Assess students and staff with communicable diseases, sudden illnesses, and serious injuries to determine the need to exclude them from school. Exclusion from school should apply to students and staff whose presence poses a significant risk to themselves or others.

Explicit guidelines on exclusion of staff and students help to ensure that those who can safely attend school are not kept home or excluded from certain school activities by overly vigilant parents or school staff. Explicit guidelines also make it easier for schools to protect students and staff when exclusion policies need to be enforced.

Students and staff with a disease, illness, or injury may attend school if their attendance does not pose a significant risk to themselves or others. Exclusion from attending school is warranted when that person is either too ill to participate in school activities, the condition creates an unsafe or unhealthy environment for others at school, or when the illness or injury requires a level of care or observation that cannot be managed at school.

Examples of reasons that justify exclusion, at least until cleared by a health care provider, are: chicken pox, bloody diarrhea, fever, lethargy, sudden breathing difficulties, and any undiagnosed rash that is accompanied by fever.

Students and staff who are well enough to carry on with school functions should not be sent home for colds, bronchitis, or the rash of Fifth Disease, because inclusion in these circumstances has not been found to increase the chances others will become ill. Exclusion from selected activities is also sometimes appropriate (e.g., a student recovering from pneumonia may be exempt from certain vigorous physical activities).

Many other contagious illnesses justify exclusion only under certain circumstances. For example, sores from herpes simplex (the cause of "cold sores" of the lip) and herpes zoster (the cause of "shingles") are not transmitted if they can be covered with clothing or bandages. "Strep throat" is infectious, but not after 24 hours of antibiotic treatment. Head lice are not a danger, only a nuisance. An extended absence for a student whose head lice condition is not treated properly is not warranted. There is no evidence that having only "nits" (the term for eggs that head lice produce) on one's hair is a risk for the spread of head lice to others.

Written protocols can never be so well outlined and up-to-date that they will answer all questions regarding exclusion for every possible situation. There are too many diseases and an almost infinite number of special circumstances, such as emerging diseases like Severe Acute Respiratory Syndrome (SARS). School protocols can affirm, however, that staff will verify whether any state or local law requires exclusion and that decisions will be based on science—not on fear. Utilize authoritative sources (e.g., American Academy of Pediatrics' Red Book (15), local public health offices, the Internet site of the Centers for Disease Control and Prevention) to assist in making determinations on exclusion.

American Academy of Pediatrics. 2000 Red Book 2000: Report of the Committee on Infectious Diseases. Pickering LK, ed. 25th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003.

Taras, HL. Too sick to go to school? Principal. 2002; 81(5):20-21.

Williams LK, Reichert A, MacKenzie WR, Hightower AW, Blake PA. Lice, nits, and school policy. Pediatrics. 2001; 107(5):1011-1015.