It was wonderful to contribute to the DVAEYC conference at the Philadelphia Convention Center today.We enjoyed the discussion generated by our presentation and appreciated the opportunity to teach the teachers. For those who attended and for those who wish they attended, here’s the gist of what we discussed. Guidelines are based on Managing Infectious Diseases in Child Care and Schools, 2^nd edition, Editors: Susan S. Aronson, MD, FAAP and Timothy R. Shope, MD, MPH, FAAP, published by the American Academy of Pediatrics. You can purchase a copy from the American Academy of Pediatrics bookstore at www.aap.org.

Click here to listen to our brief podcast covering all topics in our talk except the rashes. Please read on for a summary of when to send children home from school for medical reasons.

When should a child go home from daycare? Remember these overriding goals:

• To expedite the child’s recovery
• To prevent undue burden on teachers
• To protect other children and teachers from disease

Fever.

• Fever is a sign of illness and we refer you to our posts on fever, part 1 and part 2, to better understand fever itself.
• If a child with a fever has no other symptom of illness, acts well, and does not require extra attention from teachers, then that child is medically safe to stay in school. Sending them home is unlikely to protect others because that child was likely contagious the day before the fever started and thus has already exposed his class to his fever-provoking illness.
• 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.
• The reason many schools have a “no school until fever-free for 24 hours” policy is that most children are truly better from illness and unlikely to have another fever spike once their fever has been gone for 24 hours.

Vomiting more than one time is a reason to go home from school.

• Some kids vomit when excited, anxious, or have reflux (heartburn) and these kids do not need to go home if they throw up one time in school.
• Vomiting more than once may indicate stomach virus or at any rate takes up too much time for the teacher to reasonably care for the other children in class.
• Vomiting after a head injury could be a sign of bleeding in the head and that child should leave school for a medical evaluation.

Diarrhea, meaning a dramatic increase in stool frequency and a 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 contained in the diaper but results in more than two stools above normal for that child--too many diaper changes compromises the teacher's ability to attend to other children.

Children are rash prone. 

Children who show the rash of Fifth disease are not contagious at the time of the rash and by all means should remain in school. This is an illness, however, that can be dangerous to a pregnant woman so any pregnant teachers who have been exposed to the child with Fifth disease should alert their obstetricians to their exposure. Please see our post on this subject.

The poison ivy rash is not contagious to other people. The reason to exclude a child from school would be if the itch from poison ivy makes her too miserable to participate in class activities. Also some children can scratch their way to a skin infection which IS contagious, so the child with poison ivy who develops a painful infected skin area that cannot be completely covered should go home from school. Read more about poison ivy here.

Hives are not contagious. Hives can result from allergic reactions or from viruses and typically the itch as well as the hives respond well to diphenhydramine (brand name Benedryl). However, this medication often causes sedation so if the child is too sleepy, she may need to go home. Likewise, if the itch from the rash makes her miserable and demanding, she should stay home until she is able to enjoy school.

Hand-foot-mouth disease causes a blister-like rash on hands, feet, and in the mouth and sometimes in the diaper area. This disease is spread through saliva which is fairly plentiful in early childhood education centers. The child who is becoming dehydrated from refusing to drink from the painful mouth lesions should go home so the parent can help improve hydration. In addition the child who refuses to participate in activities because of feeling sick should stay home. Otherwise, careful hand washing measures limit spread of this illness and the child does not need to be excluded on the basis of this rash alone.

Molluscum contageosum 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.

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 lesion is small and can be covered completely, the child may stay in school.

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

• The child with 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 them home early from school only punishes the child and does nothing to prevent spread.
• Lice survive off of heads for 1-2 days at most so a weekend without people in school kills any lice that may have crawled off of any heads during the week.
• Lice do not jump or fly and thus need close head-to-head contact to spread, so follow those standard recommendations about how far apart children need to stay for naps in daycare and do not allow kids to share hats or combs.

Pink eye:

• If caused by allergies, the discharge is either absent or just watery and eyes feel itchy. These kids should stay in school.
•  If the child already had a cold and has runny eyes as well as a runny nose, the child can stay in school.
• Any child with pink eye who suffers eye pain, inability to open an eye, or has so much discharge that causes discomfort to the child needs to go home.
• Bacterial pink eye is no longer contagious after 24 hours of antibiotic drops, but remember viral pink eye, just like a cold virus, is still contagious even if the child is taking antibiotics because antibiotics do not kill viruses.
• Good hand washing technique is key to preventing spread of pink eye. Please see our post on this topic for further information.

Julie Kardos, MD and Naline Lai, MD
©2011 Two Peds in a Pod®