How Sick is Too Sick For School? A Pediatrician’s Perspective

Disclosure: “How sick is too sick for school” is a topic that was a real hot button when we asked a question about it on our Facebook page. Fascinated by the differing views and the controversy, one of our contributors wrote an excellent piece showing her views on the topic both as a working mom and a work from home mom. We wondered, though, what would the professionals say?! Today’s post is sponsored by Children’s Hospital and will bring you a pediatrician’s perspective on truly, “How Sick is Too Sick For School.”

How sick is too sick

When I was 6 years old, chicken pox was going around my class. Three of my classmates had already fallen ill. So when a friend of mine awoke one day with a fever and itchy rash, her mom gave her some fever reducer and off to school she went. She made it about half day before her fever returned, the itching became bothersome and she went to the office asking to go home. The office staff took her temperature and determined that she did indeed have a fever. She told them it was because she had chicken pox. One of the staff then asked, “Why would your mom send you to school if she knew you had chicken pox?” By the time she returned to school from her illness, all but 2 of the kids in my class had fallen ill. She was obviously too sick for school.

So why might a child be too sick for school? Here are a few reasons:

  • Fever :: Generally defined as a temperature ≥ to 100.4 degrees F or 38 degrees C, but some schools, especially daycares, prefer to lower this threshold to 100 degrees F. If your child knowingly has a temperature elevation, they should not attend school. While the fever itself is not contagious, the cause of the fever might be, and the child is considered more contagious while febrile. Whether your febrile child needs to be evaluated by a doctor depends on the child’s age, medical history, the highest temperature known, how long the fever has lasted, associated symptoms, and whether the fever occurred at school. If the fever occurred at school, he or she may need a note to return. A febrile child should remain out of school until fever free without the use of fever reducers for 24 hours.
  • Vomiting and diarrhea :: Some kids vomit more easily than most. Others are sensitive to certain foods. Everyone is allowed to have an upset stomach from time to time and it not be too big of a deal. But, if there are more than two episodes of either vomiting or diarrhea within 24 hours, it is best to keep your child home. A child should not return to school until the vomiting and/or diarrhea has resolved for at least 24 hours.
  • Rash :: Some rashes are highly contagious. If a new rash appears, it is probably best to keep your child home until it can be identified and possibly treated.
  • A diagnosed highly contagious illness :: This includes (but is not limited to) pink eye, strep throat, staph skin infection, impetigo, influenza, scabies, lice, measles, mumps, hand foot and mouth disease and varicella (chicken pox/shingles). If your child goes to the doctor for an illness, do not forget to ask when he or she may return to school, if the doctor does not readily offer this information. For most treatable illnesses, the timeframe for return to school is 24 hours after starting treatment. This does not mean that your child will feel 100% normal or that they will be completely disease free by the end of 24 hours. Allow your child more time out of school if they do not feel well enough to return, even if it is beyond 24 hours of treatment. If your child has been diagnosed with something contagious for which there is no treatment, it is best to discuss with your pediatrician what criteria should be met prior to allowing your child to return to school.

But what about those gray areas of illness?

The common cold is a frequent gray area of illness. A child in a school or group setting may catch between 8-12 colds a year and Children's Hospital logoeach cold can last 7-10 days, with some symptoms lasting even longer. Does a child need to stay out of school each time they have a cold? Not necessarily, even though they may still be considered contagious. The first few days of a cold are when a person is most contagious, is likely to run a fever and have the worst symptoms. An infant or toddler is more likely than an older child to be too ill to go to school at the very start of a cold. For other vague symptoms of illness, consider your child in relation to their symptoms. What is a typical day like for them? How will their current state of health affect them and those around them? Will they need more attention from teachers or caregivers than can be given? Did the child take any medications that may affect their ability to learn and make it through the day? Does the illness seem likely to get worse as the day progresses? If you feel in your gut that your sick child might be too sick for school, maybe they are and you should strongly consider keeping them home.

Dr. Brandace Hider

Dr. Hider with her two childrenDr. Brandace Hider is a Board-certified pediatrician at Napoleon Pediatrics. She is a native New Orleanian and a married mother of two children, Brady (5) and Bree (3). Napoleon Pediatrics is an affiliate of Children’s Hospital Medical Practice Corporation (CHMPC), a non-profit wholly owned subsidiary of Children’s Hospital, created to provide pediatric primary care to the children in and around New Orleans, including medically underserved areas. With 14 practices and 16 locations, CHMPC treats more than 150,000 children every year. Our pediatricians are continually involved in community activities aimed at promoting good health. For more information on Napoleon Pediatrics and CHMPC, please visit

Disclaimer: The information contained in this blog post is for networking and informational purposes only, and should not be used to replace the relationship that exists between you and your child’s healthcare provider. Please contact your healthcare provider for specific medical advice and/or treatment recommendations. The opinions expressed in this blog are the personal opinions of the author, not of Children’s Hospital or Children’s Hospital Medical Practice Corporation (CHMPC).


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