When to Keep Your Child Home From School

Stay home if any new illness or symptom prevents your child from doing routine activities. Return to school when feeling better and able to participate in school.

Definition: Pain experienced anywhere between the chest and groin; pain may be continuous or may come and go.

May attend school unless the child has one of the following:

• Pain is severe enough that child has difficulty participating in routine activities
• Pain starts after an injury
• Bloody or black stools
• Diarrhea (see Diarrhea)
• Vomiting (see Vomiting)
• No urine for 8 hours (dry diaper, or ask older children if they have urinated since they woke up)
• Fever (see “Fever” for return guidance)

Definition: May include runny/stuffy nose, sore throat, sneezing, congestion, body aches, and/or cough, typically lasting up to 7–10 days.

May attend school unless the child has one of the following:

• Fever (see “Fever” for return guidance)
• Difficulty with or rapid rate of breathing (see “Difficult or noisy breathing”)
• Cough is severe or child cannot catch breath after coughing
• For a cough suspected to be associated with asthma: coughing that cannot be controlled by the medications that the child care or school has been instructed to use

Note: Recommend wearing a mask if returning to school with mild symptoms.

Definition: Stools that are more frequent (typically at least two more than normal) or less formed than usual for that child AND not associated with a change in diet.

May attend* school unless the child has one of the following:

• Stool not contained in the diaper or toilet (when toilet-trained)
• Stool looks like it contains blood or mucus, or appears like sticky black tar
• Yellow skin/eyes (jaundice)
• Diarrhea that occurs during an outbreak, and exclusion is recommended by the local health department

*Note: Encourage frequent handwashing.  If the child has been diagnosed with a specific infection follow the advice of the child’s health care professional. If there is concern for an outbreak (more persons with diarrhea than would be expected in the setting for that time of year), Health Services will contact the local health department for guidance.

Definition: Wheezing (high-pitched sounds) that can be heard when a child breathes in or out, chest retractions (see below), OR extra effort is required to breathe. Seek medical attention for new symptoms such as wheezing or breathing difficulties.

May attend school unless the child has one of the following:

• Wheezing that is new for the child or cannot be controlled by medications, the child care/school has been instructed to use for known conditions (e.g., asthma plan)
• Skin or lips seem purple, blue, or grey. Call 9-1-1.
• Fever (see “Fever” for return guidance)
• Behavior changes
• Very rapid breathing or increased effort to breathe, such as chest retractions (space between ribs sinks with each breath), belly breathing (belly goes up and down with breathing) 
• Breathing problem that causes the child to have pursed lips, difficulty speaking, or difficulty feeding

Note: Seek medical attention for new symptoms such as wheezing or breathing difficulties.

Definition: Pain (dull, sharp, or burning sensation) experienced inside the ear.

May attend school unless the child has one of the following:

• Fever (see “Fever” for return guidance)
• Behavior changes
• Pain prevents participation in routine activities

Definition: Red or pink appearance to the white part of the eyeball. A child’s eye may also be itchy, have crusted/matted eyelashes, more watering than usual, or yellow/white drainage.

May attend school unless the child has one of the following:

• Problems seeing (vision changes)
• An injury to the eye involving forceful impact to or penetration of the eye
• Pain or discomfort that the child cannot tolerate

Note: Encourage frequent handwashing. Pink eye (i.e., conjunctivitis) is inflammation of the layer that covers much of the eyeball. A virus is most often the cause, and children with viral pink eye typically recover within 5-6 days without antibiotics. Eye irritation can also result from allergies or chemical exposures (e.g., air pollution, smoke, or swimming in chlorinated pool water).  Staying home from school is not necessary.

Definition: An oral (under the tongue), temporal (forehead), rectal, or axillary (underarm) temperature above 100.4°F (38°C). Axillary (underarm) measurements should be used only if other options are not available. Follow instructions for the specific thermometer, including directions for use, cleaning, and covers (if applicable). If the temperature is close to 100.4°F, repeat the measurement to confirm the result. 

May NOT attend school until: 

• Fever went away in the night – without using fever reducing medications, e.g., Tylenol®, Advil®, Motrin® (acetaminophen or ibuprofen) - and is still gone in the morning; AND 
• Other symptoms are improving, and the child can participate comfortably in routine activities.

Definition:  Pain experienced in any part of the head ranging from sharp to dull; may occur along with other symptoms.

