Student Illness

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

May attend school or child care 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:  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. Note that young infants may normally have frequent, somewhat watery stools, particularly if breastfed.

May attend* school or child care 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:

• If the child has been diagnosed with a specific infection (such as Shigella, Salmonella/typhoid, Shiga toxin-producing E. Coli, norovirus (PDF), etc.), follow the advice of the local health department if they are involved, or the guidance 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), contact the local health department for guidance.

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

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

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

​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 a temperature is close to 100.4°F, repeat to confirm the result. 

It is ONLY recommended to take a child’s temperature if the child seems ill, feels hot, or has other symptoms or signs of illness. Checking the temperature of a child or group of children to allow entry (also known as screening) is NOT recommended in school or child care settings.

Unless otherwise directed by a healthcare provider, a child with another symptom or sign of illness who also has a fever should NOT attend school or child care. 

Return when:

• 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:  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 or child care 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). 
• 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 the local health department should be contacted.

Note: For diagnosed conditions, follow the advice of the healthcare provider. In general, 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:  Forceful expelling of stomach contents out of the mouth 2 times or more in 24 hours. 

Note:  Not all vomiting is due to an infection and other causes (e.g., spit-up in a healthy infant with reflux, motion sickness, overeating) should be considered.

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

• Vomiting has occurred 2 or more times in 24 hours.
• Fever (see “Fever” for return guidance).
• Concern for a serious allergic reaction, such as hives appearing with vomiting. 
• Vomit appears green or bloody
• Child has not urinated in the past 8 hours (i.e., has dry diapers, or ask older children).
• Recent head injury.
• Looks or acts very ill.

Return when:

• Vomiting ended during the night and child is able to hold down food or liquids in the morning.

Note: If there is concern for an outbreak (more persons with vomiting than would be expected in the setting for that time of year), contact the local health department as norovirus (PDF) should be suspected and children should not return until 48 hours after symptoms have resolved.