Going back to school or daycare after an illness – when should my child attend daycare or school after an illness?
When is it acceptable to send a child back to daycare or school? Should we wait at least 24 hours after the fever has resolved? Are there certain illnesses when it is advisable to wait for longer than 24 hours?
These are the type of questions pediatricians get asked all the time, in many different ways.
On the one hand, we have to consider the family’s desire to go back to routine as quickly as possible following a child’s illness. On the other hand, it is important not to place your child at risk of catching another disease.
The following post is based on general guidelines, typically accepted all around the world but may vary slightly depending on the country in which you reside.
If I may, I will not be going into the obvious in this post – that is, a child who is very ill and lethargic (even if he/she doesn’t have one of the signs or symptoms mentioed below), or a child suffering from a condition that requires management or observation that educators are unable to provide, should obviously not go back to school.
Interestingly, I have also come across families that do not rush to send their child back, in a cosmic attempt to get them to become stronger before they catch their next infection.
Therefore, the following post will describe the minimum requirements for sending a child back to school after an illness.
Illnesses that permit return to school prior to their resolution:
• Medical conditions that are not accompanied by fever, including runny nose, throat pain, cough or ear infections. What is a mild cough? A cough that does not present with frequent episodes or prolonged episodes, does not cause red or blue discoloration, does not cause vomiting, and is not accompanied by shortness of breath or rapid breathing.
• Mild conjunctivitis, without secretions, pain, swelling of the eyelids or fever. Find out more about conjunctivitis in the following link.
• A rash in the absence of fever or behavioural changes
• A healthy child with parvovirus B19 infection. Learn about parvovirus here.
• Chronic hepatitis B or C infection
• Infectious mononucleosis (once the child is feeling better and fever-free) including Cytomegalovirus/Epstein-barr virus.
• Roseola – after the fever has resolved and the child is feeling better, even if the rash is still present. Find our more about roseola here.
• Colonization (carrier state) of a known bacteria (Methicillin-resistant Staphylococcus aureus, MRSA) without any active lesions.
• Colonization (carrier state) of other stable bacteria
• Pinworm infections – find out more about Enterobiasis here.
• Molluscum – more in this link.
• Children who are receiving antibiotics – as long as they have been assessed by a physician and are feeling well enough to return to school.
• Labial herpes – more here.
General conditions in which children should be sent back to school until the resolution of symptoms:
• Fever above 38 degrees Celsius, with or without additional symptoms. One must wait at least 24 hours following the resolution of fever before sending the child back to school.
• Oral sores accompanied by drooling. One must wait at least 24 hours after all sores have dried up and the child has stopped drooling.
• A rash with fever or behavioural change. One must wait at least 24 hours following the resolution of symptoms.
• Conjunctivitis with secretions. One must wait until the pustular secretions have resolved.
• In general – any illness that would prevent a child from comfortably participating in the daily activities at school or daycare, or any illness that stops the educators from being able to care for other children.
Vomiting
Two episodes of vomiting within one day unless the physician decides that the cause is not infectious, and the child’s condition permits them to return to school.
When is a child with diarrhea able to go back to school or daycare?
Diarrhea is defined as two watery stools in a day. A child with diarrhea should not be sent back to school if they fall under one of the following:
• Two or more episodes of diarrhea per day (specifically with mucous or bloody diarrhea that could indicate the presence of bacteria in the stool), unless a physician has determined that the diarrhea is not of infectious origin.
• If one of the following pathogens is isolated from the child’s stool – shigella, non-typhoidal salmonella, campylobacter, clostridium difficile and rotavirus – the child can go back to school approximately 24 hours following the last episode of diarrhea.
• If cryptosporidium or norovirus are isolated – the child can go back to school about 48 hours following the last episode of diarrhea.
• Most North American guidelines require a child to have received adequate treatment for shigella and to have tested negative on stool culture prior to going back to school.
The problem with these guidelines is that sometimes a stool culture is not obtained, and other times the stool culture is obtained at the end of a child’s illness (whether it resolved spontaneously or with treatment).
• When the bacteria E. Coli (specifically 0157:H7) that produces a specific toxin is isolated. Two negative stool tests are required before the child can go back to activities.
• If typhoidal salmonella is isolated, two or three negative stool tests are required before the child can return to activities, depending on which province or state you reside in.
• In case of hepatitis A infection – the child can go back to school one week after the onset of jaundice or once it is confirmed that all the caretakers/educators and children were vaccinated at least two weeks prior to the child’s return.
When can a child who had streptococcus infection go back to school?
Most of us are familiar with group A streptococcus as a pathogen causing throat infections. But these bacteria can also cause a skin infections called impetigo and infections elsewhere (such as ear infections).
• In cases of impetigo caused by these bacteria (or other bacteria) – the child can go back to school about one day after the start of adequate antibiotic treatment and should cover the lesions, if possible.
• In cases of throat infection (strep throat, tonsillitis) – the child can return to school about 24 hours following the resolution of fever and at least 12 hours following the start of adequate antibiotic treatment.
When can a child who had herpes go back to school?
• Chicken pox – the child can resume activities once all the lesions have dried up (about 3 days following the onset of rash).
• Shingles (herpes zoster) – if the area of the body where the rash is present can be covered, then the child can return to activities immediately.
• Primary herpetic stomatitis – until the resolution of the lesions.
Specific illnesses:
- Lice, scabies or scalp ringworm – the child can go back to school as soon as treatment is started
- Pertussis – a child treated with antibiotics must complete 5 days of treatment before going back to school. A child who is not receiving antibiotic treatment must wait 3 weeks following onset of cough before returning to school.
- Measles – the child can return about 4 days following the appearance of rash.
- Mumps – the child can return about 5 days following the appearance of rash.
- Rubella – the child can return about 7 days following the appearance of rash
- Influenza/COVID-19 – one day after the resolution of fever
How shall we summarize this topic?
This is a chapter written for our advanced readers but I hope this helps organize this confusing topic for you.
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