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Sick Student Policy

Posted

Specializes in School Nursing. Has 6 years experience.

I am a new school nurse, and I'm trying to come up with policies for how we should handle children returning to school after being sent home due to illness. It's especially difficult during this pandemic to decide what is reasonable. I want to be cautious but not overly demanding to parents.

I do think any child with respiratory symptoms and/or a fever who is sent home should be required to stay home. But I'm struggling with some other gray areas. We had a child vomit once yesterday, and we sent him home. He had no fever or other symptoms. Is it acceptable for him to return today or should we ask that he stay home for 24 hours? I'm just trying to get some ideas of how other schools are handling children with non-covid related symptoms and what kind of policies you are putting in place for sick children.

BrisketRN, BSN, RN

Has 4 years experience.

We have to follow our state mandates which are very strict.  What guidance does your state or local health department have?

 

Here is the notice I send out to parents:

If your child has any of the following symptoms, they cannot attend in-person lessons:

  • Fever (temperature of 100.4F or higher)
  • Sore throat or nasal congestion
  • Uncontrolled cough
  • Shortness of breath/difficulty breathing
  • Nausea, vomiting, or diarrhea
  • Fatigue, muscle or body aches
  • Severe headache
  • New loss of taste or smell

Your child may return to in-person lessons when one of the following events have occurred:

  • The school nurse has received proof of a negative COVID PCR test (please note rapid antigen tests are not accepted due to the high rate of false negatives) and an alternative diagnosis

                                                         OR

  • Your child has been out of school for 10 calendar days since the onset of symptoms, has been fever free for 24 hours without the use of fever-reducing medications, and has improved respiratory symptoms

 

Jedrnurse, BSN, RN

Specializes in school nurse. Has 28 years experience.

11 minutes ago, BrisketRN said:

We have to follow our state mandates which are very strict.  What guidance does your state or local health department have?

 

Here is the notice I send out to parents:

If your child has any of the following symptoms, they cannot attend in-person lessons:

  • Fever (temperature of 100.4F or higher)
  • Sore throat or nasal congestion
  • Uncontrolled cough
  • Shortness of breath/difficulty breathing
  • Nausea, vomiting, or diarrhea
  • Fatigue, muscle or body aches
  • Severe headache
  • New loss of taste or smell

Your child may return to in-person lessons when one of the following events have occurred:

  • The school nurse has received proof of a negative COVID PCR test (please note rapid antigen tests are not accepted due to the high rate of false negatives) and an alternative diagnosis

                                                         OR

  • Your child has been out of school for 10 calendar days since the onset of symptoms, has been fever free for 24 hours without the use of fever-reducing medications, and has improved respiratory symptoms

 

^^^ This about sums it up. Most of our parents are getting the testing done to avoid the full quarantine, but with Winter and the holidays coming up I don't know if the supply of tests will come close to meeting the demand. 

We are going to be doing the Binax testing in our school, but a negative still needs to be confirmed by a PCR...

AllieEmerson

Specializes in School Nursing. Has 6 years experience.

I do understand those precautions for children with fever or any respiratory concerns. It just doesn't feel right to me to demand that a parent keep a child home for 10 days OR have a negative test for a child that has one episode of vomiting and shows no other symptoms.

k1p1ssk, BSN, RN

Specializes in pediatrics. Has 9 years experience.

15 minutes ago, AllieEmerson said:

I do understand those precautions for children with fever or any respiratory concerns. It just doesn't feel right to me to demand that a parent keep a child home for 10 days OR have a negative test for a child that has one episode of vomiting and shows no other symptoms.

I agree that one episode of vomiting with no other symptoms would not warrant testing or a mandatory 10 days @ home. However, I would require one full day off from school. I have stopped using "24hours" for this exact reason. If the kid vomits at 11am on Tuesday, they can return on Thursday, not 11:01am on Wednesday.

As for when to require a test (or the option of keeping the kid home for 10 days), we have been using the One Major Symptom (fever at or above 100.0, chills, new cough, SOB/difficulty breathing, sore throat, or new loss of taste/smell) OR Two or more minor symptoms (fatigue, muscle/body aches, nausea/vomiting, diarrhea, headache (unrelated to a previously diagnosed condition) congestion and/or runny nose (unrelated to a previously diagnosed condition) to set the criteria. This makes the decision very easy. And I ask kids if they're experiencing anything they haven't reported. 

The PCPs in our area have generally been supportive of testing, even for just one minor symptom. 

BrisketRN, BSN, RN

Has 4 years experience.

2 hours ago, AllieEmerson said:

I do understand those precautions for children with fever or any respiratory concerns. It just doesn't feel right to me to demand that a parent keep a child home for 10 days OR have a negative test for a child that has one episode of vomiting and shows no other symptoms.

The majority children who have tested positive for COVID at my school have not had any respiratory symptoms.  Most had no symptoms (tested due to exposure), GI symptoms, or headache. Only two have had respiratory symptoms.

amoLucia

Specializes in LTC.

