HCDS Health Library

The following links are provided as a convenience for families seeking additional information about common childhood illnesses and for our return policies for these specific illnesses and conditions. Information and recommendations may change over time. Families should consult their healthcare provider with questions about a specific diagnosis or treatment plan.

RESPIRATORY SYNCYTIAL VIRUS (RSV)

RSV may appear to be a common cold, but it is not. It is especially hard on young babies. Most preschoolers will not have severe symptoms and will be able to return to school 8 days after contracting RSV. They may return a day or two sooner if their symptoms have resolved — no fever for at least 24 hours, no runny nose or nasal congestion, and they are eating and drinking well. Since they may be coughing from time to time for weeks after infection, if all other symptoms have resolved, they do not have to stay home with a mild and infrequent cough. The key words here are mild and infrequent. If your child’s cough is still productive, they should remain at home. If your child is experiencing coughing “fits,” they should remain at home. If your child is bringing mucus up from their lungs or sneezing mucus out of their nose, they should remain at home.

There is much good RSV information on the internet. These 2 sites are particularly informative:

COVID-19

COVID-19 is a respiratory illness that continues to circulate in the community. The most common symptoms of COVID-19 are fever, cough, trouble breathing, sore throat, congestion, and gastrointestinal problems like bellyache, nausea, vomiting, and diarrhea. Other complaints include headaches, muscle aches, and loss of taste and smell. The virus can be more serious in some people. And some people have no symptoms at all.

Children diagnosed with COVID-19 may return to school when:

  • They have been fever-free for at least 24 hours without the use of fever-reducing medication; and
  • Their symptoms have significantly improved.

What does “significantly improved” mean?

Your child’s symptoms have largely resolved and are manageable by the child. An occasional mild cough may persist, but your child should not be:

  • Freely coughing into the air
  • Freely sneezing into the air
  • Producing excessive nasal discharge
  • Unable to participate comfortably in normal school activities

The CDC advises that people recovering from COVID-19 take additional precautions for several days after symptoms improve because they may still be contagious. These precautions include measures such as masking and avoiding close contact with others. Because preschool-aged children are generally unable to reliably follow these precautions, HCDS requires that children demonstrate significant symptom improvement before returning to school.

Parents should also be aware that HCDS respiratory illness policies may be more restrictive than general public-health recommendations due to the close-contact nature of a preschool environment.

For information about symptoms, testing, home care, and when to seek medical attention, see the following resources at Nemours KidsHealth and Cleveland Clinic.

HAND, FOOT AND MOUTH DISEASE

The good news is Hand, Foot and Mouth Disease (HFM) is not usually a particularly serious illness. Some children are miserable with it, but most are only mildly ill. It is always extremely contagious. Over the years we’ve known of centers that had to shut down for several days to break the cycle of contagion because it was running wild through the children enrolled there. To keep HFM from setting up shop among the kids, we ask parents to keep their children at home for the first week of the illness which is when they are usually most contagious. They can return after that first week if they’ve been:

  • fever-free without fever-reducing medication for 24 hours
  • the blisters on their body have dried up and the sores (ulcers) in their mouth are healed and they are no longer drooling, and
  • they are feeling well and will be able to participate in our activities.

We understand there are schools with a less strict response to HFM who expect it will get passed around. We do our best to avoid that scenario.

There are many HFM information sheets on the internet, but we think this one has the most concrete advice on what to do for symptoms, and information about what course the illness might take.

NOROVIRUS (the Stomach Bug)

Norovirus is EXTREMELY contagious. Uncontrolled infection has been known to shut down childcare centers for many days. If your child has symptoms of Norovirus, they need to stay home for at least 48 full hours AFTER their symptoms have completely resolved. The return clock rolls back to zero hours if your child has even the slightest relapse within those 48 hours. If you Google Norovirus you’ll see some sites recommending a return to work or school after 24 hours, which is why Norovirus never seems to end once it takes hold of an institution. You are most contagious while symptomatic and in the first few days after you’ve recovered. The 48-hour return time is firm at HCDS.

MOLLUSCUM CONTAGIOSUM

This is one of those unidentified skin conditions that needs to be diagnosed by your physician. It is a contagious but manageable skin rash consisting of small bumps often with dents in the centers. The rash/bumps should be completely covered by clothing or bandages while the child is at school. The rash can be itchy and somewhat sore. If the child has bumps on their belly and you use clothing rather than bandages as a cover, be sure to tuck the shirt into the child’s pants or have the child wear long tunic tops. We know from experience that a child will reach up under their shirt to scratch. Other than occasional itching, the affected child usually feels fine, but it typically takes many months to resolve.

If your child has Molluscum please let us know so we can help them to manage it while at school. Thank you!

Visit Nemours KidsHealth website for more information.

IMPETIGO

This is one of those unidentified skin conditions that needs to be diagnosed by your physician. It is a contagious, blistering rash that can appear anywhere on the body, and in preschoolers is often seen on the face around the mouth or nose. Once diagnosed and treatment has started, the child can usually return to school after 24 hours on antibiotics.

Visit Nemours KidsHealth website for more information.

HEAD LICE

If you (or we) discover your child has head lice, they will need to be treated and nit-free before they can return to school. We understand that some schools have abandoned their nit-free policy, but we are keeping it at HCDS. Tackling lice right away is the only way to get a handle on an infestation. It’s a big job because you not only have to delouse your child’s head (and possibly other family members’ heads), but the environment, as well.

If you’re not sure what lice and nits look like, there are some excellent magnified pictures at this EPA lice-related website. The CDC offers advice here. HealthyChildren.org also offers advice. You will need to choose between treating with head lice shampoo and fine-tooth combing. Alternatively, you can try removing lice and nits manually with a specialized comb. I recommend contacting your pediatrician for treatment advice.

We are such a small population at HCDS, lice have only shown up here a few times over the last 40+ years. They historically start in kids with older siblings who’ve brought them home from elementary school. If you get the word that lice are in your big kid’s school, please let us know so we can keep an extra eye out at HCDS. Thank you!

CONJUNCTIVITIS (Pinkeye)

Conjunctivitis is an inflammation of the white part of the eye. Bacterial and viral conjunctivitis are contagious. Allergic and irritant conjunctivitis are not contagious. A doctor’s visit is required for a firm diagnosis. A child with bacterial conjunctivitis can return to school after 24 hours of antibiotic treatment. A child with viral conjunctivitis will have to be out of school as long as they are symptomatic as there is no treatment. A child with allergic or irritant conjunctivitis is not contagious and may return to school if they are comfortable and not distracted by their irritated eye.

Visit Nemours Kids Health website for more information.

STREP THROAT

Strep throat is a bacterial infection that must be diagnosed by a health professional and requires antibiotic treatment. The symptoms come on quickly, and commonly include sore throat (especially painful when swallowing), red and swollen tonsils streaked with white, and fever.  Your child may also experience any or all of the following symptoms as well: stomach pain, nausea, vomiting, headache, loss of appetite or rash. After being infected, people can spread the bacteria to others for a few days before they themselves have any symptoms. Your child may return to school after they’ve been on antibiotics for 24 hours AND have been fever-free without fever-reducing medication for 24 hours AND their symptoms have significantly improved.

Visit Nemours Kids Health website for more information.