How long should you keep your child off school when they are sick?
Winter is the time of year when illnesses can spread quickly, especially around schools.
From sniffles and colds to more serious afflictions like chicken pox, schools can be like petri dishes this time of year.
So if your little one is feeling under the weather, here are the government’s guidelines for when you should keep them off school.
The guidelines reveal how long you should keep your children off school for different illnesses.
Here's what they say:
Influenza, commonly known as flu, is very infectious and easily spreads in crowded populations and in enclosed spaces.
Flu viruses are always changing so this winter’s flu strains will be slightly different from last winter’s.
Symptoms include headache, fever, cough, sore throat, aching muscles and joints and tiredness.
Cases are infectious 1 day before to 3 to 5 days after symptoms appear.
Here’s how long to keep your child off: There is no precise exclusion period. Children with symptoms of influenza are advised to remain at home until they have recovered.
Chicken pox (shingles)
Chickenpox is highly infectious and shingles is spread by direct contact with fluid from blisters.
It cannot produce shingles in another person but the virus can spread to those who never had chickenpox from fluid in the blisters of a case.
Symptoms include sudden onset with fever, runny nose, cough and a generalised rash.
Here’s how long to keep your child off: Cases of chickenpox are generally infectious from 2 days before the rash appears to 5 days after the onset of rash.
Although the usual exclusion period is 5 days, all lesions should be crusted over before children return to nursery or school.
A person with shingles is infectious to those who have not had chickenpox and should be excluded from school if the rash is weeping and cannot be covered or until the rash is dry and crusted over.
Food poisoning is a general term for gastrointestinal infections caused by consuming contaminated food or drink.
Person to person spread of these infections is unusual.
Symptoms include feeling sick (nausea), vomiting, diarrhoea, stomach cramps and fever.
Here’s how long to keep your child off: Children and adults with diarrhoea should be excluded until 48 hours after the diarrhoea and vomiting has stopped and they are well enough to return.
For some infections, longer periods of exclusion from school are required and there may be a need to obtain microbiological clearance.
For these groups your local Health Protection Team will advise.
All outbreaks of food poisoning need to be investigated in order to identify their cause.
This parasitic disease is spread from those with the infection to others by the faecal-oral route. It may also be spread by drinking water contaminated with faeces. Infection with giardia may not cause any symptoms. The incubation period is between 5 and 25 days.
When symptoms do occur, they may include abdominal pain, bloating, fatigue and pale, loose stools. Cases need to be treated with antibiotics.
Here’s how long to keep your child off: Children should be excluded until 48 hours after symptoms have stopped.
Salmonella is a caused by eating contaminated food, particularly poultry or eggs. It can also be spread directly from person to person by the faecal-oral route.
Symptoms include diarrhoea, headache, fever and sometimes vomiting.
Infection can be more serious in the very young and very old.
The incubation period can be from as little as 6 hours up to 72 hours (most commonly 12 to 36 hours).
Here’s how long to keep your child off: Your child should be excluded until 48 hours after symptoms have stopped.
Typhoid and Paratyphoid fever
These are less common but serious illnesses.
They are spread by consuming food or water contaminated by the faeces or urine of someone with the illness or someone without symptoms who may be excreting the organism.
These infections are most commonly acquired abroad. Symptoms of typhoid fever are tiredness, fever and constipation, whereas those of paratyphoid fever are fever, diarrhoea and vomiting.
The severity of the illness and length of the incubation period (typhoid 1 to 3 weeks, paratyphoid 1 to 10 days), are related to the number of infecting organisms ingested.
Here’s how long to keep your child off: Environmental health officers or your local Health Protection Team will advise.
Escherichia coli (E. coli) are bacteria that live in the gut of humans and animals, particularly cattle and sheep.
A few strains of E. coli, such as VTEC can produce toxins that lead to more serious and potentially fatal illness.
Spread is by eating contaminated food, direct contact with animals and by faecal-oral route from an infected person as a result of sharing towels and food.
Spread by contaminated drinking has also been reported.
Symptoms vary depending on the severity of the infection but include diarrhoea, abdominal cramps, headache and bloody diarrhoea.
The incubation period is 1 to 10 days and cases are infectious as long as bacteria are present in the faeces.
Here’s how long to keep your child off: The standard exclusion period is until 48 hours after symptoms have resolved.
However, some people pose a greater risk to others and may be excluded until they have a negative stool sample(s) for example pre-school infants, food handlers, and care staff working with vulnerable people.
The HPT will advise in these instances.
Diarrhoea and vomiting (Gastroenteritis)
Diarrhoea has numerous causes but diarrhoea caused by an infection in the gut can be easily passed to others.
Diarrhoea is defined as 3 or more liquid or semi-liquid stools in a 24 hour period.
Here’s how long to keep your child off: Children and adults with diarrhoea or vomiting should be excluded until 48 hours after symptoms have stopped and they are well enough to return.
If medication is prescribed, ensure that the full course is completed and there is no further diarrhoea or vomiting for 48 hours after the course is completed.
For some gastrointestinal infections, longer periods of exclusion from school are required and there may be a need to obtain microbiological clearance.
For these groups, your local HPT, school health advisor or environmental health officer will advise.
If a child has been diagnosed with cryptosporidium, they should NOT go swimming for two weeks following the last episode of diarrhoea.
