Ask a Pediatrician: Is It OK to Send My Child into School with a Cold?

My daughter has a runny nose, but she tested negative for Covid. Her preschool is saying she has to stay home until she's symptom-free, but I think that's crazy! What do you think? Is it OK to send a kid with a cold to school?

This is probably the most popular question I get right now. When it comes to differentiating between COVID-19 and other circulating cold viruses, it can be tricky to tell the difference between the two just based on the physical exam alone. With children being vulnerable to the Delta variant, as one of the largely unvaccinated populations, it’s important to remain as cautious as you were in the early 2020 days of the pandemic. So, I’m sorry to be the bearer of bad news, but if your child is exhibiting any cold or flu-like symptoms it is best practice to keep them home until symptoms subside (more specifics on timing below) and a negative COVID test results. No matter how skilled a clinician is, the symptoms of the common cold, allergies, and COVID-19 are so similar that diagnostic testing is the best way to be sure. But what happens if the test is negative and your child still has symptoms?

As a parent, I know it’s challenging to keep kids home from school, especially if you’re trying to juggle work and/or additional children. The data show that the average 2-year-old experiences six to eight upper respiratory infections per year, each of which can last for seven to 10 days. To make matters worse, these infections are generally the most concentrated in the winter season. My general guidance is to keep kids home whenever they are feeling unwell. Sounds like a “Captain Obvious” statement, but the truth is that they have an increased chance of transmitting their infection to another student, and will unlikely be in the right frame of mind and physical wellness to be able to have a successful day of learning. So if they are experiencing symptoms, call your pediatrician for further guidance. It’s what we’re here for!

As we head into what we usually consider “cold and flu season,” we cannot be thinking only about COVID-19: we should keep in mind the other upper respiratory infections, as well. We saw a big surge in Respiratory Syncytial Virus, or RSV, in the last several months, particularly among children under the age of 2. We all have to do our part to keep kids healthy and control the spread of illness, but there is a reasonable balance to strike so that children don’t miss an excessive number of school days. 

All we, as parents, can do is try our best. No system is perfect, but I’d like to urge parents to keep the below general guidance in mind.

If your child does not have a fever, the guidance is to stay home and rest until you notice symptoms starting to improve. At that point it is reasonable to send children back to school or daycare assuming they are hydrating well, not going to disrupt the class with constant coughing, and generally on the upswing. (So, for example, your son is on day five of symptoms and has his regular energy back, is no longer constantly coughing or wiping his nose all over his shirt and all he has left is a bit of a runny nose.) Most school districts are still requiring a negative COVID test for any symptoms that are consistent with COVID-19 infection, so please keep that requirement in mind.

A fever, or temperature of 100.4 degrees Fahrenheit or above, is a sign that a child should remain home. A fever can be a symptom of COVID-19 infection, so a COVID test is required here yet again as a best practice. If the test is negative and the fever is in fact just your child fighting off another infection, he/she should be fever-free for an uninterrupted 24 hours before it is safe to return to school or daycare. 

Recovery from viral illness takes time. The big takeaway here is that if a child is diagnosed with a viral infection, antibiotics will not help them because antibiotics only treat bacterial infections. Instead, ensure your child gets enough sleep, remains properly hydrated throughout the day, and is eating nutritious foods. For very young children—babies and kids under 2—make sure you are helping them clear secretions from their noses regularly to keep airways as clear as possible as they fight off infection.

The dreaded cold and flu season looms, but the good news is that clinical trials for the COVID-19 vaccine have been completed in over 2,000 children ages 5 to 11 with very promising data. The advisory committee on immunization practices meets this month, so we are on the road to vaccinations being approved and distributed to children in this age group, potentially by Halloween. Let’s remain hopeful, but also diligent in our efforts to help mitigate the spread of illness, be it COVID-19 or other upper respiratory infections, to keep our children and our communities safe and healthy. 

Dr. Christina Johns is a pediatrician + Senior Medical Advisor at PM Pediatrics, the largest pediatric urgent care group in the U.S.