Signs of Possible Severe Illness - symptoms to include unusual lethargy, irritability, persistent crying, difficult breathing, uncontrolled coughing.
Fever
Good to go:
Your child is good to go if he's over 4 months old, has a temperature below 100°F, is receptive to drinking fluids, and doesn't appear to have had a personality transplant. Temperature should not be checked sooner than 30 minutes after a child's waking from sleep. Temperature will be taken and then retaken after 15 minutes to assure accuracy.
Too sick:
If your baby is 4 months old or younger, call the doctor at the slightest indication of fever (anything above 98.6°F) or a sudden change in behavior; child care is out. Older children should stay home if their temps rise above 100°F or greater accompanied by behavior changes or other signs or symptoms of illness. A feverish child is not only considered contagious, but he/she's also probably not feeling well enough to learn or participate. Keep him/her home until he/she's been fever-free for 24 hours and is feeling like his usual self.
Vomiting
Good to go:
She's heaved only once in 24 hours. It's not likely he/she has an infection, nor is he/she at risk for dehydration. Sometimes kids throw up because mucus left over from a cold has drained, in which case it's also not necessarily a sick day.
Too sick:
If your child has vomited two or more times in 24 hours. Watch for signs of dehydration as well: He/she's urinating less than usual and his/her urine is dark yellow; he/she doesn't produce tears when he/she cries; or there are no bubbles between his/her lips and gums. To avoid dehydration, offer small amounts of fluid frequently, increasing the amount as tolerated. One more thing: Do not automatically send your child back once the vomiting stops. If he/she's not demonstrating signs of getting better after a few days, call the doctor.
Red eyes
Good to go:
When the white part of the child's eye is only slightly pink and the discharge is clear and watery, he's likely got a school-safe allergy.
Too sick:
His eye is stuck shut, bright red, and/or oozing yellow or green discharge. These symptoms all indicate the highly contagious bacterial form of pinkeye (conjunctivitis), and the kiddo should stay put until he's been on antibiotics for 24 hours or until the goopiness dries up.
Diarrhea
Good to go:
Your child's stools are only slightly loose and she's acting normally. Some kids develop "toddler's diarrhea," triggered by a juice OD; as long as the poop isn't excessive, the child has the all-clear.
Too sick:
Kids who have the runs more than three times a day and/or have poop so watery it leaks out of the diaper need to stay put. They likely have an infection that can spread. If you see blood or mucus in the stool, call the doctor; she may want to do a culture. As with vomiting, watch for signs of dehydration, and follow the same prevention advice.
Sore throat
Good to go:
A sore throat accompanied by a runny nose is often just due to simple irritation from the draining mucus; send him/her off to school as long as he/she's fever-free.
Too sick:
If the achy throat is accompanied by swollen glands, a fever, headache, or stomachache, bring him/her to the doctor for a strep test, especially if he/she's 3 or older (the bacterial infection is unusual in younger kids). Children with strep should be on antibiotics for at least a full day before mixing in with the class. Child may return to child care 24 hours after treatment has begun and child is without fever for 24 hours.
Stomachache
Good to go:
If this is your child's only symptom and he/she's active, send her off. It could signal constipation, or even a case of nerves (in which case, a hug will go far).
Too sick:
Any stomachache associated with vomiting, diarrhea, fever, or no interest in play warrants a trip to the M.D. Sharp stomach pain and a rigid belly can be signs of severe constipation, appendicitis, or a bowel obstruction.
Colds
Good to go:
If your child is fever-free and isn't hacking up a storm, he/she's a go. After all, if children with snotty noses were excluded, schools would be empty!
Too sick:
Junior is staying home if he has a persistent, phlegm cough and seems cranky or lethargic. He's also couch-bound if his cold symptoms are accompanied by a fever or wheezing.
Head lice
Keep your child home until the morning after her first treatment. Some programs may ask you to keep her home longer. Note: Some treatments work better than others do, so check your child’s head thoroughly before sending her back to child care. Child may return to child care 24 hours after treatment has begun and all nits have been removed.
Chicken pox /Shingles
Keep your child home at least 6 days after the rash first appears.
Mumps - Until 9 days after onset of parotid gland swelling.
Measles/Rubella - Unit 6 days after the rash appears.
Hepatitis A
Child should remain home 1 week after the onset of illness or until after immune serum globulin has been administered and child is free of jaundice and other symptoms. Child should have note from doctor approving return to daycare.
Pertussis - Child can be re-admitted 5 days after antibiotic treatment has begun.
Ear Infection - A child must be treated with antibiotics by a doctor and free from drainage from the ear.
In general, keep your child home if he is not well enough to take part in the usual class activities or might infect others. Ask your health care provider if you are unsure.
Information reproduced from NAEYC's Healthy Young Children A Manual for Programs pg 207
Tanya Remer Altmann, M.D., author of Mommy Calls; Laura Jana, M.D., a spokesperson for the American Academy of Pediatrics and owner of the Primrose School of Legacy, an educational childcare center in Omaha, NE; and Lorry Glenn Rubin, M.D., chief of pediatric infectious diseases at Schneider Children's Hospital in New Hyde Park, NY.
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