SYMPTOMS |  any symptom that prevents a child from participating meaningfully in routine activities is cause to stay home.

OK TO ATTEND WITH MILD SYMPTOMS as long as both of the following are true:

• symptoms are improving & do not interfere with routine activities -  and -
• no fever has been present for at least 24 hours (without the use of fever-reducing medications)

STAY HOME IF  symptoms are not improving, worsening, or severe enough that child has difficulty participating in routine activities, or if any of the following symptoms are present:

• diarrhea  - see “Diarrhea” for return guidance 
• vomiting - see “Vomiting” for return guidance
• fever (100.4°F or higher) - see “Fever” for return guidance

RETURNING TO SCHOOL 

When going back to normal activities it is recommended that students and staff take additional precautions for the next 5-10 days such as:

• ensure symptoms continue to improve (and no fever for at least 24 hours without medication)
• child can comfortably participate in routine activities
• Increase handwashing
• If respiratory illness (including COVID)
  • CDPH recommends students mask around others for 5 days after symptoms start 
  • Cal/OSHA requires employees/adults to mask around others for 10 days after symptoms start (if COVID)

⚠ SEEK IMMEDIATE MEDICAL ASSISTANCE IF:

• ⚠  acting strangely, becomes less and less responsive (unusually sleepy), or is unconscious
• ⚠ difficulty breathing or is unable to speak
• ⚠  blue, purple or gray skin or lips
• ⚠ throat-closing, tongue swelling, or significant trouble breathing (severe allergic reaction/anaphylaxis)
• ⚠  rhythmic jerking of arms and legs and loss of consciousness (seizure), unless otherwise directed by a current seizure action plan for a child with known prior seizures
• ⚠  a stiff neck, headache, and fever - see “Fever” for return guidance
• ⚠  any of the following symptoms after a head injury: confusion, decreased level of alertness, headache, vomiting, irritability, or difficulty walking
• ⚠  increasing or severe pain anywhere
• ⚠   cut or burn that is large or deep or will not stop bleeding
• ⚠  vomiting blood

⚠ - seek medical attention

When in doubt about whether to call EMS (911), make the call.

Source: California Department of Public Health - Symptoms of Illness in Schools

Current guidelines are for students and staff to stay home and away from others if they have respiratory virus symptoms during the infectious period.

SYMPTOMS | may include runny/stuffy nose, sore throat, sneezing, congestion, body aches, fever, chills, fatigue, headache, and/or cough, typically lasting up to 7-10 days

OK TO ATTEND WITH MILD SYMPTOMS  as long as both of the following are true:

• symptoms are improving & do not interfere with routine activities -  and -
• no fever has been present for at least 24 hours (without the use of fever-reducing medications)

STAY HOME IF symptoms are not improving, worsening, or severe enough that child has difficulty participating in routine activities, or if any of the following symptoms are present:

• symptoms prevent participation in routine activities
• diarrhea  - see “Diarrhea” for return guidance 
• vomiting - see “Vomiting” for return guidance
• fever (100.4°F or higher) - see “Fever” for return guidance
• ⚠ difficulty or rapid rate of breathing - or wheezing
• ⚠ cough is severe of difficulty catching breath after coughing 
• ⚠ coughing associated with asthma that cannot be controlled by medication (like albuterol)
• ⚠ wheezing or breathing difficulties, even if mild

⚠ - seek medical attention

STAY HOME (EMPLOYEES / ADULTS)

Per Cal/OSHA requirements,  employees/adults must stay home during the infectious period, defined as one of the following: 

1. For cases with symptoms: the infectious period is at least 24 hours from the day of symptom onset
2. For cases without symptoms: there is no infectious period. 

RETURNING TO SCHOOL  (STUDENTS) 

When going back to normal activities it is recommended that students and staff take additional precautions for the next 5-10 days such as:

• ensure symptoms continue to improve (and no fever for at least 24 hours without medication)
• child can comfortably participate in routine activities
• frequent hand washing is recommended
• masking for during/after respiratory illness
  • For all respiratory illnesses (including COVID) CDPH recommends students mask around others for 5 days after returning to school and resuming routine activities.

*Note: masking guidance is different for employees with COVID. Cal/OSHA requires masking around others for 10 days after symptoms start (or date of positive COVID test – if no symptoms)

RETURNING TO SCHOOL  (EMPLOYEES / ADULTS) 

Please note that Cal/OSHA  sustains certain additional requirements for employees (adults in schools).

1. Cases with symptoms may return if 24 hours have passed with no fever (without the use of fever-reducing medications) AND their symptoms are mild and improving.
2. Cases with no symptoms do not need to stay away from work. If symptoms develop, the criteria above will apply.