Allie - welcome to AN, and esp this forum. The school nurses here are just super awesome. And I so respect you all.

But for new members, others & I strongly recommend that you change your screen name to something anonymous. Anonymity is your FRIEND on social media. Everybody and anybody visits this site. Inc the trolls, lurkers and others who will surprise you (by knowing you). The mods can help you.

Again, welcome.

laflaca, BSN, RN

Specializes in School Nursing. Has 6 years experience.

Our guidance is the same as @BrisketRN and @Jedrnurse.

 

And yep, I exclude them for 10 days (or until I see negative results with my own eyeballs) even if they vomited once.

The ones that have come back positive would surprise you... they've included kids only with GI symptoms and headache, or even just congestion. Sometimes they report asomnia 2-4 days later.

So no matter how silly it seems, out they go.

Jedrnurse, BSN, RN

Specializes in school nurse. Has 28 years experience.

6 hours ago, laflaca said:

Our guidance is the same as @BrisketRN and @Jedrnurse.

 

And yep, I exclude them for 10 days (or until I see negative results with my own eyeballs) even if they vomited once.

The ones that have come back positive would surprise you... they've included kids only with GI symptoms and headache, or even just congestion. Sometimes they report asomnia 2-4 days later.

So no matter how silly it seems, out they go.

It's good to know about the "atypical" presentations - it makes being strict more palatable.

As to the kiddos coming back positive, how has it been going with the quarantining for their close contacts at school? Are you getting a lot of grief from the affected families? What's the impact been on staffing?

ruby_jane, BSN, RN

Specializes in ICU/community health/school nursing. Has 10 years experience.

19 hours ago, AllieEmerson said:

I do understand those precautions for children with fever or any respiratory concerns. It just doesn't feel right to me to demand that a parent keep a child home for 10 days OR have a negative test for a child that has one episode of vomiting and shows no other symptoms.

Exclusion based on symptoms, negative COVID test OR alternative diagnosis to return. Meaning a provider signs something that says in their opinion this is not COVID. Return when you have no sx or one of the above.

Also be aware that providers are wrong sometimes (about one time in five in my district, although they are doing better about actually testing people).

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

55 minutes ago, ruby_jane said:

Exclusion based on symptoms, negative COVID test OR alternative diagnosis to return. Meaning a provider signs something that says in their opinion this is not COVID. Return when you have no sx or one of the above.

Also be aware that providers are wrong sometimes (about one time in five in my district, although they are doing better about actually testing people).

This. And I've said this before, but most pediatric providers aren't doing sick visits in person in my state with any COVID symptoms - they are sending the kid out to be tested first. 

NutmeggeRN, BSN

Specializes in kids. Has 25 years experience.

17 hours ago, BrisketRN said:

The majority children who have tested positive for COVID at my school have not had any respiratory symptoms.  Most had no symptoms (tested due to exposure), GI symptoms, or headache. Only two have had respiratory symptoms.

And therein lies the bigger issue...we just don't know.😕

AllieEmerson

Specializes in School Nursing. Has 6 years experience.

Thank you so much for the replies. This is helping a lot as I'm getting a policy together to get staff on the same page at my school. It does seem to be best to take a "better safe than sorry" approach even if some parents and staff may have objections.

And as for your concern for my anonymity, this is not my real name.

amoLucia

Specializes in LTC.

Allie -TY for your comeback re your name. Just trying to be protective to newbies here to AN.

beachynurse, ASN, BSN

Specializes in School Nursing. Has 35 years experience.

On 11/18/2020 at 3:28 AM, Jedrnurse said:

It's good to know about the "atypical" presentations - it makes being strict more palatable.

As to the kiddos coming back positive, how has it been going with the quarantining for their close contacts at school? Are you getting a lot of grief from the affected families? What's the impact been on staffing?

Most families have been pretty good about it. I have had a few who were rather unpleasant, and a few tried to send their kids back in to school thinking I wouldn't know about it... Surprise..... I find out within 15 minutes of the day starting..

BrisketRN, BSN, RN

Has 4 years experience.

23 hours ago, JenTheSchoolRN said:

This. And I've said this before, but most pediatric providers aren't doing sick visits in person in my state with any COVID symptoms - they are sending the kid out to be tested first. 

A parent let me know that one of our larger peds offices has a "COVID" waiting room and a "well" waiting room.  Her child had one mild symptom but still needed a test, and she was terrified to put her child & herself in the COVID waiting room.  All of the other peds offices that are providing tests are doing telehealth visit and walk up/drive up testing.  Luckily we were able to find somewhere else for her to have the test done.

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

1 minute ago, BrisketRN said:

A parent let me know that one of our larger peds offices has a "COVID" waiting room and a "well" waiting room.  Her child had one mild symptom but still needed a test, and she was terrified to put her child & herself in the COVID waiting room.  All of the other peds offices that are providing tests are doing telehealth visit and walk up/drive up testing.  Luckily we were able to find somewhere else for her to have the test done.

I've been told that several pedi offices around here have a COVID testing tent in their parking lot. You go there at a scheduled time.