When to keep your child home: fever, head lice, pink eye and hand-foot-mouth

Many schools and daycares ask for the same thing: your child is fever-free for 24 hours without acetaminophen or ibuprofen before going back. The CDC uses the same approach for respiratory infections such as flu, COVID-19 and colds: a child can return when symptoms are improving overall and they have been fever-free for 24 hours without fever-reducing medicine.

A fever is 100.4 °F (38.0 °C) or higher. Use a digital thermometer and write down the temperature with the time. If the fever dropped because you gave a medicine, it still counts: the 24-hour clock starts when the temperature stays normal on its own. Every school and daycare can set its own rules, so check the handbook or policy if you have it.

Besides fever, keep your child home with any of these:

A fever is a sign the body is fighting an infection; how your child looks and acts matters as much as the number. A child with a fever who plays, drinks and looks well is in a different place than one who is limp and refuses food and drink. Either way they stay home until they have been fever-free for 24 hours.

Offer fluids, rest and, if needed for comfort, the dose of acetaminophen or ibuprofen that matches their weight and age. If you are unsure about the dose, ask the doctor or your pharmacist. A baby under 3 months with 100.4 °F (38.0 °C) or higher needs the ER, without waiting. Read the full guide to fever in children.

Head lice do not spread disease and have nothing to do with cleanliness. The CDC and the American Academy of Pediatrics (AAP) do not recommend keeping children out of school for head lice, and they advise against "no-nit" rules: your child can finish the school day, start treatment that evening and return the next day.

Most cases are treated at home with an over-the-counter product and a nit comb, repeating treatment as the label directs. Check everyone else in the house too. If treatment does not work, the doctor can evaluate your child by video and, if appropriate, prescribe. Read more about head lice.

Pink eye can be viral, bacterial or allergic. Allergic pink eye does not spread. Viral and bacterial types do, mostly through hands and objects that touch the eyes. The CDC says a person without fever or other symptoms may be allowed to return with their doctor's approval; many schools and daycares also ask for at least 24 hours of treatment or no eye discharge that soaks the eye.

Wash hands often, do not share towels or pillows, and discourage eye rubbing. If the eye has thick discharge, is very red or hurts, the doctor evaluates it by video and, if appropriate, prescribes. Read pink eye. If an eye hurts a lot, vision is blurry or light hurts, go to the ER.

Hand, foot and mouth disease is a viral infection common in children under 5. It causes fever, mouth sores and spots or blisters on the hands and feet. According to the CDC, children can return to daycare or school once they have no fever and feel well enough; the blisters do not have to be completely gone, but weeping sores should be covered. Some schools and daycares are stricter, so ask about their policy.

The virus spreads through saliva, nose secretions, fluid from blisters and stool, and it can keep shedding in stool for weeks, so washing hands with soap and water, especially after a diaper change, helps most. The main concern is fluids: if mouth sores hurt so much your child won't drink, get a visit. Read hand-foot-mouth.

Dr. Diana Nieves Castro, MD, a general practice physician licensed in Puerto Rico, sees children of all ages in English or Spanish. In an online doctor visit for kids she evaluates your child on camera with you present, tells you whether they can go to school, guides you on fever, fluids and pain relief and, if appropriate, prescribes and we send the prescription to your pharmacy. If a test such as a strep test is needed, you get a lab order for a lab near you. Video doctor visits 24/7: book online and choose your time right away.

If your child missed school or daycare for an illness the doctor evaluated, a doctor's note is included after the visit at no extra cost, as long as the evaluation supports it. A note is not given without a visit or dated before the visit.

If what you need is for the school, daycare or university medical form to be completed, that is a different visit, a forms visit, which the doctor completes only if what it asks can be certified by a video evaluation. To see what schools ask for, read school health forms in Puerto Rico. Book your visit for your child. For rates, see pricing. The service is run by The Health Initiative, a nonprofit.

If your child has any of these, do not wait for a video visit and do not worry about school: call 911 or go to the ER, day or night.

The simple things help most: wash hands with soap and water for 20 seconds, teach your child to cough into their elbow, do not share cups, towels or utensils, and keep your child home while they are contagious. In flu season or back-to-school weeks, keep the thermometer and the school's contact list handy. If more than one child is sick, or an adult at home is at higher risk, mention it at the visit.