Sending Sick Children to School: New Guidelines by Israeli Pediatric Association

redheaded child with spots

The Israeli Pediatric Association has issued new guidelines about sending kids to school or daycare when they are sick. We all know there are some parents who let their sick kids infect everyone else. There are also gananot (kindergarten teachers) who send children home over minor issues. With their report, the pediatricians hope to make “seder” (order).

Here are the new recommendations.

Send children to school with:


  • A runny nose, a sore throat, cough, ear infection or rash—but no fever.
  • Minor, painless eye infection.
  • Lice or scabies.
  • A single episode of vomiting or diarrhea.
  • Hepatitis B or C, CMV,  and HIV.

Keep children home with:

  • Two or more episodes of vomiting or diarrhea within 24 hours.
  • Salmonella or e-coli infection—until a clean culture is obtained.
  • Hepatitis A sores, for  a week after the outbreak or until all children and staff have been vaccinated. Impetigo.
  • Tonsillitis or ear infection caused by Streptococcus A, for 24 hours after the start of antibiotics, or if there is no fever for 24 hours.
  • Mouth sores accompanied by drooling.
  • Eye infection with pus.
  • Rash accompanied by fever.
  • Chickenpox—until all the sores are dry.
  • Pertussis, rubella, mumps, measles, flu—until 24 hours after symptoms subside.
  • Other fevers—until symptoms subside.

The pediatricians considered the level of contagiousness, seriousness, and how much attention the staff would need to give to the sick child at the expense of the others.

Guidelines for daycare workers include washing hands with soap after using the bathroom, diapering, and before and after handling food. Food needs to be separate from the bathroom area, and diaper-changing surfaces should be wiped with alcohol solution between changes. Along with the vaccinations routinely given by Tipat Chalav, pediatricians recommended vaccinating infants against rotavirus, annual flu shots, and swine flu vaccine according to the health ministry’s current guidelines.

Personally, I have an additional guideline–how my child feels. If children are acting abnormal—no appetite, apathetic or cranky, I will keep them home if at all possible. It’s no fun to be at school when you feel lousy, even if you don’t have a fever. I also wait at least half a day to make sure the fever is truly gone. Fever at night automatically gets my kids out  of school the next day because fever often returns in the afternoon. So I think the fever recommendation is too lax.

So what do you think of the guidelines? Will they make parents’ lives easier, or harder?

You may also enjoy:

Ultimate Guide to Getting Rid of Lice

An Insider’s View of  Tipat Chalav

Breastfeeding and Introduction of Solid Foods: New Guidelines from the Health Ministry

Teen Locked in Apartment, Parents Unconcerned

Photo credit: stockerre


  1. Then I’m really glad my school-aged kids are boys.

    Okay to send with LICE??????????????

  2. Lice are a nuisance but they don’t cause disease or infection.

  3. How do these guidelines differ from the previous ones? I wasn’t aware of any official rules as to where to draw the line, but it sounds pretty much like what I’ve done (and been advised to do) until now.

  4. I still shudder thinking about all those times when I was in the middle of teaching and got a phone call that one of my kids was sick. Kate and I were just saying that when our cell phones ring we get heart palpitations – who’s going to need the doctor now?

    The guidelines sound reasonable, but I agree with you about taking into consideration how your kid feels – a few times they had really bad colds, no fever, but really, would I want to sit in school/gan all day feeling like that?

  5. Thanks for posting these, I want to print them out and hand them to my daughter’s gannent! I would prefer parents just get rid of the lice before sending the kids back to school, especially since it spreads so easily!

    I also had NO idea that a fever at night that isn’t there in the morning usually comes back in the afternoon. My daughter had 100.7F last night but was 98.6 this morning so I sent her to gan. No phone call yet. Do you think I should pick her up?

  6. new US guidelines re lice with an explanation (including the fact that no nits policies were ineffective and keeping kids out of school with false positives):

  7. Missnursing says

    I have ALWAYS kept my kids home after fever for 24 hours. Fever goes up and down, disappears and reappears–that’s the nature of fever. Why risk it? Sure the career suffered–but the kids didn’t. What’s more important?

  8. I agree with your take on also just seeing how the child feels – my 3rd grade just spent 2 days home due to a cough because he said he was tired… and then proceeded to sleep from 7:15 to noon both mornings. To me, that is the true test of ‘sick’.

    The guidelines listed above sound like exactly what our children’s pediatrician has said for years so i feel comfortable with them.

  9. and no giving acamol and then sending them to gan.your kid has temperature–don”t get my kid sick!

  10. Nurse Yachne says

    The health department rule regarding the permissability of attending school with lice was made after a lice-infested kid was kept out of school and got hit by a car.