MASKING AT WORK  (EMPLOYEES / ADULTS) 

Per Cal/OSHA requirements,  adult/employee COVID-19 cases may return after the infectious period (see above) and must wear a mask indoors:

1. Cases with symptoms: 10 days from the start of symptoms
2. Cases without symptoms: 10 days from the first positive test

*Note that this is different from student guidance which is to mask around others for 5 days after returning to school.

.

Source: California Department of Public Health - Symptoms of Illness in Schools

SYMPTOMS |  wheezing (high-pitched sounds) that can be heard when a child breathes in or out, chest retractions (see below) OR extra effort is required to breathe

OK TO ATTEND WITH MILD SYMPTOMS as long as both of the following are true:

• symptoms are improving & do not interfere with routine activities -  and -
• no fever has been present for at least 24 hours (without the use of fever-reducing medications)

STAY HOME IF  symptoms are not improving, worsening, or severe enough that child has difficulty participating in routine activities, or if any of the following symptoms are present:

• symptoms prevent participation in routine activities
• diarrhea  - see “Diarrhea” for return guidance 
• vomiting - see “Vomiting” for return guidance
• fever (100.4°F or higher) - see “Fever” for return guidance
• ⚠ wheezing that is new for the child or cannot be controlled by medications (e.g., albuterol) for known conditions (e.g., asthma)
• ⚠ skin or lips seem purple, blue, or gray, depending on skin tone 
• ⚠ behavior changes 
• ⚠ very rapid breathing or increased effort to breathe, such as chest retractions (space between ribs sinks with each breath), belly breathing (belly goes up and down with breathing) 
• ⚠ breathing problem that causes child to have pursed lips, difficulty speaking, or difficulty feeding
• ⚠ any breathing difficulties, even if mild

⚠ - seek medical attention

RETURNING TO SCHOOL 

When going back to normal activities it is recommended that students and staff take additional precautions for the next 5-10 days such as:

• ensure symptoms continue to improve (and no fever for at least 24 hours without medication)
• child can comfortably participate in routine activities
• frequent hand washing is recommended
• masking recommended for 5 days (students) and required for 10 days (employees/adults - if COVID per Cal/OSHA)

.

Source: California Department of Public Health - Symptoms of Illness in Schools

SYMPTOMS | pain experienced anywhere between the chest and groin; pain may be continuous or may come and go

OK TO ATTEND WITH MILD SYMPTOMS  as long as both of the following are true:

• symptoms are improving & do not interfere with routine activities -  and -
• no fever has been present for at least 24 hours (without the use of fever-reducing medications)

STAY HOME IF symptoms are not improving, worsening, or severe enough that child has difficulty participating in routine activities, or if any of the following symptoms are present:

• symptoms prevent participation in routine activities
• diarrhea  - see “Diarrhea” for return guidance 
• vomiting - see “Vomiting” for return guidance
• fever (100.4°F or higher) - see “Fever” for return guidance
• ⚠ no urine for 8 hours, or upon waking up 
• ⚠ bloody or black stools 
• pain starts after an injury

⚠ - seek medical attention

RETURNING TO SCHOOL 

When going back to normal activities it is recommended that students and staff take additional precautions for the next 5-10 days such as:

• ensure symptoms continue to improve (and no fever for at least 24 hours without medication)
• child can comfortably participate in routine activities
• frequent hand washing is recommended

.

Source: California Department of Public Health - Symptoms of Illness in Schools

SYMPTOMS | red or pink appearance to the white part of the eyeball. Child’s eye may also be itchy, have crusted/matted eyelashes, more watering than normal, or yellow/white drainage

OK TO ATTEND WITH MILD SYMPTOMS  as long as both of the following are true:

• symptoms are improving & do not interfere with routine activities -  and -
• no fever has been present for at least 24 hours (without the use of fever-reducing medications)

NOTE: In general, it is no longer recommended to exclude students from school for Pink Eye as long as symptoms are not interfering with their ability to participate and a fever, diarrhea, and/or vomiting is not present. 

STAY HOME IF symptoms are not improving, worsening, or severe enough that child has difficulty participating in routine activities, or if any of the following symptoms are present:

• symptoms prevent participation in routine activities
• diarrhea  - see “Diarrhea” for return guidance 
• vomiting - see “Vomiting” for return guidance
• fever (100.4°F or higher) - see “Fever” for return guidance
•  ⚠  problems seeing (vision changes) 
•  ⚠ pain begins after an injury to the eye involving forceful impact to or penetration of the eye
•  ⚠ pain or discomfort the child cannot tolerate

 ⚠ - seek medical attention

RETURNING TO SCHOOL 

When going back to normal activities it is recommended that students and staff take additional precautions for the next 5-10 days such as:

• ensure symptoms continue to improve (and no fever for at least 24 hours without medication)
• child can comfortably participate in routine activities
• frequent hand washing is recommended

Note:  Pink eye (i.e., conjunctivitis) is inflammation of a layer that covers much of the eyeball. It is most often caused by a virus, and children with viral pink eye typically get better after 5-6 days without antibiotics. Staying home from school or child care is not necessary. Frequent hand washing should be encouraged. Eye irritation can also result from allergies or ch​​emical exposures (e.g., air pollution, smoke, or swimming in chlorinated pool water).

