HCDS Health Library

The following links are provided as a convenience for families seeking additional information about certain childhood illnesses and for our return policies for these specific illnesses and conditions. Some illnesses are quite common, some are rarely seen, and others have yet to be seen at Hogarth. Knowledge is power, and knowing in advance what particular symptoms may indicate allows you to make informed health decisions for your child. Information and recommendations may change over time. Families should consult their healthcare provider with questions about a specific diagnosis or treatment plan.

Important Information About Exclusion, Medical Evaluation, and Exposure

The return requirements below are HCDS minimums. A child may need to remain home longer if symptoms have not sufficiently resolved, the child may still be contagious, the child cannot participate comfortably in normal school activities, or the child requires more care than staff can reasonably provide.

A healthcare provider’s note does not automatically override HCDS return requirements. The child must also meet the observable return criteria described in the applicable policy.

Unexplained Rashes, Bumps, Blisters, or Sores

A child with a new or unexplained rash, cluster of bumps or blisters, or open, crusted, or draining skin lesions must be evaluated by a licensed healthcare provider before attending or returning to school. The provider must identify the condition or state that there is no evidence that it is communicable.

A parent’s belief that a rash is caused by allergies, eczema, insect bites, heat, or another harmless condition is not sufficient when the cause is uncertain. A familiar, previously diagnosed noncommunicable condition does not require reevaluation unless the rash looks different, spreads, blisters, drains, crusts, becomes painful or intensely itchy, or is accompanied by fever or a change in the child’s behavior.

Exposure to Communicable Illness

Parents must promptly notify HCDS when an enrolled child or someone in the child’s household has been diagnosed with—or is strongly suspected of having—a communicable illness featured in this Health Library.

Unless a specific section says otherwise, a child who has been exposed but remains completely symptom-free is not automatically excluded. The child should be closely monitored and must remain home at the first sign of possible illness. HCDS may impose additional exposure-related requirements when directed by the New Hampshire Division of Public Health Services or when an outbreak requires additional precautions.

RESPIRATORY SYNCYTIAL VIRUS (RSV)

RSV often looks like a common cold, and symptoms alone cannot reliably distinguish it from influenza, COVID-19, or another respiratory virus. Although most preschoolers recover without complications, RSV can be especially serious for infants and other medically vulnerable people.

A child diagnosed with or strongly suspected of having RSV must remain home while actively ill. Because people with RSV are usually contagious for three to eight days, HCDS uses the first day of symptoms—not the date of diagnosis—as the beginning of the illness period.

Before returning, the child must:

  • have been fever-free for at least 24 hours without fever-reducing medication;
  • have no uncontrolled, persistent, productive, or fit-like coughing;
  • have no wheezing or difficulty breathing;
  • have no free-flowing nasal discharge or frequent mucus-producing sneezing;
  • be eating and drinking normally; and
  • be comfortable and able to participate fully in normal school activities.

A mild, dry, infrequent cough may linger after the rest of the illness has resolved and does not automatically require continued exclusion.

Exposure without symptoms does not automatically require exclusion, but parents must notify HCDS of a diagnosed or strongly suspected household case.

For more information, see the CDC’s pages about RSV and how RSV spreads.

COVID-19

COVID-19 continues to circulate in the community. Symptoms may include fever, cough, difficulty breathing, sore throat, congestion, headache, muscle aches, fatigue, loss of taste or smell, vomiting, and diarrhea. Some infected people have no symptoms.

A child with symptomatic COVID-19 must remain home through at least Day 5 of the illness, with the first day of symptoms counted as Day 1. The earliest possible return is Day 6, and only if all other return requirements have been met.

A child who tests positive but has no symptoms must remain home through Day 5 following the positive test, with the test date counted as Day 1. If symptoms subsequently develop, the illness clock begins again with the first day of symptoms as Day 1.

Before returning, the child must:

  • have been fever-free for at least 24 hours without fever-reducing medication;
  • have symptoms that have largely resolved and are manageable by the child;
  • have no uncontrolled coughing or sneezing;
  • have no excessive nasal discharge; and
  • be comfortable and able to participate fully in normal school activities.

