When Students or Staff are Sick

Schools can expect that children and staff will get sick during the school year. In a recent survey, more than two-thirds of children missed at least one day of school for illness or injury in the previous year, and about half of those students were absent 1-3 days (National Survey for Child Health, 2022).  When children or staff do become ill, schools can implement strategies to help slow the spread of infectious diseases including:

• Staying home when sick.
• Knowing when to return to school.
• Using personal protective equipment for staff caring for sick children.

Staying Home When Sick

Staying home when sick can lower the risk of spreading infections. Under routine circumstances, some illness spread among school communities is expected. In general, children with improving symptoms should be able to participate in school.

If a child’s needs while sick with an infectious illness would interfere with school staff’s ability to teach and care for other students, the child should stay home. Schools must balance the risk of infectious disease spread with educational, social, and mental health needs of children when determining when students should stay home.

Schools, parents, and caregivers often do not know what specific illness a child may have; rather, children present with symptoms. If someone has the following symptoms, they should stay home because their illness could affect their ability to participate in school and there is concern that they might spread an infection to staff and students.

• Fever, including a fever with a new rash.
• Vomiting more than twice in the preceding 24 hours.
• Diarrhea that causes ‘accidents’, is bloody, or results in greater than two bowel movements above what the child normally experiences in a 24-hour period.
• Skin sores that are draining fluid on an uncovered part of the body and are unable to be covered with a bandage.
• Respiratory virus symptoms that are worsening or not improving and not better explained by another cause such as seasonal allergies.

The above list describes symptoms of common illnesses experienced in school-aged children and can also apply to school staff. Schools should develop policies for common illnesses, such as strep throat and hand-foot-mouth disease, that are informed by CDC pathogen-specific guidance, with assistance from school health teams and other professionals with expertise in infectious disease management and spread. Teams can include people with child-health and infection-prevention expertise, such as school nurses, pediatricians, and health department advisors. When developing illness-specific policies, schools can reference resources from school health experts (for example, the American Academy of Pediatrics , the National Association of School Nurses, and the School-Based Health Alliance) who provide several resources that may be useful. Schools can also refer to state and local health department school health resources.

Return to School

When a person can return to school depends on the nature of the illness. In general, a child returning to school should be well enough to participate in school (e.g., can adequately manage improving cough and congestion on own, not overly fatigued), and care of the returning child should not interfere with the school staff’s ability to teach or care for other students. Students and staff returning to school following an illness may still be contagious, but are likely to be less contagious as symptoms improve, depending on factors like duration and severity of illness. Parents and caregivers should consult their child’s health care providers with specific questions about their child’s condition or recovery.

For the general symptoms described in the stay at home when sick section of this guidance, policies can allow return to the school setting when:

• The child has not had a fever (and is not using fever-reducing medicine) for at least 24 hours.
• Fever with a new rash has been evaluated by a healthcare provider and fever has resolved.
• Uncovered skin sores are crusting, and the child is under treatment from a provider.
• Vomiting has resolved overnight and the child can hold down food / liquids in the morning.
• Diarrhea has improved, the child is no longer having accidents or is having bowel movements no more than 2 above normal per 24-hour period for the child. Bloody diarrhea should be evaluated by a healthcare provider prior to return.
• Respiratory virus symptoms are getting better overall for at least 24 hours. Students and staff returning after a respiratory illness can consider additional actions to reduce spread.

State and local health departments may have additional guidance for staying home when sick and return to school considerations for some illnesses; schools should refer to those policies, in addition to this guidance. There may be instances when schools adjust illness exclusion procedures due to community disease spread (e.g., during an outbreak or pandemic or a time of excessive absences due to respiratory or gastrointestinal illness). Schools can describe these instances in their emergency operations plan (EOP) as part of a layered approach to preventing disease spread. Schools can also work in coordination with health departments and school health advisory teams to develop these plans.

Schools can establish policies and practices that support having students and staff stay home when sick and ensure that employees and families are aware of and understand these policies. In accordance with applicable laws and regulations, schools could:

• Allow flexible, non-punitive paid sick leave policies and practices for staff.
• Set policies to accommodate individuals who are sick and avoid incentivizing coming to school or work while sick.
• Support children who are learning at home because they are sick.

Schools should carefully consider requirements for families to obtain notes from a healthcare provider for illness-related absences. Many common childhood illnesses can be managed at home. Visits made only to obtain a provider note can create undue burden on families and the healthcare system (e.g., caregivers might need to take additional time off from work or pay additional co-pays for these visits). Such requirements can disproportionately impact vulnerable populations and discourage illness-related absence.

Use Personal Protective Equipment When Caring for Sick Children

School staff who are assigned responsibility for caring for sick children or who will be exposed to infectious materials should understand appropriate use and selection of personal protective equipment (PPE).  PPE is equipment worn to minimize exposure to infectious material that may cause illness. PPE includes items such as gloves, safety glasses, masks or respirators, and gowns. For protection from infectious diseases, PPE can be available for use when there is an expectation of possible exposure to infectious materials (e.g., when caring for a sick student or when cleaning up used tissues or vomitus). Guidance intended for healthcare settings, such as CDC’s Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings, is appropriate for school health staff, for example, school nurses or school-based health center personnel.