Illnesses

Common Illnesses
Returning to School

Common Illnesses

Use the sign/symptom guidance table ONLY if:

The child can participate meaningfully in childcare or school activities; AND
The staff can provide appropriate care without compromising the health and safety of other children.

If these criteria are not met, the child should be sent home.

Note that this list is NOT exhaustive, and there may be other situations where the school should seek medical attention for the child.

Sign/Symptom	Symptom definition and additional criteria for when the child should stay home
Abdominal pain/stomachache	Definition: Pain experienced anywhere between the chest and groin; pain may be continuous or may come and go. May attend school unless the child has one of the following: Pain is severe enough that child has difficulty participating in routine activities Pain starts after an injury Bloody or black stools Diarrhea (see Diarrhea) Vomiting (see Vomiting) No urine for 8 hours (dry diaper, or ask older children if they have urinated since they woke up) Fever (see “Fever” for return guidance)
Cough and cold symptoms	Definition: May include runny/stuffy nose, sore throat, sneezing, congestion, body aches, and/or cough, typically lasting up to 7–10 days. May attend school unless the child has one of the following: Fever (see “Fever” for return guidance) Difficulty with or rapid rate of breathing (see “Difficult or noisy breathing”) Cough is severeor child cannot catch breath after coughing For a cough suspected to be associated with asthma: coughing that cannot be controlled by the medications that the school has been instructed to use.
Diarrhea	Definition: Stools that are more frequent (typically at least two more than normal) or less formed than usual for that child AND not associated with a change in diet. Note that young infants may normally have frequent, somewhat watery stools, particularly if breastfed. May attend* school unless the child has one of the following: Stool not contained in the diaper or toilet (when toilet-trained) Stool looks like it contains blood or mucus, or appears like sticky black tar Yellow skin/eyes (jaundice) Diarrhea that occurs during an outbreak, and exclusion is recommended by the local health department. *Note: If the child has been diagnosed with a specific infection (such as Shigella, Salmonella/typhoid, Shiga toxin-producing E. Coli, norovirus (PDF), etc.), follow the advice of the local health department if they are involved, or the guidance of the child’s health care professional.
Difficult or noisy breathing	Definition: Wheezing (high-pitched sounds) that can be heard when a child breathes in or out, chest retractions (see below) OR extra effort is required to breathe. May attend school unless the child has one of the following: Wheezing that is new for the child or cannot be controlled by medications the school has been instructed to use for known conditions (e.g., asthma plan) Skin or lips seem purple, blue, or grey, depending on skin tone. Fever (see “Fever” for return guidance) Behavior changes Very rapid breathing or increased effort to breathe, such as chest retractions (space between ribs sinks with each breath), belly breathing (belly goes up and down with breathing) Breathing problem that causes child to have pursed lips, difficulty speaking, or difficulty feeding Note: Seek medical attention for new symptoms such as wheezing or breathing difficulties, even if mild.
Earache	Definition: Pain (dull, sharp, or burning sensation) experienced inside the ear. May attend school unless the child has one of the following: Fever (see “Fever” for return guidance) Behavior changes Pain prevents participation in routine activities
Eye irritation, pink eye, or drainage	Definition: Red or pink appearance to the white part of the eyeball. Child’s eye may also be itchy, have crusted/matted eyelashes, more watering than normal, or yellow/white drainage. May attend school unless the child has one of the following: Problems seeing (vision changes) An injury to the eye involving forceful impact to or penetration of the eye Pain or discomfort the child cannot tolerate Note: Pink eye (i.e., conjunctivitis) is inflammation of a layer that covers much of the eyeball. It is most often caused by a virus, and children with viral pink eye typically get better after 5-6 days without antibiotics. Staying home from school is not necessary. Frequent hand washing should be encouraged. Eye irritation can also result from allergies or chemical exposures (e.g., air pollution, smoke, or swimming in chlorinated pool water).
