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The question: How sick is too sick to make my kid go to school? Fevers and vomiting I can understand. But what about things like stomachaches and runny noses?

The answer: This is a question that I get asked almost daily, all winter long.

When I was first starting out as a young pediatrician, I used to keep detailed charts and graphs documenting when certain illnesses started and stopped becoming contagious. Over time I have learned that viruses seldom play according to the rules or follow the charts.

Even more depressing is the fact that children are often most contagious the day before they get any symptoms. Ironically, the kid you have to worry about is not the kid who comes back to school with the runny nose, but the kid who is feeling fine and doesn't know yet that he is about to get a fever the next day!

Here are the general principles that I recommend to my patients. Keep your child at home until:

  • 1. They have been without fever for at least 24 hours. For this purpose, I consider a fever to be an ear temperature greater than 38 C. Children who have fever are still in the acute phase of their infection. As such, they are still contagious and are unlikely to be able to participate actively in any meaningful learning. Leave them at home.
  • 2. Your child is drinking well. Once a child starts taking and retaining fluids consistently, they are usually on the path to recovery. Children who aren’t drinking are at risk of developing dehydration and should be monitored at home. It may take several days for your child’s appetite for solid foods to return, and this lack of appetite shouldn’t necessarily prevent a child from returning to school, as long as they are drinking well.
  • 3. There has been no vomiting or diarrhea for at least 24 hours. Kids with ongoing diarrhea or vomiting are contagious. Even worse is the possibility that the child may vomit or have diarrhea in class, a nightmare for child and teacher alike. No meaningful learning will occur for the child who is running back and forth to the bathroom, so keep them home.
  • 4. Your child’s energy level is improving. Although the lethargic child may not be particularly contagious, it is unlikely that they will learn much in class. If your child’s energy level is low, it may be sign that they need more rest. Pushing your child to participate in a school too early may in fact delay her recovery. Don’t push it.

Dr. Michael Dickinson is the head of pediatrics and chief of staff at the Miramichi Regional Hospital in New Brunswick. He's a staunch advocate for children's health in Atlantic Canada through his involvement with the Canadian Paediatric Society.

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