Sometimes you really do need to keep your kid home from school

In a perfect world, kids would never get sick, and they'd never miss a day of school. But it's not a perfect world.

Kids get sick all the time, and they love to share their nasty little germs with everyone around them, especially this time of year.

It's not uncommon for children to get viral illnesses 10 to 12 times per year, and these symptoms can last a week or more. When kids are sick, parents are faced with a difficult decision: Send the children to school or day care, or keep them home?

This can be such a tough decision because there are a lot of conflicting priorities to consider.

We all want our children to feel better and recover quickly, and we don't want them to get other kids sick. But we also want them in school so that their education doesn't suffer - and so that we don't have to miss work or struggle to find last-minute child care.

It's not always an easy call, but here are some things to consider from a medical perspective:

How sick is your child?

Some kids are sick enough - such as those with difficulty breathing, changes in consciousness or severe abdominal pain - that they clearly need medical attention.

Depending on the severity, that may mean a trip to your pediatrician's office, an ER visit or even a hospital stay. In these cases, the decision tends to be pretty easy. School takes a back seat until things improve.

It's the milder cases that are trickier: The child doesn't necessarily need medical help, but a parent still isn't sure whether the young one should stay home.

Can your child participate in the activities at school?

Kids go to school to learn. If your child is so uncomfortable, sleepy or otherwise distracted that he wouldn't be able to get anything out of school, it may be better to keep him home.

In some cases, children are fine to sit in class, but may have trouble with gym or other demanding activities. In those cases, a note from your doctor asking for temporary accommodations may be helpful.

Will your child's day care or school be able to care for her?

Sometimes a sick child requires more care than the teachers or staff can reasonably provide.

Sending her off probably wouldn't be in her best interest and wouldn't be fair to the other children.

That's a good reason to keep a child at home.

Will your kid get others sick?

And if so, how big a deal would that be?

The answer, even in mild cases, to the first question is probably yes, but it's important to think about the second question, too.

While many childhood illnesses are contagious, they're not all equally dangerous.

Sharing pinkeye or lice is a lot different from sharing measles or bacterial meningitis. Strict guidelines based on when the disease is contagious have been established for many of the more serious illnesses; in other cases, use your judgment or ask your pediatrician.

Minimizing damage

Even though children inevitably swap germs in the crowded indoor environment of school, we can do a few things to minimize the damage:

Immunize: There's a reason that vaccines are required for school attendance. It's because they're an effective way to prevent some serious, potentially life-threatening diseases.

Wash your hands: Good hand washing is probably the best way to limit the spread of disease. Hand sanitizer is OK for most germs, but soap and water are more effective against many viruses.

It doesn't have to be antibacterial soap, and it doesn't have to be hot water.

Teach your children how to wash properly: Scrub both sides of their hands and between their fingers for at least 20 seconds. Dry with a paper towel and use the towel to turn off the sink and open the door.

Cover your mouth: Many respiratory illnesses are spread by coughing or sneezing. Teach children to cover their mouths with a tissue, elbow or shoulder - not their hand. (Because of the doorknob thing.)

Keep it clean: School and day-care employees should keep the facility as sanitary as possible, with special attention to toilets, diaper-changing areas and food-handling areas.

Medical guidelines

For certain medical conditions, very specific recommendations or requirements address whether a child should stay out of school.

Below is a list of some of these conditions, with guidance from specialists in pediatric infectious disease.

Please be aware that requirements vary among school districts.

Colds/sore throats/etc.: These illnesses are common and usually on the milder side. They'll probably get passed around, but we just can't keep kids out of school every time they have a stuffy nose. Kids should go to school as long as symptoms aren't severe enough to keep them from participating.

Influenza or flu-like illnesses: Influenza can be pretty serious and spreads easily. Children should stay home from school and return only after being fever-free without medication for 24 hours.

Strep throat: Kids who have a sore throat and a positive strep test should stay out of school until they've been on antibiotics for 24 hours. Treating with antibiotics limits the spread and reduces the risk of an extremely rare complication called rheumatic heart disease.

Ear infections: Ear infections are contained within the middle ear and aren't typically contagious. They may or may not need antibiotic treatment, but kids should go to school unless they are so miserable they wouldn't be able to participate.

RSV: Respiratory syncytial virus, or RSV, can cause typical cold symptoms and, in children younger than 2, more severe breathing problems. Just as with other cold viruses, your child's classmates will probably get sick. Fortunately, most of these illnesses will be relatively mild. Unless children are too sick to participate, it's OK for them to go to school or day care.

Conjunctivitis/pinkeye: Conjunctivitis is just inflammation of the eye, and it can be caused by a lot of different things: viruses, allergies and (more rarely) bacteria. Many of these cases are viral and don't require treatment: Yes, it can be spread, but we can't do anything about it. For cases thought to be caused by bacteria, children can return to school after antibiotic drops are started.

Vomiting: If kids are vomiting twice or more in 24 hours, they should stay home from school until their symptoms resolve.

Hand, foot and mouth disease: A common outbreak in day-care facilities, this can cause some painful mouth ulcers and a rash. Kids should be kept at home for fever or if they are unable to control their drooling.

Rash: Rashes can be caused by all kinds of things. Some are contagious and some aren't. In general, a child whose only symptom is a rash is OK to go to school.

Erythema infectiosum (Fifth disease): This is a viral infection common in preschoolers that can cause fever, rash (classically a "slapped-cheek" appearance) and sometimes joint pain or other symptoms. In most healthy children, it resolves without major problems. The rash tends to show up late, after kids are no longer contagious. So if they've had it long enough to figure out that they have it, anybody who was going to get it already has it. Send the child to school.

There are other illnesses that require children to stay out of school, such as measles, mumps chickenpox and pertussis. Fortunately, these diseases are preventable with routine vaccines.