The CDC recommends additional precautions for five days after a person resumes normal activities because some contagiousness may remain. Those precautions can include masking and distancing. Because preschool-aged children cannot reliably maintain those precautions, HCDS uses a minimum illness period together with significant symptom improvement before return.

Exposure without symptoms does not automatically require exclusion. A positive test, however, means the child is infected rather than merely exposed.

For more information, see the CDC’s respiratory-virus guidance, Nemours KidsHealth, and Cleveland Clinic.

Vaccination: Staying up to date with age-appropriate COVID-19 vaccination can reduce a child’s chance of becoming ill and, most importantly, reduce the risk of serious illness and the need for emergency or hospital care. No vaccine prevents every infection, and protection against infection can decrease over time. Families should consult their child’s healthcare provider about current vaccination recommendations for their child.

HAND, FOOT AND MOUTH DISEASE

The good news is that Hand, Foot and Mouth Disease (HFM) is not usually a serious illness. Some children are miserable with it, but others are only mildly ill. It is, however, extremely contagious and can spread quickly among young children.

HFM is generally most contagious during the first week of illness. To keep it from setting up shop among the children at Hogarth, a child diagnosed with HFM must remain home for a minimum of seven days beginning with the first day of symptoms. The first day of symptoms is considered Day 1; the earliest possible return is Day 8.

After that seven-day period, the child may return when all of the following conditions have been met:

  • The child has been fever-free without fever-reducing medication for at least 24 hours.
  • No new blisters have appeared during the previous 24 hours.
  • Existing blisters are dry and closed, with no exposed or weeping fluid. Lingering flat spots, discoloration, or peeling skin do not necessarily prevent return.
  • Mouth sores have healed sufficiently for the child to eat and drink normally, and the child is no longer drooling because of mouth pain.
  • The child feels well and can participate comfortably in all school activities.

Parents must notify HCDS when HFM is diagnosed or strongly suspected in the enrolled child or anyone else in the child’s household. Symptoms typically appear three to six days after infection, and an infected person may spread the virus before symptoms are recognized or without developing noticeable symptoms.

An asymptomatic child with an active household exposure will not automatically be excluded in every instance. However, HCDS may require the child to remain home temporarily based on the timing of the exposure, the appearance of additional cases within the household, and the likelihood that the child is incubating the illness. Illness-related absences may be placed on the HCDS make-up class schedule.

We understand that some schools permit children with HFM to return as soon as their fever is gone. HCDS maintains a more cautious policy because preschool children play in close contact, frequently share classroom materials, and cannot reliably manage saliva, nasal secretions, or hand hygiene without adult assistance.

For comprehensive information about symptoms, transmission, treatment, and return to school, see Hand, Foot & Mouth Disease: Symptoms, Treatment & Prevention from the American Academy of Pediatrics.

For detailed home-care advice and guidance about when to contact a healthcare provider, see Seattle Children’s Hand-Foot-and-Mouth Disease guide.

NOROVIRUS (the Stomach Bug) AND UNEXPLAINED VOMITING OR DIARRHEA

Norovirus is extremely contagious and can spread rapidly through schools and childcare programs.

A child with unexplained vomiting or diarrhea must remain home for at least 48 full hours after the last episode of vomiting or diarrheal stool. The 48-hour clock returns to zero if even a slight relapse occurs.

This rule applies regardless of whether the illness is presumed to be norovirus, a “stomach bug,” food poisoning, or something the child ate. Symptoms alone generally cannot establish the cause. An exception may be made only when a licensed healthcare provider documents that the symptoms have a noncommunicable cause and the child is not at risk of dehydration.

Before returning, the child must:

  • have had no vomiting or diarrhea for 48 full hours;
  • have been fever-free for at least 24 hours without fever-reducing medication;
  • be eating and drinking normally;
  • show no signs of nausea, significant stomach pain, or dehydration; and
  • be comfortable and able to participate fully.

Exposure without symptoms does not automatically require exclusion, but a household case should be reported to HCDS and the child must remain home immediately if any symptoms develop.

The CDC confirms that people are especially contagious while ill and during the first few days after recovery and recommends remaining home for at least 48 hours after symptoms stop. See the CDC’s norovirus information and prevention guidance.