Fever	Definition: An oral (under the tongue), temporal (forehead), rectal, or axillary (underarm) temperature above 100.4°F (38°C). Axillary (underarm) measurements should be used only if other options are not available. Follow instructions for the specific thermometer, including directions for use, cleaning and covers (if applicable). If a temperature is close to 100.4°F, repeat to confirm the result. Unless otherwise directed by a healthcare provider, a child with another symptom or sign of illness who also has a fever should NOT attend school. Return when: Fever went away in the night – without using fever reducing medications, e.g., Tylenol®, Advil®, Motrin® (acetaminophen or ibuprofen) - and is still gone in the morning; AND Other symptoms are improving, and the child can participate comfortably in routine activities.
Headache, stiff or painful neck	Definition: Pain experienced in any part of the head ranging from sharp to dull; may occur along with other symptoms. May attend school unless the child has one of the following: Concussion symptoms: Pain occurs after a fall or other injury to the head and is severe or associated with vomiting, vision changes, behavior change, or confusion. Possible infection: Stiff neck, headache and fever can be symptoms of meningitis a potentially serious infection. Meningitis can also cause sensitivity to light, vomiting, and/or confusion. A stiff neck is most concerning if the child can’t look at their belly button (putting chin to chest) due to pain or the BACK of the neck is painful (not soreness in the sides) along with the other symptoms above. Get immediate medical attention for either of the above conditions.
Rash or itching	Definition: An area of the skin that has changes in color or texture and may look inflamed or irritated. The skin may be darker than or lighter than normal or red or purple. It may be, warm, scaly, bumpy, dry, itchy, swollen, or painful. It may also crack or blister. May attend school unless the child has one of the following: Oozing, open wound or infection that cannot be covered and is in an area that might come in contact with others. Skin that looks bruised without a known injury or in an unusual location. Rapidly spreading dark red or purple rash (may indicate a rare but severe bacterial infection; usually accompanied by fever). Tender, red area of skin, rapidly increasing in size or tenderness. Associated symptoms of a serious allergic reaction (rash with throat closing, abdominal pain, vomiting, or wheezing). Fever (see Fever for return guidance) There is concern for a disease like chickenpox or measles. If this is the case, the child should see a healthcare provider and the local health department should be contacted. Note: For diagnosed conditions, follow the advice of the healthcare provider. In general, for conditions such as lice, impetigo, ringworm, scabies, and pinworms, no waiting period is typically necessary after starting treatment and the child may return after the appropriate treatment is started.
Sore throat (pharyngitis) and/or mouth sores	Definition: Sore throat includes pain or irritation of the throat often resulting from a viral or bacterial infection (e.g., cold, flu, strep throat). May feel worse when swallowing. Mouth sores include white patches on the tongue, gums and/or inner cheeks (oral thrush/yeast infection); white/red spots in the mouth, blisters on lips or inside mouth; or painful ulcers inside cheeks or on gums (canker sores). May attend school unless the child has one of the following: Inability to swallow Fever (see “Fever” for return guidance) Breathing difficulties Excessive drooling or muffled voice Note: Most children with sore throat have viral infections. Children younger than 3 years of age usually do not have strep throat. If a child is diagnosed with strep throat, they should receive antibiotics for at least 12 hours before returning.
Vomiting	Definition: Forceful expelling of stomach contents out of the mouth 2 times or more in 24 hours. Note: Not all vomiting is due to an infection and other causes (e.g., spit-up in a healthy infant with reflux, motion sickness, overeating) should be considered. May attend school unless the child has one of the following: Vomiting has occurred 2 or more times in 24 hours. Fever (see “Fever” for return guidance). Concern for a serious allergic reaction, such as hives appearing with vomiting. Vomit appears green or bloody Child has not urinated in the past 8 hours (i.e., has dry diapers, or ask older children). Recent head injury. Looks or acts very ill. Return when: Vomiting ended during the night and child is able to hold down food or liquids in the morning.

