Deciding whether your child is too sick for school can be a tough call these days. Working parents often feel pressed to send their child so they can get themselves to work. And stay-at-home moms and dads are often tempted to keep their kids home longer than necessary.
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But doctors say there are sure-fire signs and symptoms that can help any parent make the right choice.
The three symptoms that constitute absolute stay-homes are a high fever, vomiting and diarrhoea.
"The fever is the only one that's a little bit of a hard call," says Dr David Fleece, a primary care paediatrician at Temple University Children's Medical Centre in Philadelphia.
"If a child has maybe a fever of 37.7 degrees Celsius and maybe a little bit of a runny nose, but otherwise feels OK, that's maybe a child that you could send to school," Fleece says. "Of course, if they have a fever of 40 degrees Celsius, they absolutely should stay home and they're certainly not going to feel like going anyway."
"So to me, how a child feels is almost more important than the temperature," he adds.
But determining precisely how a child feels can be tricky, adds Dr Jane McGrath, an assistant professor of paediatrics at the University of New Mexico.
"Signs of illness can vary according to the age of the child," she explains. "With a young child, you want to look for things like whether they have lost their appetite, are crankier than usual, are not able to sleep or are behaving differently."
"But in older children, it can be harder to tell because they might minimise their symptoms, especially if they've got something big coming up at school. Or, they simply might not be aware that they have an illness," McGrath adds.
Besides helping a child to recuperate, one of the main reasons for keeping your son or daughter home is to prevent the spread of germs to other students. And while parental theories abound about what's contagious and at what point, experts say accurate information is in short supply.
"It's certainly true that you can spread something such as a cold virus before it has hit you and you have your symptoms," says McGrath. "But it's very hard to say when you are no longer contagious."
Cases in which symptoms may still appear but children are no longer contagious can include scabs from chicken pox, or the telltale marks of ringworm.
One common ailment that frequently prompts parents to be overprotective is pinkeye, an infection of the outer surface of the eye, Fleece says. "Pinkeye is really sort of over-exaggerated in terms of how contagious these kids are," he adds.
"At some places, the first sign of any pinkness in a person's eye and the child is sent home and isn't allowed back without a note from the doctor, and I think that's overkill," Fleece says.
"If a child has a very red eye with lots of discharge, that child should probably stay home," he adds. "But if you have a child with just some mild pinkeye, they should be able to continue to go to school."
But there's little argument that hand washing is the best way to combat the spread of germs.
"So many of the viruses that are passed around in day-care centres and schools are transmitted through respiratory droplets, hand to mouth, hand to eye," Fleece says. "And I think with really good hand washing and basic things like not having kids share cups or objects with microbes on them are the best measures you can take."
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