This is the third and final blog post on managing infectious diseases, based upon a talk given by Dr. Andrew Hashikawa from The University of Michigan’s Department of Emergency Medicine. Here we will talk about when and why to exclude students from class due to illnesses. In short, I believe Dr. Hashikawa would say we do so far too frequently (see the staggering stats I posted in the first post). “By the time we see the symptoms, kids have already infected everyone,” he started off by saying. He then went on to list five reasons to send a child home/not allow her to come to school:
1.) Symptoms prevent the child from participating in activities comfortably
2.) Symptoms prevent a greater need for care than that which can be provided
3.) Persistent abdominal pain that lasts for more than two hours
4.) If a child vomits more than twice—he says once isn’t enough to send home unless coupled with another symptom (diarrhea, fever, etc.)
5.) Diarrhea which contains blood or mucus, or that causes accidents or dehydration
Many providers (I’m including myself in this) have sat with a child, notice he feels warm, takes his temperature to find it is 101.1, and immediately place a call to a family member to pick him up. From a health care professional’s standpoint, he says this isn’t necessary. Once a fever hits, the contagious part of the illness has already occurred. So long as this child isn’t displaying other symptoms (or anything else from the list above) then he ought not to be excluded from activities. We then looked at specific cases and when/why to exclude a child from school
Pink Eye: more than 96% of conjunctivitis cases are caused by a virus (such as a cold). There is no need to exclude a student with pink eye, unless she also has a fever, a change in behavior, and/or is experiencing eyelid swelling & redness
Fever: Exclude a child with a fever only if it is couple with a change in behavior, is accompanied by other symptoms, if the student is under four-months old, or if he can’t participate in activities or can’t be appropriately cared for. The American Academy of Pediatrics recommends not adjusting or adding a degree to kids’ temperatures, just note the method in which the temperature was taken.
Vomit/diarrhea: exclude when blood or mucus is present, for non-toilet trained children it is a “blowout” and for toilet trained children when they have an accident, concerns of dehydration exist, if it is coupled with a fever, or there is severe belly pain
Cough & other respiratory issues: once a child displays respiratory symptoms, the damage has been done. Therefore a child should only be excluded if it comes with a fever, if she can’t participate in “normal” activities, or if the symptoms persist two or more weeks.
Lice: Excuse me while I itch my head for a few minutes. OK, Dr. Hashikawa says once you see the lice the spreading of it has already occurred. So there really isn’t a reason for a child to be picked-up as soon as a bug has been spotted, or excluded until from group activities. As soon as a child has received the shampoo treatment, then he or she is good to come back. Lice die without humans within three to four hours, so there really is no reason to scrub or treat classrooms.
And the moral of all of this: spreading illness in our environments is inevitable, and while there is much we can do to keep it at bay, we really ought to take a closer look at when and why we exclude students from school.
Finally, thank you so much to Dr. Andrew Hashikawa for his fabulous presentation and wealth of knowledge shared with our community!
Hashikawa, Andrew. (October 2011). Curriculum for Managing Infectious Diseases in Early Education & Child Care presented at ECDA-WCAEYC Joint Luncheon in Ann Arbor, MI.