Glandular fever is caused by the Epstein-Barr virus.
Symptoms include severe tiredness, aching muscles and sore throat, fever, swollen glands and occasionally jaundice (yellowing of the skin and eyes).
In children, the disease is generally mild and difficult to recognise.
The incubation period is 4 to 6 weeks but the infectious period is not accurately known.
Duration of the illness is from 1 to several weeks or months.
Here’s how long to keep your child off: Exclusion is not required and children can return once they feel well.
Hand, foot and mouth disease
Hand, foot and mouth disease is a common viral illness in childhood. It is generally a mild illness caused by an enterovirus.
In very rare instances it can be more severe.
The child usually develops a fever, reduced appetite and generally feeling unwell.
One or two days after these symptoms a rash will develop with blisters on their cheeks, hands and feet. Not all cases have symptoms.
The incubation period is 3 to 5 days.
Here’s how long to keep your child off: You should keep your child off school until they are feeling better, there is no need to stay off until the blisters have all healed.
Keeping your child off for longer periods is unlikely to stop the illness spreading.
Impetigo is an infectious bacterial skin disease and may be a primary infection or a complication of an existing skin condition such as eczema, scabies or insect bites.
Impetigo is common in children, particularly during warm weather.
The infection can develop anywhere on the body but lesions tend to occur on the face, flexures and limbs not covered by clothing.
Here’s how long to keep your child off: The child should be excluded from school until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment.
Measles is a highly infectious viral infection.
The mumps, measles-rubella (MMR) immunisation campaign carried out in the UK 1994 resulted in a dramatic reduction in cases of measles.
Symptoms include a runny nose; cough; conjunctivitis (sticky eye); high fever and small white spots (Koplik spots) inside the cheeks. Around day 3 of the illness, a rash of flat red or brown blotches appear, beginning on the face and spreading over the body.
The incubation period is between 7 to 18 days.
Here’s how long to keep your child off: Children are infectious from 4 days before onset of rash to 4 days after so it is important to ensure cases are excluded from school during this period.
Meningitis is a general term that describes an inflammation of the membranes covering the brain and spinal cord.
It can be caused by a range of bacteria or viruses.
Bacterial meningitis is less common but more serious than viral meningitis and needs urgent antibiotic treatment.
Common signs and symptoms of meningitis and septicaemia include fever, severe headache, photophobia, neck stiffness, non-blanching rash (see glass test box below), vomiting, drowsiness.
The incubation period varies with the organism causing the infection. Bacterial meningitis incubation is between 2 and 10 days.
Here’s how long to keep your child off: Once the child has been treated (if necessary) and has recovered, they can return to school.
Mumps is a viral infection.
The first symptoms of mumps are usually a raised temperature and general malaise. Following this there is stiffness or pain in the jaws or neck.
Then the glands in the cheeks and under the jaw swell up and cause pain. The swelling can be one sided or affect both sides.
Mumps is usually fairly mild in young children, but can cause swelling of the testicles and rarely, infertility in males over the age of puberty.
Here’s how long to keep your child off: Infected children can return to school 5 days after the onset of swelling, if well.
Rubella (German Measles)
Rubella is a viral infection.
The symptoms of rubella are mild. Usually the rash is the first indication, although there may be mild catarrh, headache or vomiting at the start.
The rash takes the form of small pink spots all over the body.
There may be a slight fever and some tenderness in the neck, armpits or groin and there may be joint pains.
The rash lasts for only 1 or 2 days, and the spots remain distinct, unlike measles.
Here’s how long to keep your child off: Exclude from school for 5 days from the appearance of the rash.
Scabies is a skin infection caused by tiny mites that burrow in the skin.
The appearance of the rash varies but tiny pimples and nodules are characteristic.
Secondary infection can occur if the rash has been scratched.
The scabies mites are attracted to folded skin such as the webs of the fingers.
Burrows may also be seen on the wrists, palms elbows, genitalia and buttocks.
Here’s how long to keep your child off: The infected child should be excluded until after the first treatment has been carried out.
A wide variety of bacteria and viruses can cause tonsillitis and other throat infections.
There is acute inflammation extending over the pharynx or tonsils.
The tonsils may be deep red in colour and partially covered with a thick yellowish exudate.
The illness symptoms vary but in severe cases there may be high fever, difficulty in swallowing and tender enlarged lymph nodes.
Here’s how long to keep your child off: Children can return to school 24 hours after commencing appropriate antibiotic treatment.
If no antibiotics have been administered the person will be infectious for 2 to 3 weeks.
If there is an outbreak of scarlet fever at the school or nursery, the HPT will assist with letters and fact sheet to send to parents or carers and staff.
Whooping cough (pertussis) is a bacterial chest infection.
The early stages of whooping cough, which may last a week or so, can be very like a heavy cold with a temperature and persistent cough.
The cough becomes worse and usually the characteristic ‘whoop’ develops.
Coughing spasms are frequently worse at night and may be associated with vomiting.
The whole illness may last several months.
Here’s how long to keep your child off: A child should not return to school until they have had 48 hours of appropriate treatment with antibiotics and they feel well enough to do so or 21 days from onset of illness if no antibiotic treatment.
Children should be immunised against whooping cough in their first year of life.