
- NAEYC Program Standards and Accreditation Assessment Items Standard 5: Health
- Support for Paid Sick Leave and Family Leave Policies
- Book – Managing Infectious Diseases in Child Care and Schools, 4th Ed
Last Updated on November 9, 2018 by Vincent Iannelli, MD