May attend school unless the child has one of the following:

• Concussion symptoms: Pain occurs after a fall or other injury to the head and is severe or associated with vomiting, vision changes, behavior change, or confusion.
• Possible infection: Stiff neck, headache and fever can be symptoms of meningitis, a potentially serious infection. Meningitis can also cause sensitivity to light, vomiting, and/or confusion. A stiff neck is most concerning if the child can’t look at their belly button (putting chin to chest) due to pain or the BACK of the neck is painful (not soreness in the sides) along with the other symptoms above.

Get immediate medical attention for either of the above conditions or Call 911.

Definition:  An area of the skin that has changes in color or texture and may look inflamed or irritated. The skin may be darker than or lighter than normal or red or purple. It may be warm, scaly, bumpy, dry, itchy, swollen, or painful. It may also crack or blister.

May attend school unless the child has one of the following:

• Oozing, open wound or infection that cannot be covered and is in an area that might come in contact with others.
• Skin that looks bruised without a known injury or in an unusual location.
• Rapidly spreading dark red or purple rash (may indicate a rare but severe bacterial infection; usually accompanied by fever). 
• Tender, red area of skin, rapidly increasing in size or tenderness.
• Associated symptoms of a serious allergic reaction (rash with throat closing, abdominal pain, vomiting, or wheezing).  Call 9-1-1
• Fever (see Fever for return guidance)
• There is concern for a disease like chickenpox or measles. If this is the case, the child should see a healthcare provider and Health Services should contact the local health department.

Note: For diagnosed conditions, follow the advice of the healthcare provider. For conditions such as lice, impetigo, ringworm, scabies, and pinworms, no waiting period is typically necessary after starting treatment and the child may return after the appropriate treatment is started.

Definition:  Sore throat includes pain or irritation of the throat, often resulting from a viral or bacterial infection (e.g., cold, flu, strep throat). May feel worse when swallowing.

Mouth sores include white patches on the tongue, gums, and/or inner cheeks (oral thrush/yeast infection); white/red spots in the mouth, blisters on lips or inside mouth; or painful ulcers inside cheeks or on gums (canker sores).

May attend school unless the child has one of the following:

• Inability to swallow
• Fever (see “Fever” for return guidance)
• Breathing difficulties
• Excessive drooling or muffled voice. Call 9-1-1

Note: We recommend wearing a mask if you return to school with mild symptoms. Most children with a sore throat typically have a viral infection. If a child is diagnosed with strep throat, they should receive antibiotics for at least 12 hours before returning to school.

Definition: Forceful expelling of stomach contents out of the mouth 2 times or more in 24 hours.

May attend school unless the child has one of the following:

• Vomiting has occurred two or more times in 24 hours.
• Fever (see “Fever” for return guidance).
• Concern for a severe allergic reaction, such as hives appearing with vomiting – Call 911
• Vomit appears green or bloody – Call 911
• Child has not urinated in the past 8 hours (i.e., has dry diapers, or ask older children).
• Recent head injury – get medical attention or call 911
• Looks or acts very ill.

Note: Not all vomiting is due to an infection (e.g., motion sickness, overeating).  If there is concern for an outbreak, more persons with vomiting than would be expected in the setting for that time of year, call Health Services. If norovirus is suspected, children should not return to school until 48 hours after their symptoms have resolved.

Does not eliminate the possibility of spreading disease in childcare or school settings. This guidance is part of a broader strategy to limit the spread of disease. Other preventive measures include, but are not limited to, optimizing indoor air quality, cleaning surfaces, and promoting individual actions that help protect children and staff, such as staying up to date on vaccines, washing hands, and wearing facemasks, as appropriate.

This does not replace the advice of licensed healthcare professionals, such as school nurses, who perform individualized assessments.

Does NOT replace or revise guidance provided in an individual child’s care plan for known conditions, as provided to the child care or school by the child’s healthcare provider.

Does NOT replace or revise guidance specified in a child’s individualized education program (IEP), and Section 504 plan.

Does NOT provide recommendations on how to manage specific diagnoses (e.g., pertussis, hepatitis A). To manage particular diagnoses, follow guidance provided by a child’s healthcare provider, local health department, the California Department of Public Health (CDPH), and/or the Centers for Disease Control and Prevention (CDC). 

This guidance is limited to the evaluation of symptoms suspected to be caused by an infection, such as a virus or bacteria. Please remember to consider non-infectious causes for symptoms in any individual child, such as allergies or other chronic conditions.