School nurses handle far more than scraped knees. They assess injuries, manage chronic conditions like asthma and diabetes, screen for contagious illnesses, and even catch early signs of mental health struggles. Knowing when to visit the nurse’s office helps students get the right care at the right time and keeps classrooms healthier for everyone.
Fever and Stomach Illness
A temperature over 100.4°F (38°C) is the standard threshold for being sent home from school. If your child feels warm, clammy, or “off,” a quick trip to the nurse’s office can confirm whether a fever is present. Students sent home with a fever need to be fever-free for a full 24 hours, without fever-reducing medicine, before they can return.
Vomiting and diarrhea follow a similar rule. The CDC recommends staying home if a student has vomited more than twice in the past 24 hours or has diarrhea severe enough to cause accidents, contain blood, or produce more than two extra bowel movements beyond what’s normal for that child. If any of these symptoms develop during the school day, the nurse will assess the situation and call a parent or guardian for pickup.
Contagious Conditions: Pink Eye, Lice, and Rashes
Pink eye is one of the most common reasons parents wonder about school exclusion, but current guidelines are more relaxed than many people expect. Students with bacterial or viral conjunctivitis do not need to be excluded unless they can’t participate in normal activities. Antibiotics are not required for return. If your child’s eye is red but they feel fine and can function, the nurse may let them stay.
Head lice are handled differently. A student with live lice is typically excluded at the end of the school day and can return once treatment has started and live lice have been removed. The nurse can confirm a case and walk families through next steps. Personal items like towels and hats should not be shared, but classmates aren’t excluded just because of exposure.
Skin sores that are draining fluid and can’t be covered with a bandage are another reason to see the nurse. If they can be properly bandaged, the student can usually stay. A new rash combined with a fever is a stay-home situation.
Head Injuries and Concussions
Any blow to the head during recess, gym, or sports warrants a nurse visit, even if the student says they feel fine. Concussion symptoms sometimes take hours to appear. The nurse will watch for warning signs and decide whether a student can stay at school, needs to go home, or requires emergency care.
Certain symptoms after a head impact are emergencies. According to CDC guidelines, a student should go to the emergency department if they develop a headache that keeps getting worse and won’t go away, repeated vomiting, increasing confusion or agitation, drowsiness or difficulty waking up, slurred speech, weakness or numbness on one side, seizures, or loss of consciousness. These can signal brain swelling, which is rare but life-threatening.
Even milder symptoms like brief dizziness, difficulty concentrating, or sensitivity to light should prompt a call to parents so the student can be evaluated by a healthcare provider.
Asthma Flare-Ups
Students with asthma should visit the nurse when they notice coughing, shortness of breath, chest tightness, or wheezing that isn’t responding to their usual routine. Many children with asthma have an action plan on file in the nurse’s office, which spells out exactly what steps to take based on symptom severity.
Some students use a peak flow meter at school to measure how well air is moving through their lungs. The readings fall into color-coded zones, like a traffic light. Green means breathing is on track. Yellow signals caution and usually means it’s time for a rescue inhaler. Red means the student needs immediate help. The nurse uses these readings, along with other factors like what triggered the episode and whether the child has a fever, to decide whether the student can stay at school or needs to go home.
Diabetes and Blood Sugar Checks
Students with Type 1 diabetes often visit the nurse’s office several times a day for blood sugar monitoring, insulin, or snacks. This is routine, not a sign that something is wrong. The nurse follows an individualized care plan created with the student’s doctor and family.
Outside of scheduled visits, a student should head to the nurse immediately if they feel symptoms of low blood sugar (shakiness, sweating, confusion, irritability) or high blood sugar (excessive thirst, frequent urination, fatigue). Both situations require a blood sugar check and a specific response outlined in the care plan. Severe low blood sugar is a medical emergency that may require a glucagon injection, which trained school staff can administer.
Medication at School
Students cannot take any medication at school, including over-the-counter options like ibuprofen or allergy pills, without proper paperwork. Schools require written authorization from both a parent or guardian and, in many cases, a prescribing healthcare provider before the nurse can give any medication. This applies to daily prescriptions and one-time doses alike.
If your child needs to take medication during school hours, contact the nurse’s office before the first day it’s needed. You’ll typically fill out a form specifying the medication, dose, and timing. The medication must be in its original labeled container. Without this documentation, the nurse cannot legally administer it.
Frequent Visits and Mental Health
A pattern of repeated nurse visits for vague physical complaints, especially stomachaches, headaches, or fatigue that don’t have an obvious medical cause, can be an early signal of something emotional. School nurses are trained to recognize these “frequent visitors” and gently explore whether stress, anxiety, bullying, or other mental health concerns might be driving the physical symptoms.
This doesn’t mean every stomachache is psychological. But when a student shows up to the nurse’s office multiple times a week with complaints that resolve quickly or don’t match any clear illness, the nurse may connect the student with a school counselor or recommend that parents follow up. School nurses sit at a unique intersection: students trust them enough to come in with a physical complaint even when the real problem is harder to name.
Respiratory Symptoms That Are Getting Worse
Coughs and sniffles are a constant presence in schools, and not every sniffle needs a nurse visit. The line to watch for is whether respiratory symptoms are worsening rather than improving. A student whose cough is getting deeper, whose congestion is increasing day over day, or who is visibly struggling to breathe should see the nurse. Symptoms that are clearly caused by seasonal allergies, like the same itchy-nose pattern every spring, are generally not a reason for exclusion. The nurse can help distinguish between allergies and something that might be contagious.