How long should kids stay home from school after becoming ill?

How Long Should Kids Stay Home from School After Becoming Ill

Children who are ill should stay home from school until they are fever-free and well enough to participate in normal activities, which is recommended at all times for voluntary home isolation of ill persons, not just during pandemics. 1

General Principle for School Attendance

The CDC's community mitigation guidelines establish that voluntary home isolation of ill persons (staying home when ill) is recommended at all times as a core personal nonpharmaceutical intervention, regardless of whether there is a pandemic. 1 This means children should remain home whenever they have symptoms of infectious illness that could spread to others.

Specific Duration Guidelines

For Influenza-Like Illness

• Children should stay home until fever has resolved without the use of fever-reducing medications and they feel well enough to participate in normal school activities. 1
• During pandemics, voluntary home quarantine of exposed household members for up to 3 days may be recommended when a household member is ill, though this is reserved for pandemic situations. 1

For Specific Conditions Where Exclusion Is NOT Required

Hand, Foot, and Mouth Disease:

• The American Academy of Pediatrics recommends no school exclusion once diagnosed, as by the time of diagnosis the child has already been infectious for a significant period, making exclusion ineffective. 2
• Children can remain in class with emphasis on hand hygiene and discouraging close direct contact. 2

Fifth Disease (Parvovirus B19):

• Children do not require exclusion from school once the rash appears, as they are no longer contagious at this stage. 3
• This differs from measles, rubella, and varicella which do require specific exclusion periods. 3

Key Considerations for Return to School

Symptom-Based Approach

• Fever resolution is the most critical marker - children should be fever-free without antipyretics before returning. 1
• Children should be well enough to participate in normal school activities without requiring special accommodations. 1
• Non-specific symptoms like nasal congestion, rhinorrhea, sore throat, or mild gastrointestinal symptoms alone may not warrant prolonged exclusion, particularly when COVID-19 or other serious infections have been ruled out. 4

Common Pitfalls to Avoid

• Avoid premature return with fever-reducing medications: Parents sometimes send children to school after giving antipyretics, which masks ongoing illness and maintains transmission risk. 5
• Don't rely on "mild symptoms" as justification: Research shows parents who believe children should attend school with mild symptoms or after taking over-the-counter medications are more likely to send symptomatic children to school, contributing to disease spread. 5
• Consider the specific illness: Not all childhood illnesses require the same exclusion period - some like HFMD and fifth disease have different transmission patterns that don't benefit from exclusion once diagnosed. 2, 3

Practical Implementation

When to Keep Children Home

Children should stay home if they have:

• Fever (temperature elevation requiring antipyretics or documented fever). 1
• Symptoms preventing normal participation in school activities. 1
• Vomiting or diarrhea (stay-at-home symptoms). 5
• New continuous cough with systemic symptoms. 5
• Known exposure to serious infectious diseases during the incubation period. 1

When Children Can Return

Children can return when:

• Fever-free for 24 hours without antipyretics. 1
• Able to participate in normal school activities. 1
• No longer in the acute phase of illness with systemic symptoms. 1

Special Circumstances

• For children at high risk for complications (chronic medical conditions, immunosuppression, age <2 years), more conservative approaches may be warranted with medical guidance. 1
• During influenza season, children with confirmed or suspected influenza should ideally stay home until fever-free for 24 hours and symptoms are improving, particularly if antiviral treatment was initiated. 1

Evidence Quality Note

The CDC guidelines on voluntary home isolation represent the highest quality evidence available, published in MMWR Recommendations and Reports and consistently reinforced across multiple pandemic preparedness documents. 1 These recommendations prioritize both individual health outcomes and community transmission reduction, balancing the educational needs of children with public health imperatives.