MOLLUSCUM CONTAGIOSUM

Molluscum contagiosum is a contagious viral skin infection that causes small, firm bumps, often with a dent in the center. Because molluscum can resemble other skin conditions, previously undiagnosed bumps must be evaluated by a licensed healthcare provider before HCDS treats them as molluscum.

A child with confirmed molluscum does not ordinarily need to remain home for the many months it may take the infection to disappear. The child may attend when:

  • every lesion can remain completely covered by clothing or a secure bandage throughout the school session;
  • no lesion is open, bleeding, or draining;
  • there are no signs of secondary bacterial infection; and
  • itching is sufficiently controlled that the child is not repeatedly scratching or removing the covering.

Please inform HCDS of the diagnosis so we can help the child manage the condition at school. Exposure without symptoms does not require exclusion.

See the CDC’s molluscum contagiosum guidance.

IMPETIGO

Impetigo is a highly contagious bacterial skin infection. It commonly begins as red or blister-like sores that break open and develop yellow or honey-colored crusts. Suspected impetigo must be evaluated by a licensed healthcare provider.

A child with impetigo may return when all of the following are true:

  • appropriate prescription antibiotic treatment—topical or oral—has been underway for at least 24 full hours;
  • the child has been fever-free for at least 24 hours without fever-reducing medication;
  • no new lesions have appeared for at least 24 hours;
  • the infection is clearly improving;
  • every lesion is dry or can be completely and securely covered; and
  • there is no uncontrolled drainage.

A lesion on the face or another location that cannot be securely covered must be dry and no longer draining before the child returns.

Exposure without symptoms does not require exclusion. Household members should avoid sharing towels, washcloths, bedding, or clothing with the infected person.

The CDC allows return after at least 12 hours of appropriate treatment when the child is well and lesions are covered; HCDS’s 24-hour requirement is intentionally more conservative. See the CDC’s impetigo guidance.

HEAD LICE

Head lice spread primarily through direct hair-to-hair contact. They do not jump or fly, do not result from poor cleanliness, and do not transmit disease.

If live lice are discovered, the child must receive appropriate treatment before returning to school. Before return:

  • an appropriate over-the-counter or prescription treatment must have been completed according to its directions;
  • a careful examination must find no live crawling lice; and
  • the family must agree to complete any required second treatment and continue checking and combing the hair as directed.

All household members and close contacts should be carefully checked. Anyone with an active infestation—and anyone who shares a bed with the affected child—should be treated at the same time.

Wash and heat-dry clothing, bedding, and towels used during the two days before treatment. Soak combs and brushes in hot water and vacuum areas where the child recently sat or lay. Extensive housecleaning and insecticide sprays or fogs are unnecessary and may be harmful.

See the CDC’s head-lice information and treatment directions.

CONJUNCTIVITIS (Pinkeye)

Conjunctivitis is inflammation of the surface of the eye. Viral and bacterial conjunctivitis are contagious; allergic and irritant conjunctivitis are not. Because the causes can be difficult to distinguish, a child with an unexplained red eye—particularly one accompanied by discharge, crusting, swelling, discomfort, or repeated rubbing—must be evaluated by a licensed healthcare provider.

For bacterial conjunctivitis, the child may return when:

  • prescribed antibiotic treatment has been underway for at least 24 full hours;
  • there has been no pus-like discharge or eyelid matting for at least 24 hours;
  • redness and swelling have substantially improved;
  • the child has been fever-free for at least 24 hours without fever-reducing medication; and
  • the child is comfortable and no longer repeatedly touching or rubbing the eye.

Antibiotics are not appropriate for every case of bacterial conjunctivitis. If the healthcare provider determines that antibiotics are unnecessary, the child may return only when the provider approves return and the discharge, matting, fever, and comfort requirements above have been met.

A child with viral conjunctivitis must remain home until there has been no eye discharge or eyelid crusting for at least 24 hours, redness and swelling have substantially improved, any accompanying respiratory symptoms meet HCDS return requirements, and the child is no longer repeatedly rubbing the eye.

A child with healthcare-provider-confirmed allergic or irritant conjunctivitis may attend when comfortable and able to manage the irritation without continual rubbing or assistance.

Exposure without symptoms does not require exclusion.

See the CDC’s information about conjunctivitis and its treatment.

