Is Your Child Too Sick for Day Care or School?

Your 3-year-old is playing listlessly with her oatmeal. "My tummy hurts, Mommy," she says. There's no fever, no vomiting and no diarrhea, but she's not her normal bundle of energy.

Now comes the tough part. Do you send her to day care, or keep her home?

The American Academy of Pediatrics and the American Public Health Association have guidelines that can help you make up your mind. Drawn up in 1992 and revised in 2002, they cover kids in group care and school.

Kids should stay home if the illness:

• Poses a risk of spreading a serious or harmful disease.

• Needs more care than the staff can provide without a risk to the health and safety of other children.

• Would keep the child from joining in activities.

These are specific examples of when to keep children home:

• Fever higher than 101 degrees F orally or 102 degrees F rectally

• Diarrhea or blood in stools

• Persistent abdominal pain

• Vomiting twice or more in 24 hours

• Conjunctivitis (pinkeye), strep throat or chicken pox, until no longer contagious

• Sluggishness, uncontrolled coughing, constant crying or other signs of possible severe illness

Children with colds, runny noses or mild fever may be able to go to school or day care depending on other factors.

"Deciding whether mildly ill young children can or cannot go to child care or school is difficult," says Timothy R. Shope, M.D., associate professor of pediatrics at the Uniformed Services University of the Health Sciences. "Parents have very little time to observe and assess morning symptoms before driving them to a child-care center or school.

"For example, vague abdominal complaints could be the beginning of vomiting or diarrhea, but can also be due to anxiety about school," he says.