.

Source: California Department of Public Health - Symptoms of Illness in Schools

SYMPTOMS |  an oral (under the tongue), temporal (forehead), rectal, or axillary (underarm) temperature above 100.4°F (38°C). Axillary (underarm) measurements should be used only if other options are not available. Follow instructions for the specific thermometer, including directions for use, cleaning and covers (if applicable). If a temperature is close to 100.4°F, repeat to confirm the result

STAY HOME  (unless otherwise directed by a healthcare provider) a child with a fever should NOT attend school or child care. 

RETURNING TO SCHOOL 

• Fever went away in the night – without using fever reducing medications, e.g., Tylenol®, Advil®, Motrin® (acetaminophen or ibuprofen) - and is still gone in the morning; AND
• child can comfortably participate in routine activities

.

Source: California Department of Public Health - Symptoms of Illness in Schools

SYMPTOMS | pain experienced in any part of the head ranging from sharp to dull; may occur along with other symptoms

OK TO ATTEND WITH MILD SYMPTOMS  as long as both of the following are true:

• symptoms are improving & do not interfere with routine activities -  and -
• no fever has been present for at least 24 hours (without the use of fever-reducing medications)

STAY HOME IF symptoms are not improving, worsening, or severe enough that child has difficulty participating in routine activities, or if any of the following symptoms are present:

• symptoms prevent participation in routine activities
• diarrhea  - see “Diarrhea” for return guidance 
• vomiting - see “Vomiting” for return guidance
• fever (100.4°F or higher) - see “Fever” for return guidance
• ⚠ Concussion symptoms:  Pain occurs after a fall or other injury to the head and is severe or associated with vomiting, vision changes, behavior change, or confusion 
• ⚠ Possible infection:  Stiff neck, headache and fever can be symptoms of meningitis a potentially serious infection. Meningitis can also cause sensitivity to light, vomiting, and/or confusion. A stiff neck is most concerning if the child can’t look at their belly button (putting chin to chest) due to pain or the BACK of the neck is painful (not soreness in the sides) along with the other symptoms above

 ⚠ - seek medical attention

RETURNING TO SCHOOL 

When going back to normal activities it is recommended that students and staff take additional precautions for the next 5-10 days such as:

• ensure symptoms continue to improve (and no fever for at least 24 hours without medication)
• child can comfortably participate in routine activities
• frequent hand washing is recommended

.

Source: California Department of Public Health - Symptoms of Illness in Schools

SYMPTOMS | an area of the skin that has changes in color or texture and may look inflamed or irritated. The skin may be darker than or lighter than normal or red or purple; skin may be, warm, scaly, bumpy, dry, itchy, swollen, or painful; it may also crack or blister

OK TO ATTEND WITH MILD SYMPTOMS as long as both of the following are true:

• symptoms are improving & do not interfere with routine activities -  and -
• no fever has been present for at least 24 hours (without the use of fever-reducing medications)

STAY HOME IF symptoms are not improving, worsening, or severe enough that child has difficulty participating in routine activities, or if any of the following symptoms are present:

• symptoms prevent participation in routine activities
• diarrhea  - see “Diarrhea” for return guidance 
• vomiting - see “Vomiting” for return guidance
• fever (100.4°F or higher) - see “Fever” for return guidance
• rash is worsening, painful, blistering, or not healing 
• oozing, open wound or infection that cannot be covered and is in an area that might come in contact with others 
• skin that looks bruised without a known injury or in an unusual location
• tender, red area of skin, rapidly increasing in size or tenderness
• rapidly spreading dark red or purple rash (may indicate a rare but severe bacterial infection; usually accompanied by fever)
• ⚠ associated symptoms of a serious allergic reaction (rash with throat closing, abdominal pain, vomiting, or wheezing)
• ⚠ concern for a disease like chickenpox or measles

⚠ - seek medical attention

Note: For diagnosed conditions, follow the advice of the healthcare provider. In general, for conditions such as lice, impetigo, ringworm, scabies, and pinworms, no waiting period is typically necessary after starting treatment and the child may return after the appropriate treatment is started.

RETURNING TO SCHOOL 

When going back to normal activities it is recommended that students and staff take additional precautions for the next 5-10 days such as:

• ensure symptoms continue to improve (and no fever for at least 24 hours without medication)
• child can comfortably participate in routine activities
• frequent hand washing is recommended

.