Sign/Symptom

Symptom definition and additional criteria for when the child should stay home

Abdominal pain/stomachache

Stomachache

Definition: Pain experienced anywhere between the chest and groin; pain may be continuous or may come and go.

May attend school unless the child has one of the following:

Pain is severe enough that child has difficulty participating in routine activities
Pain starts after an injury
Bloody or black stools
Diarrhea (see Diarrhea)
Vomiting (see Vomiting)
No urine for 8 hours (dry diaper, or ask older children if they have urinated since they woke up)
Fever (see “Fever” for return guidance)

Cough and cold symptoms

Cough

Definition: May include runny/stuffy nose, sore throat, sneezing, congestion, body aches, and/or cough, typically lasting up to 7–10 days.

May attend school unless the child has one of the following:

Fever (see “Fever” for return guidance)
Difficulty with or rapid rate of breathing (see “Difficult or noisy breathing”)
Cough is severeor child cannot catch breath after coughing
For a cough suspected to be associated with asthma: coughing that cannot be controlled by the medications that the school has been instructed to use.

Diarrhea

Definition: Stools that are more frequent (typically at least two more than normal) or less formed than usual for that child AND not associated with a change in diet. Note that young infants may normally have frequent, somewhat watery stools, particularly if breastfed.

May attend* school unless the child has one of the following:

Stool not contained in the diaper or toilet (when toilet-trained)
Stool looks like it contains blood or mucus, or appears like sticky black tar
Yellow skin/eyes (jaundice)
Diarrhea that occurs during an outbreak, and exclusion is recommended by the local health department.

*Note:

If the child has been diagnosed with a specific infection (such as Shigella, Salmonella/typhoid, Shiga toxin-producing E. Coli, norovirus (PDF), etc.), follow the advice of the local health department if they are involved, or the guidance of the child’s health care professional.

Difficult or noisy breathing

Difficult breathing

Definition: Wheezing (high-pitched sounds) that can be heard when a child breathes in or out, chest retractions (see below) OR extra effort is required to breathe.

May attend school unless the child has one of the following:

Wheezing that is new for the child or cannot be controlled by medications the school has been instructed to use for known conditions (e.g., asthma plan)
Skin or lips seem purple, blue, or grey, depending on skin tone.
Fever (see “Fever” for return guidance)
Behavior changes
Very rapid breathing or increased effort to breathe, such as chest retractions (space between ribs sinks with each breath), belly breathing (belly goes up and down with breathing)
Breathing problem that causes child to have pursed lips, difficulty speaking, or difficulty feeding

Note: Seek medical attention for new symptoms such as wheezing or breathing difficulties, even if mild.

Earache

Definition: Pain (dull, sharp, or burning sensation) experienced inside the ear.

May attend school unless the child has one of the following:

Fever (see “Fever” for return guidance)
Behavior changes
Pain prevents participation in routine activities

Eye irritation, pink eye, or drainage

Definition: Red or pink appearance to the white part of the eyeball. Child’s eye may also be itchy, have crusted/matted eyelashes, more watering than normal, or yellow/white drainage.

May attend school unless the child has one of the following:

Problems seeing (vision changes)
An injury to the eye involving forceful impact to or penetration of the eye
Pain or discomfort the child cannot tolerate

Note: Pink eye (i.e., conjunctivitis) is inflammation of a layer that covers much of the eyeball. It is most often caused by a virus, and children with viral pink eye typically get better after 5-6 days without antibiotics. Staying home from school is not necessary. Frequent hand washing should be encouraged. Eye irritation can also result from allergies or chemical exposures (e.g., air pollution, smoke, or swimming in chlorinated pool water).

Fever

Definition: An oral (under the tongue), temporal (forehead), rectal, or axillary (underarm) temperature above 100.4°F (38°C). Axillary (underarm) measurements should be used only if other options are not available. Follow instructions for the specific thermometer, including directions for use, cleaning and covers (if applicable). If a temperature is close to 100.4°F, repeat to confirm the result.

Unless otherwise directed by a healthcare provider, a child with another symptom or sign of illness who also has a fever should NOT attend school.

Return when:

Fever went away in the night – without using fever reducing medications, e.g., Tylenol®, Advil®, Motrin® (acetaminophen or ibuprofen) - and is still gone in the morning; AND
Other symptoms are improving, and the child can participate comfortably in routine activities.

Headache, stiff or painful neck

Headache

Definition: Pain experienced in any part of the head ranging from sharp to dull; may occur along with other symptoms.

May attend school unless the child has one of the following:

Concussion symptoms: Pain occurs after a fall or other injury to the head and is severe or associated with vomiting, vision changes, behavior change, or confusion.
Possible infection: Stiff neck, headache and fever can be symptoms of meningitis a potentially serious infection. Meningitis can also cause sensitivity to light, vomiting, and/or confusion. A stiff neck is most concerning if the child can’t look at their belly button (putting chin to chest) due to pain or the BACK of the neck is painful (not soreness in the sides) along with the other symptoms above.

