Back to School: Staying Healthy

Dr. Yadira Soler
Dr. Yadira Soler
September 14, 2022

School is back in session! As kids head back into the classroom many parents brace themselves for the onslaught of germs and illnesses that get passed around. While most children are likely to get sick at least once during the school year, there are ways to minimize the frequency of illness.  

Eating a Healthy Diet

The American Academy of Pediatrics believes that healthy children receiving a normal, well-balanced diet do not need vitamin supplementation over and above the recommended dietary allowances.  Foods are the best source of nutrients. Regular meals and snacks can provide all the nutrients most preschoolers need.  

While many young children are picky eaters, that doesn't necessarily mean that they have nutritional deficiencies. Many common foods — including breakfast cereal, milk and orange juice — are fortified with important nutrients, such as B vitamins, vitamin D, calcium and iron. So your child may be getting more vitamins and minerals than you think.  

Children who may need a multivitamin include children who are failing to thrive, have food allergies or sensitivities, are on a strict vegetarian diet, or have a chronic disease.    

The one exception is vitamin D. Recently the AAP has found that most children aren’t getting enough vitamin D which helps promote healthy bone growth and the prevention of chronic diseases. The AAP is now recommending 400 IU a day beginning in the first few days of life, even if your child drinks milk and plays outside.  

Although the AAP says multivitamins aren’t necessary, many parents still decide to use them just to be on the safe side. Taking a multivitamin most likely won’t do your child any harm, but you will want to follow the below guidelines.  

Promote a Healthy Diet: Resist the temptation to use a vitamin as an excuse not to improve your child’s diet. Although a multivitamin may deliver nutrients, your child will be missing out on a host of benefits provided by health foods. Food is still the very best way to get the nutrients you need.  

Shop Carefully: Many supplements don’t include nutrients like calcium and zinc that are the most likely to be missing from a child’s diet. Also, make sure it doesn’t exceed the daily-recommended amounts. You will want to buy a multivitamin intended for children so that they aren’t getting more nutrients than are safe.  

Talk to Your Child About Staying Healthy

Focus on the importance of nutrition and physical activity for feeling good and staying healthy. Avoid connecting eating well and staying active to losing weight or being slim. Speak Their Language. Explain nutrition and physical activity in terms your child can understand.  

  • Example: Fruits and Veggies – Are like fuel for your body and mind. They also help prevent you from getting sick by providing you with vitamins and minerals important for your health.
  • Make Health Fun. Find ways to make healthy habits enjoyable for your kids. Example: Cut fruits and veggies into animal shapes or create nicknames for different healthy snacks. Have your child help pick out new fruits and vegetables to try when grocery shopping.  
  • Talking About Tobacco. Being tobacco free is another important way kids can stay healthy. Try to talk with them early and often.  
  • Teach kids how to wash their hands properly—and when to do it (after blowing their nose, using the bathroom, and before eating). This helps reduce their risk of getting sick and in turn, from infecting others. When hand washing is not possible, hand sanitizer containing at least 60% alcohol is the next best way to kill germs that cause COVID-19 and other illnesses, according to the CDC.  
  • Remove televisions and video games from bedrooms. Kids who get enough sleep are more likely to maintain a healthy weight and perform better in school. The American Academy of Pediatrics recommends no television in children's rooms to reduce screen time and promote healthy sleep habits.  

When to Keep Your Child Home  

When your children get sick, you want to do whatever you can to make them feel better. No matter the symptoms, it is always best to contact your child’s pediatrician if you have concerns about your child’s health.  

Fevers indicate that your child’s immune system is fighting an infection.  Fevers are generally not dangerous unless your child is young, has an immunodeficiency, or the fever is very high.  The most important thing to do when your child has a fever is to keep him/her hydrated and monitor for signs of a serious illness.  It is a good sign if your child interacts with you in a normal manner after receiving medication for discomfort.  

When should I call the doctor for an appointment?  

  • Fever for greater than 2 days in a child over 2 years of age  
  • Persistent vomiting and diarrhea  
  • Cough that is persistent or getting worse over several days  
  • Cuts that may need stitches  
  • Limping or not able to move an arm or leg  
  • Ear pain or drainage from an ear  
  • Severe sore throat or problems swallowing  
  • Pain with urination or blood in the urine  

When should I seek urgent care or emergency care?  

  • Rectal temperature of 100.4ºF (38ºC) or higher in a baby less than 2 months old  
  • Repeated fever above 104ºF (40ºC) for a child of any age  
  • Persistent vomiting and unable to keep sips of replacement fluids down  
  • Difficulty breathing  
  • Neck stiffness or rash with a fever  
  • A cut or burn that is large or deep  
  • A serious accident  

When can I look after my child at home?  

You can monitor your child at home, even with a fever, as long as your child is:  

  • Drinking and eating enough to have a minimum of 4 voids in a 24-hour period  
  • Interacting with you in a normal manner  
  • Does not appear sick  

If your child’s symptoms are not improving or persist, contact your child’s pediatrician for evaluation.  

The primary reasons for exclusion from childcare or school are that the condition:  

  • Prevents the child from participating comfortably in activities  
  • Results in a need for care that is greater than staff members can provide without compromising the health and safety of other children  
  • Poses a risk of spread of harmful disease to others  

Conditions that require exclusion from daycare or school:  

  • When the child appears to be severely ill, is not responsive, irritable, persistently crying, having difficulty breathing, or having a quickly spreading rash.  
  • Fever (temperature above 101°F [38.3°C] by any method) and behavior change or other signs and symptoms (e.g., sore throat, rash, vomiting, or diarrhea). For infants less than 2 months of age, an unexplained fever should be evaluated by a health professional.  
  • Diarrhea—Exclusion is required for all diapered children whose stool is not contained in the diaper and toilet-trained children if the diarrhea is causing "accidents," and for children whose stool frequency exceeds 2 stools above normal per 24-hours for that child while the child is in the program or whose stool contains more than a drop of blood or mucus.  
  • Vomiting 2 or more times in the previous 24 hours unless the vomiting is determined to be caused by a non-communicable/non-infectious condition and the child is not in danger of dehydration.  
  • Abdominal pain that continues for more than 2 hours or intermittent abdominal pain associated with fever or other signs or symptoms.  
  • Mouth sores with drooling that the child cannot control unless the child's primary health care provider or local health department authority states that the child is noninfectious.  
  • Rash with fever or behavioral changes, until a primary care provider has determined that the illness is not a communicable disease.  
  • Skin sores that are weeping fluid and are on an exposed body surface that cannot be covered with a waterproof dressing.  
Little girl with a fever

When your child can go back to school will vary depending on what symptoms or type of illness your child experienced, and your child’s school policies.  

A child should stay home with a fever, which is a temperature of 100.4 °F or higher. Many schools require that children be fever free for 24 hours before returning to school. After a vomiting illness, children can return to school when they tolerate liquids and solid food without vomiting.  

After a cold or flu-like illness, children can return to school when they no longer have a fever and they feel well enough to participate in class.  

If a child is COVID-19 positive, they should stay home while symptoms persist. The child will be able to return to the classroom after 5 days have passed since the onset of symptoms and are fever free for 24 hours.