vaccine preventable diseases Archives

Can Your Sick Child Still Go to Daycare or School?

Is your child to sick to go to school or daycare?

There are a lot of different rules that dictate when kids can go to daycare or school when they are sick.

Kids don't always have to stay at home from daycare or school when they are sick. — Kids don’t always have to stay home from 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.

Treating Hard to Control Vomiting and Diarrhea

Even when they don’t linger, it can be frustrating for parents to treat their kids with vomiting and diarrhea. Get the latest treatment recommendations to help you get through these very common infections quickly.

Kids get vomiting and diarrhea for many reasons, but it is most often caused by a stomach virus.

Whatever the cause, even if it is something your child eat or food poisoning, you will want to know how to best manage your child’s symptoms to help them feel better quickly and prevent them from getting dehydrated.

Vomiting and Diarrhea

Although most people associate vomiting and diarrhea with the “stomach flu,” the flu virus doesn’t usually cause vomiting and diarrhea.

Instead, there are a number of other viruses, bacteria, and parasites that do, including:

rotavirus – a vaccine-preventable disease
norovirus – the “cruise ship virus,” but very common elsewhere too
Salmonella, Shigella, E. coli – food poisoning, animals
C. diff – associated with recent antibiotic use
Cryptosporidium – drinking contaminated water, swimming pools, water parks

If necessary, especially when diarrhea is associated with severe symptoms or is lingering, stool tests can be done to figure out the specific cause. Fortunately, diarrhea and vomiting often goes away on its own fairly quickly and these tests aren’t necessary. What will likely be necessary is keeping your child well hydrated until these symptoms stop.

Treating Vomiting and Diarrhea

For most kids with vomiting and diarrhea, you can:

continue breastfeeding on demand
continue their normal diet (feed through the diarrhea), including baby formula or milk, if they just have diarrhea and no vomiting or only occasional vomiting, giving extra fluids every time your child has diarrhea (about 3 ounces if your child is under 22 pounds and about 6 ounces if they are over 22 pounds)
forget about eating and concentrate on drinking if your child has a lot of vomiting, but start by offering very small amounts of fluid, perhaps starting with a teaspoon (5ml) every 5 or 10 minutes, and then slowly working your way up to a tablespoon (15ml) and than an ounce (30ml) or two over a few hours
take a break from drinking for 30 minutes if your child has a set back and begins vomiting again, and restart at 5ml, slowly working your way back up again as tolerated
watch closely for signs and symptoms of dehydration, including weight loss, decreased urine output (fewer wet diapers or going to the bathroom less often), no tears, or dry mouth with no saliva or spit, etc.

In general, when talking about fluids, we mean an oral rehydration solution, like Pedialyte. If your older child won’t drink Pedialyte, you can offer something like Gatorade, but keep in mind that sports drinks have more sugar, so can sometimes make diarrhea worse.

But do you really make your child eat and feed through the diarrhea if he doesn’t want to? Of course not. The idea is that you don’t restrict your child’s diet if they want to eat. If they are complaining of a stomach ache, just don’t feel good, or feeding them their regular diet makes the diarrhea or vomiting worse, then move to more bland food.

Treating Hard to Control Vomiting and Diarrhea

What if your child continues to have vomiting and diarrhea?

You should still avoid treating your younger child with over-the-counter remedies to stop diarrhea, including those with loperamine (Imodium) or bismuth subsalicylate (Kaopectate).

A prescription medication, Zofran (ondansetron), might be appropriate for some children with persistent vomiting who are at risk of getting dehydrated.

If your child has persistent vomiting and diarrhea, ask yourself these questions and share the answers with your pediatrician:

Does your child have any symptoms that might require immediate medical attention, such as high fever, bloody diarrhea, severe headache, severe abdominal pain, or signs of moderate to severe dehydration?
Has your child with chronic diarrhea (diarrhea for more than four weeks) been losing weight, had fever, or regular stomach pains?
Does your otherwise well toddler have chronic, watery diarrhea even though no one else has been sick, a possible sign of Toddler’s diarrhea?
Do you have any pets or contact with pets that could put your child at risk for a Salmonella infection, including turtles, lizards, snakes, and frogs?
Has your child visited a farm or petting zoo, which puts him at risk for a Salmonella or E. coli infection?
Did your child recently take an antibiotic, which puts him at risk for a C. diff infection?
Has your child been drinking raw milk or other high risk foods?
Has your child traveled recently, which puts him at risk for traveler’s diarrhea?
Did you put your child on the BRAT diet (bananas, rice, applesauce, and toast) even though they were eager to eat?
Have you tried giving your child a probiotic?
Does your child now only have diarrhea after drinking milk, perhaps a sign of a temporary lactose deficiency?
Is your child better, with much less vomiting, but you are just frustrated that the diarrhea hasn’t gone away yet?
Is your child better, with much less vomiting, but you are just frustrated that she is still vomiting at least once each day?

While you should certainly call your pediatrician if your child’s symptoms are lingering, remember that almost everything about the idea of the “24 hour stomach flu” you have heard is probably wrong. In addition to the fact that it isn’t caused by the flu virus, the symptoms typically last more than 24 hours, at least in kids. The vomiting may get better in 24 hours, but diarrhea can easily linger for a week or two.

It is also important to keep in mind that most causes of vomiting and diarrhea are very contagious and can easily spread through the whole house if you aren’t careful. Remember to always wash hands, rinse fruits and vegetables, clean and disinfect contaminated surfaces, and don’t share food or drinks, etc. If you just do it when your kids are sick, it will be too late, as many illnesses are contagious even before you show symptoms.

What To Know About Treating Hard to Control Vomiting and Diarrhea

More Information On Treating Hard to Control Vomiting and Diarrhea

AAP – Surviving the Stomach Bug: Truths & Tips for Parents
AAP – What’s the best way to treat diarrhea?
AAP – Treating Vomiting
AAP – Drinks to Prevent Dehydration in a Vomiting Child
CDC – Managing Acute Gastroenteritis Among Children
Diarrhoea and vomiting in babies and children
Cochrane – Anti-sickness medication for vomiting in acute stomach upsets in children
GI Kids – Acute Diarrhea
GI Kids – Chronic Diarrhea
GI Kids – Toddler’s Diarrhea
CDC – Prevent the Spread of Norovirus