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When should you keep your child home from school?

Posted by Dr. Claire McCarthy  January 18, 2013 07:30 AM

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These days, with all the sickness going around, and with all the fright about the flu, it's a question parents are facing regularly: when should your keep your child home?

It's not usually a straightforward question, either. For most families (mine included), keeping a kid home means missing work--and although our families are of course our first priority, missing work can be hard. Missing school isn't great for kids' learning, either.

What makes the keeping-home decision even more complicated is the fact that it's not just about your kid--it's about other kids too. Children are really, really good at spreading germs.

I talk about this a lot with parents. For me, there are some clear-cut guidelines--and some judgment calls. First, the clear-cut ones:

If they've got any symptom you'd want to take them to the doctor urgently for, they shouldn't go to school. Like any trouble breathing, or bad pain, or a new limp. Sometimes people send them and then call the doctor, figuring they'll pick them up or take them after school. Please don't.

Fever. You can't send your kid to school with a fever. Not only will they feel miserable, but people are usually at their most infectious when they are febrile. The definition of a fever is 100.4, but chances are the school nurse will call for 100 or higher--and your kid will feel yucky at that temperature too. Besides, a temp of 100 often has a way of going up in an hour or two.

Please--resist the temptation to give acetaminophen or ibuprofen, send them off, and cross your fingers. You might decrease their fever, but you wont decrease their contagiousness--and the stuff wears off.

Vomiting or diarrhea. Reasonably obvious. Mean to send a kid with either one, although I've seen it happen. Usually it's a hopeful parent who thinks that just because the kid feels better after vomiting, they are better. Unless they've gone many hours without vomiting, they aren't better--and really, with vomiting, diarrhea and fever you should wait until your child has gone 24 hours (or pretty close to that) without symptoms.

Okay--now for the judgment call ones:

Cough and runny nose. If we kept kids home for every cough and runny nose all winter, they'd hardly ever go to school. And usually, if they don't have a fever and don't have trouble breathing, they can go. However, if they are really hacking away, or completely covered in snots, keep them home for a day or so. It's kinder to your child--and to everyone at school.

Headache and other pains (assuming they aren't severe). Take their temperature, ask about any other signs of illness, ask about injury, look them over (do your Dr. Mom exam). If you don't find anything, ask yourself: how uncomfortable are they? If they really seem uncomfortable, keep them home--and check in with the doctor. If they don't seem so bad, try some acetaminophen or ibuprofen--and tell them to go to the nurse (or let the teacher know) if they get any worse. Which means you need to make some work contingency plans.

"I don't feel so good." We all hear this from our kids some mornings--usually mornings when we've got an important meeting at work or they've got a test or something else is going on that makes missing school suboptimal. My advice for this one is the same as the above: check 'em out, and if you don't find anything and they seem basically okay, send them with instructions to call if they need you. I've also found that reminding them that if they are sick they need to stay in bed all day and not watch TV sometimes makes them suddenly feel a bit better. 

Remember, too, that you don't have to be the only one making the decision. Even if your doctor's office isn't open yet, there should be someone on call that can help you figure out the best thing to do.

Here's my interview about this on Fox 25:

Boston News, Weather, Sports | FOX 25 | MyFoxBoston

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About MD Mama

Claire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »

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