STREP THROAT and SCARLET FEVER

Strep throat is a bacterial infection that must be diagnosed by a healthcare professional, usually with a rapid strep test or throat culture. Scarlet fever is caused by the same bacteria and follows the same exclusion requirements.

Symptoms may include a rapidly developing sore throat, pain with swallowing, fever, swollen glands, red or swollen tonsils, white patches on the tonsils, headache, stomach pain, nausea, vomiting, or a fine red rash.

A child may return when all of the following are true:

  • appropriate antibiotics have been taken for at least 24 full hours;
  • the child has been fever-free for at least 24 hours without fever-reducing medication;
  • symptoms have significantly improved;
  • the child can eat and drink normally; and
  • the child is comfortable and able to participate fully.

Exposure without symptoms does not require exclusion. Symptoms generally develop two to five days after exposure, so household contacts should be monitored closely.

See the CDC’s strep-throat guidance.

INFLUENZA a/k/a THE FLU

Influenza is a contagious respiratory illness that usually begins suddenly. Symptoms may include fever or chills, cough, sore throat, congestion, headache, body aches, fatigue, vomiting, or diarrhea. Not every child with influenza develops a fever.

A child diagnosed with or strongly suspected of having influenza must remain home through at least Day 5 of the illness, with the first day of symptoms counted as Day 1. The earliest possible return is Day 6, and only if all other return requirements have been met.

Before returning, the child must:

  • have been fever-free for at least 24 hours without fever-reducing medication;
  • have symptoms that have significantly improved;
  • have no uncontrolled, productive, persistent, or fit-like cough;
  • have no free-flowing nasal discharge or frequent mucus-producing sneezing;
  • be eating and drinking normally; and
  • be comfortable and able to participate fully.

Young children can remain contagious longer than adults, so a child whose symptoms remain active after Day 5 must stay home longer. Taking antiviral medication does not shorten the HCDS exclusion period.

Exposure without symptoms does not automatically require exclusion, but a household case should be reported and the child should be monitored closely for one to four days following exposure.

See the CDC’s influenza information.

Vaccination: Annual influenza vaccination reduces the chance of getting the flu and lowers the risk of hospitalization and other serious complications. Protection varies from season to season, but vaccination can also make influenza less severe if a vaccinated person becomes infected. Annual influenza vaccination is recommended for nearly everyone 6 months of age and older.

RINGWORM 

Ringworm is a contagious fungal infection of the skin or scalp. It may cause an itchy, scaly, ring-shaped rash, but it can resemble eczema and other skin conditions. Suspected ringworm must be evaluated by a licensed healthcare provider.

A child may return after appropriate antifungal treatment has been underway for at least 24 hours, provided that:

  • all skin lesions can remain completely and securely covered;
  • there is no open, draining, or secondarily infected skin;
  • itching is manageable; and
  • the child is comfortable and able to participate fully.

Ringworm of the scalp usually requires prescription oral medication. A child with suspected scalp ringworm should not return based solely on the use of an over-the-counter skin cream.

Exposure without symptoms does not require exclusion. If a household pet may be the source, the family should consult a veterinarian.

See the CDC’s ringworm guidance.

SCABIES

Scabies is an infestation caused by microscopic mites. It commonly causes intense itching, particularly at night, and a pimple-like rash. Because it can resemble eczema, insect bites, and other rashes, suspected scabies must be evaluated and treated by a licensed healthcare provider.

A child with scabies may return the day after the first complete prescribed treatment when:

  • the treatment has been performed exactly as directed;
  • the child is wearing clean clothing;
  • clothing, bedding, and towels used during the three days before treatment have been properly washed, heat-dried, dry-cleaned, or sealed as directed; and
  • all household members and other close contacts have been treated simultaneously as recommended by their healthcare providers.

Itching may continue for several weeks after successful treatment and, by itself, does not require continued exclusion. New burrows or new pimple-like lesions after treatment require reevaluation.

Scabies is an exception to HCDS’s usual exposure policy. Because an infested person can spread scabies for weeks before symptoms appear, household members and other direct, prolonged skin-to-skin contacts must receive healthcare-provider-directed treatment at the same time. An exposed child must not attend until that required first treatment has been completed.

See the CDC’s scabies guidance.

Page updated on September 6, 2026