Appendix A

Signs and Symptoms Chart Reference for the Health Office

Symptom Common Causes Complaint/Observation Notify Send Home from School Re-admit When Parent Common Cold Viruses Nasal congestion and drainage; cough; watery eyes; fever. Yes No, unless there is fever with Criteria for sending home is behavior change; difficulty breathing; resolved child looks or acts very ill. Cough Common cold; lower Dry or wet cough; runny nose; sore throat; hoarse voice; Yes No, unless there severe cough; rapid Criteria for sending home is respiratory infection barking cough. and/or difficulty breathing; wheezing resolved (pneumonia); croup; asthma; that is not responsive to inhaler; sinus infection; bronchitis. cyanosis Diarrhea Usually viral; less commonly Frequent loose stools compared to child’s normal pattern; Yes Yes, if diarrhea is causing accidents No further accidents; cleared bacterial or parasitic. abdominal cramps; fever. for toilet trained children; stool is not by physician for any bacterial contained in diaper; blood or mucus or parasitic infection; able to in stool; fever with behavior change; participate. looks or acts very ill. Difficult or noisy Common cold; croup; Common cold-stuffy nose, sore throat, cough; croup- Yes Yes, if child has difficult or labored Criteria for sending home is breathing asthma; bronchitis; barking cough, hoarse, fever; very noisy breathing; breathing; fever accompanied by resolved epiglottitis; pneumonia; Asthma- child is working hard to breath, rapid breathing, behavior changes; child looks or acts object stuck in throat. wheezing; Epiglottitis- gasping for breath with mouth wide very ill; blue color to lips/skin; new open, high fever, drooling, cyanotic. onset of wheezing; child with known diagnosis of asthma does not respond to rescue inhaler.

Earache Bacterial or viral; often occurs Fever, pain or irritability; difficulty hearing; blocked ears; Yes No, unless unable to participate or Criteria for sending home is with common cold. drainage, swelling around ear. has fever with behavior change. resolved Eye Irritation, Bacterial or viral Bacterial infection- pinkeye with yellow/green discharge Yes No, unless child is too ill to Criteria for sending home is Pink Eye conjunctivitis; allergic or that is crusted on eyelids in morning. Viral infection- participate. resolved chemical irritation. pinkeye with swelling and watery discharge. Allergic and Yes, if student has severe sensitivity chemical irritation- red, tearing and itchy eyes, runny nose to light, pain or swelling- seek medical attention for evaluation. Fever Viral, bacterial or parasitic Flushing, tired, irritable, decreased activity. Fever alone is Yes No, unless fever is 100.5 or more Criteria for sending home is infection; overheating; not harmful. Elevated body temperature is defense against orally (or 101 taken rectally, by ear or resolved; Able to participate reaction to medication. infection. Rapid elevation of temperature sometimes temporal scan); behavior change; triggers a febrile seizure in children 6 and under. unable to participate. Headache Bacterial or viral infection; Tired an irritable. May occur with other symptoms. Yes No, unless child is unable to Able to participate other noninfectious causes. participate. A case of sudden, severe headache with vomiting and stiff neck might signal meningitis and requires prompt medical evaluation. Adapted from American Academy of Pediatrics Managing Infectious Diseases in Child Care and Schools. This chart is for references purposes, not for distribution. Developed by Howard Taras, MD, Consulting School Physician, San Diego Unified School District, used by permission of San Diego Unified School District. Approved for countywide distribution by San Diego Health & Human Services Agency - Public Health, January 2012

1 of 2 Symptom Common Causes Complaint/Observation Notify Send Home from School Re-admit When Parent Itching Ringworm; chickenpox; Ringworm- itchy ring shaped patches on skin or bald Yes; Yes, for chicken-pox, scabies and Criteria for sending home is pinworm; scabies; allergic or patches on scalp; Chickenpox- blister like spots on face, notify impetigo. For ringworm, student resolved. For conditions that irritant reaction; dry skin or scalp and body, irritable, fever; Pinworm- anal itching; school may stay in school until the end of require topical treatment eczema; impetigo. Scabies- severely itchy red bumps on warm areas of body, nurse/ day if lesion can be covered. If and/or oral medication, especially between fingers and toes. public lesion cannot be covered, send student may return 24 hours health home. Seek medical attention for after treatment is started. if treatment of scabies, impetigo and Chicken-pox- all lesions must cluster ringworm. be crusted over. of cases Mouth Sores Oral thrush (yeast infection); Oral thrush- white patches on tongue and along cheeks. Yes No, unless drooling steadily related Able to participate. herpes or coxsackievirus Herpes or coxsackievirus infection- pain on swallowing; to mouth sores, unable to infection; canker sores. fever; yellowish spots in mouth; fever blister. Canker sores- participate. . painful ulcers on cheeks or gums. Rash Many causes. Viral- roseola Skin may show similar findings with many different causes. Yes; Yes, if rash is undiagnosed/treated; On antibiotic ointment at infantum, fifth disease, Determining causes of rash requires evaluation by health notify rash is accompanied with fever and least 24 hours. Able to chickenpox, herpes virus, professional. Viral- each viral rash may have a distinctive school behavior change; joint pain is participate in daily activities. warts; cold sores; shingles. appearance. Usually signs of general illness with fever, nurse/ present with rash; drainage from Criteria for sending home is Skin infections and runny nose, cough. Minor skin infections- see itching. More public any lesions; bruising not associated resolved. infestations- ringworm; serious skin infections: redness, pain, fever, pus. Severe health with injury scabies; impetigo; abscess; bacterial infections are rare- fever, rash, and very ill. if cellulitis. cluster of cases Sore Throat Viral- common cold viruses Viral- complaint of sore throat and cold symptoms. Strep- Yes No, unless unable to swallow; Able to swallow. Able to that cause upper respiratory throat- red tissue with white patches; enlarged tonsils and excessive drooling with breathing; participate. On medication at symptoms. Strep throat. swollen lymph nodes. fever with behavior change. least 24 hours (if strep). Stomachache Viral gastroenteritis or strep Vomiting and diarrhea or cramping are signs of viral Yes No, unless severe abdominal pain or Pain resolves. Able to throat. Problems with internal infection. Problems with internal organs of abdomen- pain after injury; diarrhea or participate. organs of abdomen such as persistent severe pain in abdomen. vomiting; bloody/black stools; fever intestine, colon, liver, with behavioral change. bladder. Vomiting Viral infection of stomach or Diarrhea, vomiting and/or cramping for viral Yes Yes, if vomited more than 2 times in Vomiting ends. intestines. Coughing strongly. gastroenteritis. 24 hours; vomiting and fever; recent Other viral illnesses with history of head injury; looks or acts fever. very ill.

Adapted from American Academy of Pediatrics Managing Infectious Diseases in Child Care and Schools. This chart is for references purposes, not for distribution. Developed by Howard Taras, MD, Consulting School Physician, San Diego Unified School District, used by permission of San Diego Unified School District. Approved for countywide distribution by San Diego Health & Human Services Agency - Public Health, January 2012

2 of 2