Sick Day Rules: When to Keep Your Child Home From School or Daycare
It is 6:45 a.m., your child says their throat hurts, and you have a meeting at nine. Every parent knows this moment.
Maryland has actual guidance for this. Below is what the Maryland Department of Health tells schools and child care programs, translated into plain English. Your school may have its own policy on top of this, so check it — but this is the baseline.
Fever
Maryland's school guidance defines fever as 100°F or higher by mouth, 100.4°F or higher by rectal, ear, or forehead thermometer, or 99°F or higher under the arm.
Keep your child home until they have gone at least 24 hours with no fever and without fever-reducing medicine. Medicating at 7 a.m. so they can go to school does not count.
Any unexplained fever in a baby under 3 months needs to be seen by a medical provider. Call us right away — do not wait it out.
Vomiting and diarrhea
Vomiting: two or more episodes in 24 hours means home. Your child can return once the vomiting has stopped and they are keeping down enough fluid to stay hydrated.
Diarrhea: keep them home if there is blood in the stool, if it cannot be contained by a diaper or normal toileting, if there is fever or other signs of illness, or if there are signs of dehydration such as reduced urine output or a dry mouth.
Norovirus: this one is stricter. Maryland recommends staying home for 48 hours after the last episode of vomiting or diarrhea. Hand sanitizer does not kill norovirus — soap and water is the only thing that works.
Strep throat or other Bacterial Infection
Once your child has been diagnosed and started on antibiotics, they can return after 24 hours of treatment, as long as the fever is gone. Before that, they are contagious. Only a rapid strep test or throat culture can confirm strep, so if the sore throat comes with fever, painful swallowing, and swollen neck glands but no cough or runny nose, call us.
Pink eye
Infectious pink eye means staying home until one of the following: your provider clears them to return, they have had 24 hours of antibiotic treatment, or the symptoms have resolved. Allergic conjunctivitis is different — no exclusion is needed if a provider has evaluated and documented it.
Hand, foot and mouth disease
This one is less restrictive than most parents expect. Children can attend school or child care as long as they have no fever, drooling from mouth sores is under control, any sores on the body can be covered, and they feel well enough to take part in the day. For children who are unable to cover the sores on the body, we recommend staying home until recovered.
The Common Cold
A runny nose is not a reason to stay home — and Maryland's guidance says specifically that the color or thickness of nasal discharge does not change that. Green mucus does not mean a bacterial infection or antibiotics. A cough alone is not a reason to stay home either. Fever, or a child too miserable to participate, is.
Flu
Home until at least 24 hours after the fever is gone without fever-reducing medicine, and symptoms have improved. Flu is contagious starting about a day before symptoms appear, and children shed the virus longer than adults do.
Head lice
Lice are not a medical emergency and no child needs to be sent home mid-day for them. Maryland does not recommend "no-nit" policies. Treat at home, and your child can return after the first treatment.
When to call us, and when to go to the ER
Call Pediatric Providers first for fever without alarming symptoms, ear pain, sore throat, cough, vomiting without dehydration, rashes, and anything you are unsure about. We hold same-day sick visit appointments and we would much rather hear from you early.
Go to the emergency room right away for difficulty breathing, a severe allergic reaction, uncontrolled bleeding, a seizure, or loss of consciousness.
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