What are the Centers for Disease Control and Prevention (CDC) guidelines for when a patient can return to school after an illness, according to patient education?

Return to School After Illness: CDC Guidelines

Children can return to school when they are fever-free for at least 24 hours without fever-reducing medications AND are well enough to participate in normal school activities. 1

General Return-to-School Principles

The American Academy of Pediatrics establishes that school exclusion should only occur when the child poses a meaningful transmission risk to others or is too ill to participate in normal activities. 1 This means:

• A clinically well, afebrile child who can participate in normal activities may return to school immediately without any mandatory waiting period. 1
• The 24-hour fever-free rule is not arbitrary—it balances individual recovery with community protection by reducing transmission to classmates, teachers, and vulnerable household members. 2

Condition-Specific CDC Guidelines

Influenza

• Stay home until at least 24 hours after fever resolves without fever-reducing medications, which typically means 5-7 days of home isolation from symptom onset. 2
• Children may be contagious for 10 or more days after symptom onset, particularly if immunosuppressed. 2
• Do not return to school based solely on feeling better—the patient must be fever-free for 24 hours without medications. 2

COVID-19

• Isolation can be discontinued 10 days after symptom onset, provided the child has been fever-free for at least 24 hours without antipyretics AND other symptoms have improved. 3
• Severely ill patients or those on immunosuppressive medications need individualized isolation duration determination. 3

Mild Traumatic Brain Injury (mTBI/Concussion)

This represents a unique exception to typical illness guidelines:

• Return to school follows a gradual, symptom-based paradigm rather than time-based exclusion. 4, 1
• Medical and school-based teams should counsel students and families regarding gradually increasing the duration and intensity of academic activities as tolerated, with the goal of increasing participation without significantly exacerbating symptoms. 4
• Return-to-school protocols must be customized based on the severity of postconcussion symptoms as determined jointly by medical and school-based teams. 4
• Prolonged school absence has deleterious effects—early rest within the first 3 days may be beneficial, but inactivity beyond this period may worsen self-reported symptoms. 4
• For students with prolonged symptoms interfering with academic performance, school-based teams should assess educational needs and determine if additional supports are needed under federal statutes (e.g., Individuals With Disabilities Education Act §504). 4

Other Common Childhood Illnesses

• Hand, Foot, and Mouth Disease (HFMD): No school exclusion required, even with active lesions. 1
• Fifth Disease (Parvovirus B19): Immediate return to school once the rash appears, as the child is no longer contagious. 1
• Primary HSV Infections: All systemic symptoms (fever and malaise) must be resolved before return. 1
• Diarrheal illnesses from STEC (E. coli): Exclusion required until diarrhea resolves AND 2 stool cultures are negative. 1
• Salmonella Typhi: Requires 3 negative stool cultures obtained at least 24 hours apart, at least 48 hours after cessation of antimicrobial therapy, and not earlier than 1 month after symptom onset. 1

Critical Pitfalls to Avoid

• Do not apply COVID-19-specific criteria to routine viral illnesses. 1 The 10-day isolation for COVID-19 does not apply to common colds or other viral infections.
• Do not require arbitrary fever-free periods for general viral illnesses when the patient is otherwise well. 1
• Do not apply pandemic quarantine recommendations to routine seasonal influenza—exposed household members do not need to quarantine during typical flu season. 2
• Do not delay return to school after mTBI beyond what symptoms dictate, as prolonged absence worsens outcomes. 1

High-Risk Children Requiring Special Consideration

Children at high risk for complications—including those with asthma, chronic lung disease, heart disease, immunosuppression, diabetes, or other chronic conditions—may require more conservative approaches, including longer isolation periods and medical clearance before return. 2