RSV, flu and colds: How to tell when your child is too sick for school

RSV, flu and colds: How to tell when your child is too sick for school


A sniffle, sneeze or cough can set off the alarm for families with small children these days.

Mother of two Vickie Leon said her children, ages 4 and 2, can sometimes go a month or two without bringing home anything from daycare. Then there are times when a family in Aurora, Colorado seems to be sniffling the virus every other week.

“When it comes down to it, we’re just in it for a while,” she said.

Many children have spent years social distancing to protect themselves from Covid-19, and now health systems are overwhelmed with cases respiratory virus RSV — which can cause runny nose, decreased appetite, cough, sneezing, fever and wheezing.

Viral infection has always been a common occurrence. Almost all children get RSV at some point before they are 2 years old US Centers for Disease Control and Prevention says. And the immunity that develops after infection often declines over time, leading people to have more infections in their lives, said Dr. William Schaffner, professor in the Department of Infectious Diseases at Vanderbilt University School of Medicine in Nashville, Tennessee.

A public health challenge this year is that many children have been kept at home to protect against Covid-19, but have also been isolated from RSV, which means more of them now have their first – and therefore most severe – infection, said CNN medical analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health.

RSV infection is often mild, but can be a cause for concern in young infants, children with underlying illnesses and older adults, said Schaffner, who is also medical director of the National Infectious Disease Foundation.

That doesn’t mean it’s time to panic, added Wen, who is also the author of the book “Lifelines: A Doctor’s Journey in the Battle for Public Health.” Infection with RSV and other viral and bacterial infections is part of children growing up and developing their immune systems.

Here’s how to judge when to keep your child home from school, and when to visit the pediatrician, according to experts.

Between colds, the flu, strep throat, RSV and lingering Covid-19, there are many infections swirling around this winter — and they can often look quite similar in terms of symptoms, Schaffner said. Even discerning doctors can have trouble telling the difference when a patient is in the office, he added.

However, pediatricians are well trained and equipped to treat upper respiratory tract infections, even if it’s not possible to tell exactly which virus or bacteria is the cause, Wen said.

Whatever virus or bacteria is causing the sniffles, headaches or sore throats in your household, your child’s age, symptoms and health will likely affect how you proceed, she said.

Ideally, public health experts would like no child showing symptoms to be sent to school or daycare, where they could potentially spread infections, Schaffner said. But — especially for single parents or guardians who should be at work — that’s not always the most practical advice, he added.

Home tests can signal whether a child has a Covid-19 infection, he added. But for other viruses like the common cold, there may not be a good way to know for sure.

Some symptoms that could really signal that it’s time to keep your child home from school or daycare include a high fever, vomiting, diarrhea, feeding problems, poor sleep or breathing problems, Wen said.

Donna Mazyck, a registered nurse and executive director of the National School Nurse Association, breaks it down to two basic questions: Does the child have a fever and is he too sick to fully engage in learning?

Families should also check their schools’ guidelines, some of which may be more specific about when a child should be kept home from school, while others will rely more on parental judgment, she said.

“When in doubt, consult school policy and make a plan with the pediatrician,” Wen said.

And for children who are at higher risk due to other medical conditions, check with your pediatrician before your child gets sick so you know what to look for.

Again, this is where schools can have different policies and it becomes important to check with the written information, school administrator or school nurse, Wen said.

“Generally, schools will ask that the child is fever-free without the use of fever-reducing medication” before returning to school classrooms, she said.

For children with asthma or allergies, it may not be reasonable to keep them out of school whenever they show symptoms of coughing or sniffling, Wen said. That could hold them for half a year.

Some symptoms, such as continued coughing, may persist as the infection clears and the child recovers. In those cases, it may be appropriate to return the child to school, Mazyck said, reiterating that it’s important to check the school’s guidelines.

Families are often good at bringing their children to the pediatrician when they seem unwell, Schaffner said. however, with so many things going on, it’s important to remind families that doctors would rather see kids who aren’t feeling well sooner rather than later, he added.

If they appear lethargic, stop eating or have difficulty breathing, parents and caregivers would also be justified in taking their children to a pediatrician and seeking medical attention — especially if symptoms worsen, Schaffner said.

“This is not something we should hesitate about,” he said.

For younger babies and infants, it may be time to go to the emergency room if they have trouble getting fluids or have dry diapers, enlarged nostrils, trouble breathing and breasts that contract when they should be expanding, Wen added.

Families should seek emergency care for school-age children who have trouble breathing and speaking in complete sentences, Wen said. Fortunately, most won’t need emergency treatment — and those who do usually go home and are fine within a few days, Schaffner said.

“Parents should know that treating RSV and other respiratory infections is the bread and butter of pediatricians and emergency physicians,” Wen said. “This is what we do.”

To prevent these respiratory diseases, teach your children to use hygiene practices promoted by health professionals Long before the pandemic, such as washing your hands, using hand sanitizer when a sink is not available, coughing and sneezing into your elbow or a tissue, and not sharing food or utensils with friends, Wen said.

There is no FDA-approved RSV vaccine yet, but there are effective flu and Covid-19 vaccines, Schaffner said.

If your child has not yet been vaccinated, talk to his doctor about protection against these viruses, he added.

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