Get immediate medical attention for either of the above conditions.

Rash or itching

Rash

Definition: An area of the skin that has changes in color or texture and may look inflamed or irritated. The skin may be darker than or lighter than normal or red or purple. It may be, warm, scaly, bumpy, dry, itchy, swollen, or painful. It may also crack or blister.

May attend school unless the child has one of the following:

Oozing, open wound or infection that cannot be covered and is in an area that might come in contact with others.
Skin that looks bruised without a known injury or in an unusual location.

Rapidly spreading dark red or purple rash (may indicate a rare but severe bacterial infection; usually accompanied by fever).

Tender, red area of skin, rapidly increasing in size or tenderness.
Associated symptoms of a serious allergic reaction (rash with throat closing, abdominal pain, vomiting, or wheezing).
Fever (see Fever for return guidance)
There is concern for a disease like chickenpox or measles. If this is the case, the child should see a healthcare provider and the local health department should be contacted.

Note: For diagnosed conditions, follow the advice of the healthcare provider. In general, for conditions such as lice, impetigo, ringworm, scabies, and pinworms, no waiting period is typically necessary after starting treatment and the child may return after the appropriate treatment is started.

Sore throat (pharyngitis) and/or mouth sores

Sore throat

Definition: Sore throat includes pain or irritation of the throat often resulting from a viral or bacterial infection (e.g., cold, flu, strep throat). May feel worse when swallowing.

Mouth sores include white patches on the tongue, gums and/or inner cheeks (oral thrush/yeast infection); white/red spots in the mouth, blisters on lips or inside mouth; or painful ulcers inside cheeks or on gums (canker sores).

May attend school unless the child has one of the following:

Inability to swallow
Fever (see “Fever” for return guidance)
Breathing difficulties
Excessive drooling or muffled voice

Note: Most children with sore throat have viral infections. Children younger than 3 years of age usually do not have strep throat. If a child is diagnosed with strep throat, they should receive antibiotics for at least 12 hours before returning.

Vomiting

Definition: Forceful expelling of stomach contents out of the mouth 2 times or more in 24 hours.

Note: Not all vomiting is due to an infection and other causes (e.g., spit-up in a healthy infant with reflux, motion sickness, overeating) should be considered.

May attend school unless the child has one of the following:

Vomiting has occurred 2 or more times in 24 hours.
Fever (see “Fever” for return guidance).
Concern for a serious allergic reaction, such as hives appearing with vomiting.
Vomit appears green or bloody
Child has not urinated in the past 8 hours (i.e., has dry diapers, or ask older children).
Recent head injury.
Looks or acts very ill.

Return when:

Vomiting ended during the night and child is able to hold down food or liquids in the morning.

Source: California Department of Public Health

Returning to School

Returning to Child Care or School

For most illnesses, including infectious diseases, a doctor’s note is NOT necessary for returning to the child care or school setting.

In general, a child can return when they meet ALL the following conditions:

Symptoms are improving and the child is feeling better and can meaningfully participate in routine child care/school activities.
Staff can meet child’s care needs without compromising the health and safety of other children and staff.
Specific symptoms (like fever or vomiting) have met return recommendations listed in Table 2.

If a child has been seen by a healthcare provider, the child care/school may consider the advice of the provider when determining when the child may return to child care/school while also considering the interests of other children and staff. The return of children to non-classroom activities (extracurriculars or athletics) following illness may include additional clearance criteria, if appropriate. If the local health department is involved, follow their advice.

Mental Health

Mental Health Resources

Mental Health

Crisis Hotlines

National Alliance on Mental Health (NAMI): In a crisis, text NAMI to 741741 for 24/7, confidential, free crisis counseling. If you are not in crisis, call the NAMI helpline at 800-950-6264 M-F from 10AM - 6PM ET

Helpful Resources

AAKOMA Project: Helps diverse teenagers and their families achieve optimal mental health through dialogue, learning, and the understanding that everyone deserves care and support.

Black Emotional and Mental Health Collective (BEAM): Dedicated to the healing, wellness, and liberation of Black and marginalized communities.

Black Girls Smile, Inc: Promotes positive mental health for young African American girls.

Black Mental Health Alliance: Develops, promotes, and sponsors trusted, culturally-relevant educational forums, trainings, and services that support the health and wellbeing of Black people and other vulnerable communities.

