This is one of the most common questions pediatricians are asked each day in practice (along with “how can i get my kiddo to sleep through the night?”).  School absences can be difficult for caregivers due to childcare issues and missed workdays, troubling for school officials and can cause children to fall behind in extreme cases.  My advice to my patients sometimes includes, “use your mommy or daddy judgement” because you know your child better than anyone. Other times, it is streamlined alongside the recommendations of our infectious disease colleagues. 

 The Common Cold

-no fever for 24 hours  provided your child is acting normally and is not having difficulty breathing

-it is OK to go to school with cold symptoms such as runny nose, nasal congestion, cough, sore throat unless you feel like your child needs to rest (or snuggle)

 -tidbit: yellow and/or green and/or glowing yellow-green nasal drainage does not always mean an antibiotic is necessary, our decision to prescribe an antibiotic (to treat only bacterial infections) is based more on length of symptoms and/or worsening symptoms

 Pink Eye 

-need to be on antibiotics for 24 hours (remember that not all eyes that are red = “pink eye” so always have your child examined by a physician), pink eye can be caused by viruses, bacteria, allergies or chemicals, it does not always require antibiotics (only the bacterial kind)

 Strep Pharyngitis or Strep Tonsillitis

 -free of fever AND on antibiotics for at least 24 hours (although there have been some recent articles suggesting less than 24 hours may be sufficient, no official change to the recommendation as of yet)


 -despite the “no nit” policies at many schools, the recommendation is to stay out of school just until all live lice are gone (always recheck for at least 1 week for newly hatched lice, retreat if necessary)


 -once treatment has started even if itching and lesions are still present


 -once treatment has started, keep lesions covered with a bandaid


 -return to school after all lesions have crusted over AND there are no new lesions for 48 hours


-always consider what the fever is from and how your child feels, but the general rule is fever free for 24 hours

 \Vomiting and/or diarrhea

 -if fever is present? no fever for 24 hours

-vomiting?  no vomit for 24 hours

-diarrhea? no diarrhea for 24 hours

Hand Foot Mouth (Coxsackie Virus)

-no fever and when blisters are dried up

-feeling well enough and drinking enough to be at school for a given time


-tidbit: fever = 100.4, your temperature varies throughout the day and so 99 degrees in a child who is usually 98 degrees does not constitute a fever because it is likely a normal variation

-tidbit: fever is caused by infection. if you treat it with Ibuprofen (Motrin) or Acetaminophen (Tylenol), it will likely return if the infection itself is not treated / if the infection is still active in one’s body. 


So the magic number is 24, however, the most important thing to remember is to listen to your child, decipher what is reality and what is drama and have a low threshold for bringing them in to see us. Similar to well check ups, while we examine your child we are looking for specific findings to rule out (or rule in) certain dieases, some of which can have lasting effects if not treated.

 Please come in and get your kids vaccinated against the flu this September! Watch our website and our new facebook page “Hendersonville Pediatrics” for announcements.


Stay tuned for my next blogs on bullying and common rashes!