Source: California Department of Public Health - Symptoms of Illness in Schools

SYMPTOMS | pain or irritation of the throat often resulting from a viral or bacterial infection (e.g., cold, flu, strep throat) - which may feel worse when swallowing

OK TO ATTEND WITH MILD SYMPTOMS  as long as both of the following are true:

• symptoms are improving & do not interfere with routine activities -  and -
• no fever has been present for at least 24 hours (without the use of fever-reducing medications)

STAY HOME IF symptoms are not improving, worsening, or severe enough that child has difficulty participating in routine activities, or if any of the following symptoms are present:

• symptoms prevent participation in routine activities
• diarrhea  - see “Diarrhea” for return guidance 
• vomiting - see “Vomiting” for return guidance
• ⚠ fever (100.4°F or higher) - see “Fever” for return guidance - seek medical attention when present with a sore throat
• If antibiotic is prescribed, and first dose is taken within 12 hours
• Inability to swallow
• Fever (see “Fever” for return guidance)
• Breathing difficulties
• ⚠ Excessive drooling or muffled voice

RETURNING TO SCHOOL 

When going back to normal activities it is recommended that students and staff take additional precautions for the next 5-10 days such as:

• ensure symptoms continue to improve (and no fever for at least 24 hours without medication)
• frequent hand washing is recommended
• If antibiotic is prescribed, take the first dose at least 12 hours before returning 
• Consider masking around others 

Source: California Department of Public Health - Symptoms of Illness in Schools

SYMPTOMS | forceful expelling of stomach contents out of the mouth 2 times or more in 24 hours

NOTE:  Not all vomiting is due to an infection, and other causes (e.g., motion sickness, overeating, etc) should be considered.

OK TO ATTEND WITH MILD SYMPTOMS  as long as both of the following are true:

• symptoms are improving & do not interfere with routine activities -  and -
• no fever has been present for at least 24 hours (without the use of fever-reducing medications)
• vomiting ended during the night, and child is able to hold down food or liquids in the morning
• vomiting is due to other non-infections causes

STAY HOME IF if the child has any of the following: 

• symptoms prevent participation in routine activities
• diarrhea  - see “Diarrhea” for return guidance 
• vomiting - see “Vomiting” for return guidance
•  ⚠ fever (100.4°F or higher) - see “Fever” for return guidance - seek medical attention when present with a sore throat
• child has not urinated in the past 8 hours 
• recent head injury
• looks or acts very ill
•  ⚠ concern for a serious allergic reaction, such as hives appearing with vomiting
•  ⚠ vomit appears green or bloody

⚠ - seek medical attention

RETURNING TO SCHOOL

When going back to normal activities it is recommended that students and staff take additional precautions for the next 5-10 days such as:

• ensure symptoms continue to improve (and no fever for at least 24 hours without medication)
• frequent hand washing is recommended
• Consider masking around others 

NOTE: If there is concern for an outbreak (more persons with vomiting than would be expected in the setting for that time of year), contact the local health department as norovirus (PDF) should be suspected and children should not return until 48 hours after symptoms have resolved.

Source: California Department of Public Health - Symptoms of Illness in Schools

SYMPTOMS | itchy head or scalp, a “ticklin” feeling of something moving in the hair, frequent scratching – especially at night when lice are most active. 

OK TO ATTEND WITH MILD SYMPTOMS  as long as both of the following are true:

• symptoms are improving & do not interfere with routine activities -  and -
• no fever has been present for at least 24 hours (without the use of fever-reducing medications)

NOTE: In general, it is no longer recommended to exclude students from school for Head Lice, as long as symptoms are not interfering with their ability to participate and a fever, diarrhea, and/or vomiting is not present. 

STAY HOME IF symptoms are not improving, worsening, or severe enough that child has difficulty participating in routine activities, or if any of the following symptoms are present:

• symptoms prevent participation in routine activities
• diarrhea  - see “Diarrhea” for return guidance 
• vomiting - see “Vomiting” for return guidance
• fever (100.4°F or higher) - see “Fever” for return guidance

CDPH NOTE RE: HEAD LICE IN SCHOOLS

The California Department of Public Health (CDPH) recommends that children should not be excluded from the classroom based on the finding of head lice or nits. (see ‘Historical Policy’ note below)

For the effective control of head lice in schools and child care facilities, CDPH recommends a multipronged approach:

• Distribution of educational materials to parents/caregivers on head lice, nit combing, and treatment.
  • Sample materials include CDPH’s Head Lice Flyer or Fact Sheet (available in English and Spanish). Parents/caregivers can also be directed to visit the CDPH Head Lice webpage for additional information.
• Early detection of head lice infestations through routine screening by parents/caregivers.
• Treatment of children found to have live lice using a combination of lice-killing products and nit combing.

Source: California Department of Public Health - Head Lice

Respiratory Virus Guidance Snapshot

Symptom Guidance - English   Symptom Guidance - Spanish