Kids with “pink eye” CAN attend daycare, and other updated school exclusion recommendations

It’s 6 a.m., you are running late for work and your kid is “kinda” sick. Can you send him to daycare?

Dr. Kardos and Dr. Lai and a little friend talk about “Too Sick for School? The Latest Guidelines for Staying Home” at DVAEYC’s annual conference for early childhood educators

Yesterday we reviewed with an audience of early childhood education teachers the latest medical guidelines* for excluding children from early childhood education centers. Here are some of the updates we shared with the teachers attending the annual DVAEYC conference held at University of Pennsylvania:

When should a child go home from daycare? Remember the overriding goals for exclusion:

      To expedite the child’s recovery

To prevent undue burden on teachers

To protect other children and teachers from disease

Following are the guidelines that most surprised our audience, as well as other highlights from our talk.  

Pink eye (conjunctivitis)– most kids can remain in school

  • “Pink eye” is like a “cold in the eye” and can be caused by virus, bacteria, or allergies.
  • Just as kids with runny noses can still attend school, so too can kids with runny eyes.
  • A child with pink eye does not need to be on antibiotic eye drops in order to attend school. The presence or absence of treatment does not factor into letting a child attend school.
  • Any child with pink eye who suffers eye pain, inability to open an eye, or has so much discharge that she is uncomfortable, needs to go home.
  • If there is an outbreak (two or more kids in a room), the center’s health care consultant or the department of health can give ideas on how to help prevent further spread
  • Good hand washing technique prevents the spread of the contagious forms of pink eye (viral or bacterial).

fever in childrenFever – by itself, is not an automatic exclusion

  • For practical purposes, a fever (no matter how it is taken) in a child who is over 8 weeks old is a temperature of 101 degrees F. Therefore, 99 degrees F is NOT a fever, even if that number is higher than the child’s baseline temperature.
  • If a child with a fever acts well and does not require extra attention from teachers, then that child is medically safe to stay in school. Sending him home is unlikely to protect others. Kids are contagious the day before a fever starts, so febrile kids most likely already exposed their class to the fever-proking illness the day before the fever came.
  • If the fever causes the child to become dehydrated or makes the child too sleepy or miserable to participate in class, then that child should go home.
  • Any baby  two months of age or younger with a fever of 100.4 or higher needs immediate medical attention, even if he is not acting sick.
  • If a child has not received the recommended immunizations for his age, then he needs to be excluded for fever until it is known that he does NOT have a vaccine preventable illness.
  • If a child goes home with a fever, he does not need medical clearance to return to school.
  • Read more details about fever and “fever phobia” here.

Head lice, while icky and make our heads itch just to think about them, carry no actual disease.

  • The child with live lice should go home at regular dismissal time, receive treatment that night, and be allowed back in school the next day.
  • By the time you see lice on a child’s head, they have been there for likely at least a month. So sending him home early from school only punishes the child, causes the parent to miss work needlessly, and does nothing to prevent spread.
  • Lice survive off of heads for 1-2 days at most (they need blood meals, and die without them), so a weekend without people in school kills any lice left behind in the classroom by Monday morning.
  • Lice do not jump or fly and thus need close head-to-head contact to spread, hence the reasons behind why your child’s center spaces matts at nap time  a certain amount distance apart, and do not allow kids to share personal objects such as combs.

The mouth ulcers and foot rash of Hand Foot Mouth

Hand-foot-mouth disease- not an automatic exclusion

  • This common virus, spread by saliva, causes a blister-like rash that can appear on hands, feet, in the mouth and in the diaper area, sometimes in all of these locations. Hand washing limits spread, and kids can attend school with this rash.
  • The child who refuses to drink because of painful mouth lesions should go home so the parent can help improve hydration. In addition the child who refuses to participate in activities  should stay home. You can read more about this virus here.

Poison ivy rash is not contagious to other people. The rash of poison ivy is an allergic reaction/irritation from wherever the oil of a poison plant touched the skin. The ONLY way to “catch” poison ivy is from the poison ivy plant itself. But if the itch from poison ivy makes a child too miserable to participate in class activities, she may need to go  home. Read more about poison ivy here.

Vomiting more than twice, associated with other symptoms (such as fever, hives, dehydration or pain),  or with vomit which is  green-yellow or bloody are all  reasons a child should leave school. Recent history of head injury  warrants exclusion and immediate attention since vomiting can be a sign of bleeding in the head.  See our post about vomiting.

Diarrhea, meaning an increase in stool frequency, or very loose consistency of stools, is a reason to go home if the diarrhea

  • cannot be contained in a diaper,
  • causes potty accidents in the toilet trained child
  • contains blood, is bloody or black
  • results in more than two stools above baseline for that child—too many diaper changes compromises the teacher’s ability to attend to other children.
  • is with other symptoms such as fever, acting very ill or jaundiced (yellow skin/eyes)
  • Read more about poop issues here.

Molluscum contagiosum is a benign “only skin deep” illness similar to warts—direct vigorous contact or sharing of towels or bath water can spread the virus among kids but the rash itself is harmless and not a reason to stay home from school. Read our prior post for More on this little rash with the big name.

MRSA is a skin infection that looks red and pus filled and is typically painful for the child. Treatment involves draining the infection and/or taking oral antibiotics. If the infected area is small and can be covered completely, a child may stay in school.

