Back-to-School Colds: When to Keep Kids Home & When to See a Doctor

By Matthew McClure, MD 

By late summer, we often see a pattern in the emergency room: a child comes home from camp with a cough, a teen develops a fever after sports practice or a college student gets sick after moving into a dorm.

Close contact that comes with back-to-school season helps viruses spread quickly. Early symptoms of viral illness like the common cold, the flu or meningitis can look similar at first. Some infections can become serious quickly.

But how is a parent to know the difference? And when should a child stay home from school with cold symptoms?

Understanding some basic signs and symptoms of viral illness can help you make the right judgment call if your child gets sick. Remember, it’s always better to be cautious. If you are concerned about your child’s symptoms, contact your doctor’s office or go to the emergency room.

When Can You Treat a Cold at Home?

A typical cold can cause congestion, a runny nose, sneezing, sore throat and cough. Mild headache, body aches or fever may also occur.

Managing symptoms at home is usually reasonable when your child or teen is breathing comfortably, drinking fluids, urinating normally and remaining alert. Symptoms should remain stable or begin to improve as the illness runs its course.

Babies and young children may behave differently when they are sick. Poor feeding, fewer wet diapers or unusual lack of energy are signs to call the doctor, even if a cough or congestion seems mild.

Cold symptoms can often be eased with:

• Rest and regular fluids
• Saline nasal drops or spray
• Gentle nasal suction for infants
• Using a cool-mist humidifier
• Eating honey (adults and children older than 1 year only)

Babies younger than 1 should not eat honey, because it can cause a serious bacterial infection in their digestive system. The Centers for Disease Control and Prevention (CDC) also advises against over-the-counter cough and cold medicines for children under 6 years old due to the risk of side effects. Talk with your child’s doctor about the best way to help them feel comfortable.

A Fever Changes the Plan

A temperature of 100.4°F (38°C) or higher is one of the signs of a viral infection.

Feeling a child’s forehead may tell you that something has changed; take their temperature with a thermometer to know for sure. This helps you make informed decisions about giving medication, going to school or daycare or going to the doctor.

Giving your child acetaminophen or ibuprofen can reduce discomfort so they can rest and drink fluids more comfortably. It can also help control their fever. Stay ahead of their symptoms by switching between acetaminophen and ibuprofen according to the directions on the product labels. A doctor can help you understand how much and how often to give your child.

Follow these precautions with over-the-counter pain relievers:

• Don’t give babies younger than 6 months ibuprofen unless a doctor recommends it. Their bodies are developing and can’t process the medication very well.
• Never give aspirin to a child or teen with a suspected viral illness. It can cause serious, harmful swelling in the brain and liver.

When Should Your Child Stay Home?

A mild cough does not automatically require missing school or activities. CDC guidance says students should stay home when they have:

• A fever
• A new rash (possibly a sign of measles)
• Vomiting more than twice within 24 hours
• Significant or bloody diarrhea
• Respiratory symptoms that are worsening or not improving
• Fatigue that prevents normal participation

Check your school’s rules about returning to school after an illness. Generally, students can return when:

• They are fever-free for at least 24 hours without fever-reducing medicine
• Respiratory symptoms are improving for at least 24 hours
• Vomiting has stopped and fluids are staying down
• They have enough energy for a normal school day

When Should You Call a Doctor?

You know your child best. Talk with their doctor if you are worried. In general, call a doctor if:

• Your child’s cold symptoms or fever lasts longer than four days and medication doesn’t help.
• Respiratory symptoms such as a cough that lasts longer than 10 days without improvement, or if symptoms begin to improve and then return or worsen.
• Asthma or other breathing condition symptoms seem worse than normal.
• A baby 3 months old or younger has a rectal temperature of 100.4°F or higher, even with no other symptoms. This could be a sign of an infection or serious illness.

When Is It Time To Go to the ER?

Don’t hesitate to go to the emergency room if your child isn’t eating, toileting or wetting diapers normally, sleeping well or behaving like themselves. Go to the nearest emergency room right away if your child has any of these symptoms, even if they don’t have a fever:

• Fast, labored or difficult breathing
• Blue, gray or unusually pale lips or skin
• Severe dehydration or very little urine
• Confusion, unresponsiveness or difficulty waking
• Seizure symptoms, such as seeming disassociated or losing consciousness
• Persistent vomiting
• Severe headache with a stiff or painful neck
• A dark purple or bruise-like rash
• Symptoms that are deteriorating quickly

Go to the ER right away for meningitis symptoms: fever with a bad headache, stiff neck, confusion, vomiting, extreme tiredness, or sensitivity to light.

Meningitis is inflammation of the tissues around the brain and spinal cord. The disease can worsen within hours and can be fatal. Close living arrangements (such as a college dorm) increase the risk of meningitis. Many people are vaccinated against it. Check your child’s vaccination records before they go to college, camp, mission trips or military service.

Get a More Accurate Diagnosis with MeMed

Physicians PremiER is one of the few freestanding ERs with access to MeMed BV. This FDA-cleared blood test helps our doctors quickly determine whether your child’s illness is caused by a virus or bacteria.

Knowing the difference helps us give your child the right treatment. For example, giving antibiotics for a virus won’t help, and it may cause more side effects like upset stomach. MeMed results are available in as little as 15 minutes, so we can help your child feel better faster.

When you’re worried about your child’s health, it’s always better to seek a doctor’s opinion. Physicians PremiER emergency rooms are open 24/7 to take care of your family.

Stay prepared: Find an emergency room near you. If you are having a medical emergency, call 911.