Black Mental Wellness: Provides access to evidence-based information and resources about mental health and behavioral health topics from a Black perspective.

Eustress: Raises awareness on the importance of mental health in underserved communities.

How to Discuss Stressful Situations

How to Talk About Difficult Subjects

How to Talk to Children About Difficult News

Loveland Foundation: Provides financial support for therapy for Black girls and women.

National Center for School Crisis and Bereavement

National Child Traumatic Stress Network: Age-Related Reactions to a Traumatic Event

National Queer and Trans Therapists of Color Network (NQTTCN): Organization is committed to transforming mental health for queer and trans people of color.

Peer Support

Providing Support Over Time

SAMHSA: Coping Tips for Traumatic Events for Adults

San Joaquin County Behavioral Health Services: Children and Youth Services (CYS)

Sista Afya Community Mental Wellness: Sustains the mental wellness of Black girls and women through building community, sharing information, and connecting Black girls and women to quality mental wellness services.

Talking with Grieving Children

Three Component Model to Support Students’ Mental Health: A Guide for California Schools

What not to say to Grieving Children

California Health and Human Services Mental Health Resources for Youth: The California Health and Human Services and California Department of Education have partnered to provide schools with resources to use in the classroom and share with their school communities.

Suicide Prevention

If you or your child are in a crisis, please contact the National Suicide Prevention Lifeline by calling 888-467-9370 or (209) 468-9370. The lifeline is available 24 hours a day, 7 days a week.

How To Identify Suicide Warning Signs

Warning signs a student may need immediate assistance include:

1. Expressing feelings of hopelessness. A student may share verbally, in their writing, in classwork, or through social media feelings of hopelessness. This may come across as “life is not worth living” or “why even bother with any of this.
2. Isolating or withdrawing from others. The student may sit alone at lunch, not talk to anyone in class, perhaps hide at the back of the room, or shy away from others on the playground.
3. Dramatic mood changes. The mood change can be a student who is all of a sudden very sad and depressed. However, a student may also suddenly be extraordinarily happy. This can occur when a student has made a decision to harm themselves and feels relief over their decision.
4. Giving away prized possessions. The giving away of prized items may be the student’s subtle way of saying goodbye.
5. Sleeping all the time or too little. For example, the student who suddenly starts sleeping in class or complains to you about being able to sleep.
6. Increased use of substances. However, any suspected use of substances in a student should be reported.
7. Appears anxious or agitated. This type of behavior may be more pronounced than what is typical for the particular student.
8.Rage, anger, or revenge seeking. You may see a student display this behavior for the first time or get into their first fight.
9.Feeling trapped. The student may feel that there is no way out of a situation.

For more information about risk factors and warning signs, visit the American Foundation for Suicide Prevention website at https://afsp.org/risk-factors-and-warning-signs#suicide-warning-signs.

Directing Change for Suicide Prevention

The Directing Change Program and Film Contest was launched as a demonstration initiative as part of Each Mind Matters: California’s Mental Health Movement funded by the Mental Health Services Act (Proposition 63) and administered by the California Mental Health Services Authority (CalMHSA), an organization of county governments working to improve mental health outcomes for individuals, families, and communities. The website https://directingchangeca.org/films/ includes short films made by students, handouts and tip sheets on how to use the films in schools.

Crisis Hotlines

988 Suicide and Crisis Lifeline: Call or text 988 or chat online with a counselor on their website https://988lifeline.org/chat/.

California Warmline: Call 855-845-7415 or chat via IM on their website https://www.mentalhealthsf.org/peer-run-warmline/

Crisis Chat: Chat online with a specialist at an accredited crisis center through their website https://suicidepreventionlifeline.org/chat/ or their hotline 877-727-4747

Local Resources

San Joaquin County Behavioral Health Services: Call 888-468-9370 or 209-468-9370

San Joaquin County Crisis Line: For immediate crisis support, call 209-468-3549. Individuals who are over the age of 18 years, reside in San Joaquin County, and in need of non-crisis over-the-phone support can contact the San Joaquin County Warm Line at 209-468-3549. The children's non-emergency line is available M-F from 8AM - 5PM. Please call (209) 468-2385.