Measles This illness causes high fever, cough, runny nose, runny eyes, and cough and a total body rash. Your local Department of Public Health will provide recommendations about how long to exclude a child with measles as well other precautions a school should take. So they are safe, unvaccinated children will have to be excluded for period of time as well.

Also note, at times, the department of public health will exclude even children who are acting well from school for outbreak management of a variety of infectious diseases.

Surprised? As you can see, there are few medical reasons to keep your child home from daycare for an extended period of time. As Dr. Lai often says to the big kids, “If there is nothing wrong with your brain, you can go to school and learn.” Bottom line-  no matter the reason, if you realize at six in the morning that your child will not be able to learn and function at baseline, keep him home and seek the advice of your child’s pediatrician.

Julie Kardos, MD and Naline Lai, MD

©2017 Two Peds in a Pod®

*A straight-forward, comprehensive guide to the guidelines can be found in Managing Infectious Diseases in Child Care and Schools, 4th edition, Editors: Susan S. Aronson, MD, FAAP and Timothy R. Shope, MD, MPH, FAAP, published by the American Academy of Pediatrics.

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  • Reply Lisa March 20, 2017 at 1:01 pm

    Try telling the daycare center this when you’re in a classroom with 17 kids or more and one child infects 16 others. Then you can tell the parent that it’s ok, because you read on some website that it’s allowed. A kid can come back to school the next day after being sent home with head lice! Are you serious?!?!?!??

  • Reply Trina March 21, 2017 at 2:19 pm

    This is very disturbing coming from “pediatricians”.

    I work in an in-home daycare. How very presumptuous of you to write an article so that parents can argue against a policy and use this as evidence of something. Pink eye is and always will be excluded as it is contagious. Children under age 7 do not do a very good job keeping hands off of eyes when irritated and goopy. Thus the chance for spreading becomes more likely. Why should other children or adults suffer the pain and irritation of pink eye? Pink eye can lead to serious issues.

    Fever. ALWAYS GOES HOME. Children carry the worst of all illnesses. We’ve discussed their inability to keep hands out of eyes. They also put everything in their mouths and struggle to cover coughs. Fifths disease, strep, HFM, INFLUENZA…..all start with fevers. Influenza being the worst. People die every year from influenza. Minimizing the exposure to a sick child reduces the risk of others getting it. Some children have compromised immune systems. Why should they have their very life placed at risk because you think a fever shouldn’t exclude???? Rules are in place to minimize exposure to others. I understand as a working parent that it is very hard to miss work. But that’s wjy you have alternate plans for emergency situations such as a sick kid. And daycares and schools classify fevers as 100.4 or higher.

    Please stop being irresponsible with your advice and placing schools and daycares in positions to have angry parents feeling like we just don’t want to watch their kids. Also keep in mind that many daycares are in home and this is where someone’s family lives. Reducing your own family’s exposure is pretty key to keeping a harmonious relationship between home and work.

    An Appalled Provider.

  • Reply Wendy Adams March 21, 2017 at 2:33 pm

    This is such an irresponsible article it’s disgusting and so incredibly disturbing that it’s coming from Pediatricians. All this is, is a list arguments for parents who don’t want to take time off work to argue with their daycare providers. I have children who are too young to be immunized, children who have immuno suppression issues and children with extended family with compromised immunity. I WILL not accept children into my care with fevers, MRSA, diarrhea, pink eye, etc…. Why would I accept them into my care to infect every other child in my care and my own family?

  • Reply Liz March 21, 2017 at 8:53 pm

    As a family childcare provider, I love this! The item that really surprised me was the one about head lice- my prior policy was I’d allow nits (though inform the parent immediately), but send home a child with live bugs. I’ll be amending it, as the policies you outline here make perfect sense!

  • Reply Michael Thomas March 22, 2017 at 8:41 pm

    Idiotic article- and I can only hope this isn’t the new widespread practice it is made to seem. Doctors wrote this? Do doctors take Hippocratic oaths anymore? You authors left out Bubonic plague, necrotizing fasciitis, and perhaps Ebola. I mean, with enough bleach solution around the child’s desk, you can send your Ebola-stricken child to school too. On the one hand we have the mainstream promoting all forms of vaccination, as if all were fully tested and completely beneficial (see National Vaccine Injury Compensation for more info), because we need to protect the herd, with guys like Carson talking about forcing vaccinations for the public good. Yet here, on the other hand, this notion is cast by the wayside. Why is the real question. To whose benefit is this? (Certainly not the childrens’.) But you well know, many parents will read this and take it as a directive.

  • Reply Fred March 24, 2017 at 12:14 pm

    Seems some points (not all) are over rationalization for parents to avoid actually being a parent and modifying their schedule on behalf of their sick child.

  • Reply Amber Gehring-Costner March 12, 2020 at 11:16 pm

    This is way off. I know all of the schools in the area (public, private, etc) around here send any child home if they have pink eye which includes middle and high school aged students. MRSA is a BIG, BIG no no for school, the child should stay home. Headlice, the school around my area require a one to two week home stay. In addition if headlice is found out while the child is in school before the end of the day then the schools send the child home. An issue with diarrhoea needs to be investigated by a medical professional to see the causes why you child is having diarrhoea and for precautions should stay home, especially in the case of young children (daycare- to at least 2nd grade).

  • Reply twopedsinapod August 27, 2020 at 10:14 pm

    Unfortunately, in this COVID world, things have certainly changed

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