Ask the Expert: My Child Has a Cold, How Do I Know if He’s Too Sick for School?

A common call that comes in to my office at 7:00 am is this: “My child just woke up and has (cough, runny nose, headache, low-grade temp, etc)…should I send him to school?” On the surface it sounds like I should be answering the “Common Sense Hotline,” but sometimes deciding on whether or not to send your child to school can be quite difficult. In fact, just this week my wife and I deliberated over our 3rd grader and her acute onset sore throat.

So how do you know? Well, to be honest, some of it is a gut feeling and a dose of common sense. You know your child best and you can usually tell whether it is the typical Monday morning drama or a more rare and worrisome complaint. And then again, some of it is more cut and dry.


The American Academy of Pediatrics, for example, defines when to keep a child out of school in the following manner. You should keep your school-aged child out of school if he has:

  • any cold symptoms that prevent him from participating in school activities
  • any fever (temp greater than 100.5 F) within the past 24 hours
  • lethargy, droopiness, significant fatigue associated with cold symptoms
  • any difficulty breathing
  • vomiting 2 or more times in the previous 24 hours
  • diarrhea (2 loose stools per day greater than the usual frequency), stool accidents, blood or mucous in stool associated with cold symptoms
  • oral ulcers associated with drooling or fever and cold symptoms

On the other hand, symptoms that may be okay to send your child to school with:

  • mild cough, congestion, runny nose or achiness
  • cold symptoms associated with mild diarrhea
  • conjunctivitis without fever or behavioral change

We all have pressures that make us want to get our kids to school or daycare. “If I can just get through my morning at work,” “I’ll try to get into work at least briefly today and get my paperwork done,” “There is no way I can reschedule the appointment I have today.” But we have to think of our kids and the kids around them. Catching a second illness on top of what your child already has, could be enough to push him over the edge. And if you’re not sure, don’t forget you can run it by your child’s school nurse. She has a world of experience in these matters and can keep a caring eye on him for you.

As for my daughter, we sent her to school with a scratchy throat. She said it felt better after breakfast. She’s not much of a complainer, so we worried. Sure enough, we got “the call” from the school nurse at 10 am. Parenting is a daily challenge, even for a pediatrician!