    Personally, my husband has missed a lot more work days for a sick child thanb I have; they just don’t let us. I’ve been pressured to keep working with a 38.2 fever, and while waiting for a 3 cm gash in my foot to be stitched. They just called me down from the floor to the ER when the attending had time to sew it, and I limped on down.

    Last winter we had 2 medical residents who worked all the way through H1N1, albeit with face masks, and everyone seemed to assume that they did the right thing.

    Kvetching aside, the guidelines seem good. Given my druthers, I’d rather see kids who even MIGHT be sick stay home, though.

  11. Ms. Krieger says

    Very sensible guidelines. I agree with everyone else who agrees with MIL – if you kid feels awful, keep them home. And monitor closely for serious illness. If they are cheerful and acting normal but have a cough, all is probably well.

    (I ignored this to my daughter’s peril earlier this year. An inexperienced parent, I just wrote off the raging, awful tantrums of my formerly always-cheerful 18 month old. She had a runny nose too, but what kid doesn’t? After a month of this her airways began to shut down and she had to be hospitalized…we had ignored a chronic infection. Poor little one.)

  12. If children are acting abnormal—no appetite, apathetic or cranky, I will keep them home if at all possible.

    I’m with you. Two weeks ago I kept my son home despite no fever. But he was lethargic and had no appetite. (He’s also mostly nonverbal so I couldn’t be sure if anything else was bothering him.) We went to the doctor the next day and sure enough, positive strep test.

  13. The guidelines seems very sensible, and I agree also with taking how the child feels into account. If I have someone who feels really punk and just wants to sleep, they stay home, fever or no. (Sometimes they might not even be sick – some kids just need time off from school. But not officially.)

    I had an opposite problem once. Chicken pox swept through my daughter’s Gan, and she was the last to get sick. After 2 days she felt Absolutely Fine – she was covered with pox but really had a very mild case. The child was Bored Stiff and Climbing Walls – she would sit by the door waiting for her older brother to come home – and she begged me to let her go to Gan. I actually asked the teacher – after all, she felt fine and everyone else in the Gan already had had it and the teacher had had it and she felt FINE and… But the answer was No, I’m sorry, but rules are rules and she must stay home till all pox are dried. It was a Very Long Week…

  14. Sylvia_rachel says

    Those guidelines seem sensible, with the caveat you suggest. (cranky doesn’t necessarily mean no school at our house, but pale and lethargic definitely indicates that Something Is Wrong.)

    For my kid I would also keep at home for a single episode of vomiting, because there is never a single episode of vomiting — always a second ~2 hours later. And always in the middle of the night. So neither she mor the Designated Parent is in any shape to go anywhere in the morning :P. Also, our school board currently requires 24 hrs free of fever or vomiting.

  15. “Tonsillitis or ear infection caused by Streptococcus A, for 24 hours after the start of antibiotics”

    why 24 hours of antibiotics?

    ” We all know there are some parents who let their sick kids infect everyone else.”

    so you don’t believe in sending your own sick kid to school to get revenge on other parents who in the past let their sick kids get your kid sick?

    shavu’ah tov

    • Abba, presumably after 24 hours the child is no longer contagious. No idea if this is true.

      • i hear it all the time, but i’ve never found any justification. i even called up pfizer once to inquire specifically about this claim with zithromax/azithromycin.

        and even if true, it is always possible that the infection was resistant to the administered antibiotic, there was a secondary infection, parents did not administer the antibiotic properly, etc.

        and one other note, although it doesn’t involve school. we’ve had friends who were hosting us for shabbat warn us that a kid was sick but that was ok to come because he was on antibiotics. in addition to the cautions i noted above, there is also a good chance that the sick child infected siblings before he started his antibiotics.

  16. Fondly recalling the time my friend and I made plans to stay home by dipping the thermometer in hot water. Only she had to go to school because for some reason her cruel mother felt she could manage with 110 degree temperature. Or something like that. 🙂

  17. This is very relevant for me right now – home with TWO sick kids (one for the 3rd time since the chagim with the same recurrent problem, which has been going through our community for the past 3 months).

    My mom says that kids are always sick their first year in daycare/school as they get used to everyone’s germs. Many parents are not equipped to handle this emotionally and logistically, so that’s why there are so many sick kids in school.

    When we lived in a certain community someone asked the rav if it was OK to send a sick kid to school, since the parent wasn’t causing direct harm (but only grama). Needless to say the answer was no. To this day, I am not sure whether someone was really stupid enough to ask or whether the rav made it up to address what he perceived to be a real problem.