A 6-year-old boy presents to the clinic for fever, mild nasal congestion, mild cough, and malaise for 3 days. His examination demonstrates only mild nasal congestion. A COVID-19 swab is negative. The clinician shares with the parent that the patient has an acute viral illness and provides reassurance and anticipatory guidance. When can the boy return to school?
A Immediately B Once all symptoms have been resolved for 48 hours C Once the fever has been resolved for 24 hours D Once the fever has been resolved for 48 hoursAcute febrile viral illnesses are common among children and may cause them to miss school. As such, it is important to guide families in striking the right balance between staying home when ill and returning to school when able. Children may still be contagious when they return to school, but they will become less contagious as their symptoms improve and resolve. In general, the child should be well enough to participate in routine tasks of school, and their illness should not interfere with the teacher’s ability to teach other children. For acute febrile illnesses, students are typically able to return to school once the fever has been resolved for 24 hours without the use of fever-reducing medications.
Schools are encouraged to develop CDC-informed return-to-school guidelines for common childhood illnesses such as streptococcal pharyngitis or hand, foot, and mouth disease. In addition, they can develop policies that support students and teachers in staying home when needed without fear of adverse consequences. Moreover, schools should consider their policies on requiring clinician notes, as this may place an unnecessary burden on the family and clinicians when a child has a routine childhood viral illness.
Although the child has only mild respiratory symptoms, he still has a fever and thus should not return to school immediately (A).
Waiting for all symptoms to be resolved for 48 hours (B) will lead to unnecessary days of missed school, as the patient’s mild cough and congestion are likely to last for several days.
Waiting for the fever to be resolved for 48 hours (D) is longer than necessary for a child to stay home and may lead to excessive days of work lost for parents, as well.
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