San Joaquin 2-1-1: Receive help from various local resources below by calling 2-1-1, texting 898211 with your zip code, emailing 211sj@frrcsj.org, or visiting their website 211sj.org.

Child Abuse/Domestic Violence

LGBTQIA+ Support

Crisis Hotlines

LGBTQ National Hotline: The hotline provides peer-support and local resources for all ages. Call 888-843-4564.

Trans Lifeline: The lifeline provides support for transgender people. Call 877-565-8860.

The Trevor Project: The Trevor Project is the leading national organization providing crisis intervention and suicide prevention services to lesbian, gay, bisexual, transgender, queer & questioning (LGBTQ) young people under 25. Call 866-488-7386, text TREVOR to 202-304-1200, or live chat on TrevorChat at http://www.thetrevorproject.com/.

Helpful Resources

National Queer and Trans Therapists of Color Network (NQTTCN): Organization is committed to transforming mental health for queer and trans people of color.

Immunizations for School Entry

Requirements for School Entry
Requirements for Advancement to 7th Grade

Requirements for School Entry

Shots Required for TK-12 and 7th Grade

Students Admitted at TK/K-12 Need:

Diphtheria, Tetanus, and Pertussis (DTaP, DTP, Tdap, or Td) — 5 doses
(4 doses OK if one was given on or after 4th birthday. 3 doses OK if one was given on or after 7th birthday.)
For 7th-12th graders, at least 1 dose of pertussis-containing vaccine is required on or after 7th birthday.
Polio (OPV or IPV) — 4 doses
(3 doses OK if one was given on or after 4th birthday)
Hepatitis B — 3 doses
(not required for 7th grade entry)
Measles, Mumps, and Rubella (MMR) — 2 doses
(Both given on or after 1st birthday)
Varicella — 2 doses

Requirements for Advancement to 7th Grade

Substance Use

E-Cigarette/Vaping

WHAT ARE E-CIGARETTES?

Electronic cigarettes (e-cigarettes) are battery-powered devices that deliver nicotine, flavorings, and other ingredients to the user. Using e-cigarettes is sometimes called “vaping.” E-cigarettes do not create harmless “water vapor” – they create an aerosol that can contain harmful chemicals.

Links:

Product Visual Dictionary

E-Cigarettes and Youth: What Parent's Need to Know

Understanding Vaping and Other Tobacco Product Use Among Youth

Talk with Your Kids About E-Cigarettes: A Tip Sheet for Parents

Tobacco, Vaping, and Marijuana: A Parent's Guide to a New Epidemic (Video)

Opioids

What is fentanyl? Fentanyl is a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent.1,2 It is a prescription drug that is also made and used illegally. Like morphine, it is a medicine that is typically used to treat patients with severe pain, especially after surgery.3 It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids.4 Tolerance occurs when you need a higher and/or more frequent amount of a drug to get the desired effects.

Drug Enforcement Agency: Resources for Parents

Drug Enforcement Agency: Tips for Teens

Tips for Teens

Substance Use

Crisis Hotlines

Substance Abuse and Mental Health Services (SAMHSA) Disaster Distress Helpline: Call toll free at 800-985-5990 or text TALKWITHUS to 66746 (HABLAMOS al 66746 for Spanish).

The Boys Town National Hotline: Receive support by calling 800-448-3000, texting VOICE 20121, or emailing to speak to a crisis counselor.

Helpful Resources

National Queer and Trans Therapists of Color Network (NQTTCN): Organization is committed to transforming mental health for queer and trans people of color.

National Institute on Drug Abuse (NIDA): Search for free lessons and activities on the science and consequences of drug use.

Fentanyl Toolkits: Various toolkits to warn about the dangers of fentanyl.

Operation Prevention: This NO-COST, standards-aligned program for young people ages 8–18 is available in every school, home, and state in the nation to kickstart lifesaving actions TODAY

Forms

Medications at School

Activity Restrictions

Home Hospital Instruction

If your student is unable to attend school for an extended period of time due to an illness or injury, a physician must provide written documentation requesting the student to receive instruction at home. The goal of Home Hospital Instruction is to be short-term to prevent the student from falling behind while they are healing and recovering from their medical condition/ injury.

Please contact your student's school office, school nurse or Health Services for more information.

Home Hospital Request Form

Health Services Resources