Contagiousness

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ This message is from PedTalk! To reply to the group, use "" ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ At 09:36 PM 10/23/97 -0400, Ryan Werstuik wrote:

>
>I personally don't think that a kid with a fever should be in school at all.
>Fevers don't magicly come out of the air, there is a cause for them. The
>local school district around here has a policy of sending and student home
>with a temp more than 99.0 I personally think this is good. Does anyone
>agree, disagree?
>
>Sincerely,
>Ryan Werstuik
>

One of the simplest yet hardest questions to answer is: "Can my child go back to school/day care? Is he/she still contagious?" (O.K., those are two questions, but they're asking the same thing)

I tell people that I can much more easily tell them when their child is contagious than when they're not anymore. I think we'd all agree that a child with a "real" fever (>100.5) or massive amounts of snot running down the nose is likely contagious. But how about an isolated mild cough that's been going for a week or two. Could be allergic, viral, and/or bacterial? If they used any cough as a school exclusion then half the kids would be home watching Oprah. What about Hand-Foot-Mouth or Roseola where the child's feeling fine but there's still a resolving rash? At least with Fifth Disease we know that once the cheek rash comes they're no longer contagious, but with most illnesses it's rarely that clear.

The generic answer I give (when I honestly don't know if the illness is still contagious) is to ask the parents to mentally put their child's illness in one of the child's friends and pretend their own child is now healthy and the parents want him/her to stay that way. When the illness has improved to the point where they would let their own healthy child play with the friend who has an illness at that stage of resolution without worrying too much that their own child would get it, their child is ready to go out into the world again. (Did that make sense?)
What I'm trying to do is get them to use common sense and common courtesy. They ask, "Can Billy go back to school tomorrow?" I see Billy with a green river pouring out his nose and ask, "If one of Billy's friends came to school looking like that what would you do?" The parent usually replies, "Kill his mother", and the point is made.

So what do the providers do when asked about how long a particular illness is contagious. Let's start with (and please add more to the list in your reply):

Isolated (and probably viral) Fever:

Roseola:

Hand-Foot-Mouth:

Varicella:

Uncomplicated Viral URI:

Facial Impetigo:

Head Lice (The lice from hell have made a resurgence with the start of school):

Looking forward to seeing how folks respond.

Michael Sachs, M.D.
General Pediatrician