Your child shuffles downstairs, looking a little off. You feel their forehead and ask what’s wrong.

Maybe they have a stuffy nose or a sore throat. They barely slept. They feel warm. Should you send them to school? 

As a pediatrician, I share these guidelines with parents when they’re not sure what to do.

Fever

If your child has a temperature above 100.4 degrees Fahrenheit, they should stay home, as they’re contagious. They should be fever-free for at least 24 hours, without the use of fever-reducing medicine, before returning to school. If their temperature is below 100.4 degrees Fahrenheit, they’re drinking fluids and otherwise feel okay, they can go to school. 

For school-age kids, using an oral thermometer is best. Forehead and ear thermometers are good for quick checks.

Colds

Kids with a runny nose and a mild cough who are fever-free can go to school. Colds are common, especially in the fall and winter. Mild symptoms alone aren't a reason to stay home.

Keep your child home if they have a persistent or worsening cough, extreme fatigue or a fever. A cold that is getting worse or is accompanied by wheezing could be something more, like RSV or COVID-19. If your child has a fever along with cold symptoms, it's worth calling their doctor. 

Kids can return to school once they are fever-free and their symptoms have been improving for at least 24 hours.

Vomiting

If your child vomits three or more times in 24 hours, or vomiting is coupled with a fever, they should stay home. Together, those symptoms are more likely to signal an infection. Offer small sips of clear fluids often to prevent dehydration. If vomiting continues or you’re worried about dehydration, contact your child’s doctor.

A child who vomited only once and doesn’t have a fever should be able to hold down fluids and food before heading to school.

Diarrhea

If your child has more than two bowel movements outside their norm within 24 hours, or if they come with a fever, keep them home. They likely have an infection, which can spread quickly in classrooms. 

Diarrhea is often treatable at home. As with vomiting, make sure they sip fluids often to prevent dehydration. If your child’s stool contains blood or mucus, call their doctor right away.

Kids with only slightly loose stools and no fever are generally fine to head to school.

Stomachache

If the only symptom your child has is a stomachache, they can go to school. It could just be constipation or nerves. Sometimes, stomachaches on a Monday morning or before a test can be a sign of anxiety. 

Kids who have stomachaches along with vomiting, diarrhea or fever should see a doctor. Sharp stomach pain and a belly that feels hard can be signs of severe constipation, appendicitis or a blocked intestine. If your child has these symptoms, contact their doctor or go to the nearest urgent care or Emergency Department right away.

Sore Throat

A sore throat along with a runny nose is often just irritation from draining mucus. If your child is fever-free and feeling okay, they can go to school. 

Kids should stay home and see a doctor if their sore throat comes with red or white patches in the throat, swollen glands, stomachache, fever, headache or ear pain. Those can be signs of strep throat. 

If symptoms persist or worsen, your child’s doctor can do a rapid strep test. A fever alongside a sore throat may also warrant a COVID-19 test.

A child diagnosed with strep throat should be on antibiotics for at least 24 hours, be fever-free and feeling like themselves before returning to school.

COVID-19, Flu and RSV

If your child tests positive for COVID-19, flu or RSV, follow your school's return-to-school guidelines. At-home tests that check for all three at once are available over the counter and can help you get answers quickly. Most schools require kids to be fever-free for at least 24 hours and to have symptoms improving before returning.

Pink Eye

Red, swollen, goopy or crusty eyes can be a sign of pink eye (conjunctivitis), which is highly contagious. Your child’s doctor can confirm whether they need antibiotics. If it’s bacterial, your child will need to stay home until they’ve been on antibiotic eyedrops for at least 24 hours. If viral, keep your child home until the redness and discharge resolve.

Rashes

Hand, foot and mouth disease is a common viral illness that causes a rash of blister-like bumps on the hands, feet and inside the mouth. It’s also common to have a mild fever. Keep your child home until the fever is gone and open sores have dried and crusted over.

Another fairly common rash is ringworm. Despite the name, ringworm is a fungal infection, not a worm. It spreads easily through close contact and sharing items. Kids can usually return to school within 48 hours of starting treatment, as long as the affected area is covered.

A doctor should always evaluate other rashes with fever.

Lice

If your child is diagnosed with lice, check with your school on their return-to-school policy. Most schools have moved away from strict no-nit policies, but it’s still important to begin treatment promptly.

When in doubt, trust your instincts — you know your child best. And when you need backup, Children’s Wisconsin is here to help. If your child is sick and not improving after 5-7 days, or if their symptoms worsen, it's best to check in with their doctor. The Children’s Wisconsin symptom checker can help you decide whether to take your child to see a doctor. We also provide urgent care at seven clinic locations. You can reserve your spot online or book an urgent care video visit from home.