Pediatricians’ offices get bombarded daily with requests from parents for school excuses. What parents don’t realize is that for most situations, a note from the pediatrician is not necessary; parents can write those notes themselves.

By law, the Pennsylvania school year is 180 days. Children are required to attend school for 162 days. That leaves 18 days that children are legally allowed to miss for the following reasons:

  1. Illness
  2. Family emergency
  3. Death of a family member
  4. Medical and dental appointments
  5. Authorized school activities
  6. Educational travel with prior approval (includes college visits)
  7. Religious holidays


In order to be legally “excused” from school for these reasons, a parent must supply a note with the child’s name, date, parent’s signature, and the dates and reason for the absence. (Most school districts provide school excuse forms for parents to download from their websites. Here is one example from a local school district.) Parents have three days to provide a written note to the school in order for the absence to be considered “excused.” Failure to provide a note leads to an “unexcused” or “unlawful” absence. According to the Pennsylvania School Attendance Improvement and Truancy Reduction Toolkit, three unexcused absences lead to trouble:

After a student accumulates three days of unexcused absences, the school must notify the parents that any additional unexcused absences can result in a referral to the magisterial district judge. The judge may impose fines, educational classes, and/or suspend driver license operating privileges. For students under the age of 13 years of age, they shall be referred to a county child and youth agency for possible disposition as a dependent child.


For the typical child who misses a day or two (or three) due to illness, the parent simply needs to send a note back to the school for those days missed to be considered excused. There is no advantage for parents to call the pediatrician’s office for an excuse — both notes are equivalent. 

If your child is sick enough to miss three or more days of school due to one illness, then it’s probably a good idea to call the pediatrician’s office and make arrangements for them to be seen during office hours.

Children can miss up to 10 days of school and receive an excused absence simply by providing a note from a parent. Absences beyond 10 cumulative days requires a note from a health care provider. This is the only time a physician or other provider needs to write a note excusing a child from school: when a child reaches 10 missed school days.

(When a child misses 13 days, the school requires a meeting of the parents and principal. Each day missed after that generates a citation to the magistrate. Parents should receive notices from the school regarding their child’s cumulative absences after 5, then 10, and then any additional days missed after that.)

If a child comes to the office for a sick or well appointment and then heads back to school, of course we will provide a note for that absence to be excused so the parent doesn’t have to write one. (Remember that until 10 cumulative absences are reached, a parental note is just as acceptable as a physician’s note. There is no advantage to you or your child if the note comes from a doctor.)

Which brings us back to the first part of this post: Pediatricians’ offices get inundated with requests for school excuses that just aren’t necessary. Parents should write those notes themselves. 10 days is a lot of days to miss. In fact, most kids don’t even come close to missing 10 days of school each year. Unless a child has a chronic medical condition that necessitates frequent absences due to illnesses or trips to the doctor, no child should miss that much school. So it makes perfect sense that children who miss more than 10 days need to get a note from the doctor — probably after a visit to see that doctor. That is when parents should call us for a doctor’s excuse.

Some rules of thumb about when to send a sick child to school:

  • If they have a fever (temperature greater than 100.4), are vomiting, or have bad diarrhea, please keep your child home until the symptoms pass. If those symptoms become severe, or don’t resolve after three days, please call our office.
  • If they have acute conjunctivitis (very red eye(s) with yellow pus draining from them), keep them home and call our office. We will probably need to see them.
  • Keep them home if they have a particularly severe sore throat, cold, or cough. Call us if  they can’t swallow, are having difficulty breathing, or you are especially concerned.
  • Children with lice can be sent to school once they receive a treatment.
  • Children diagnosed with strep throat can go back to school 24 hours after starting antibiotics if they are feeling better. (Evidence suggests going back even sooner may be safe.)
  • For everything else, use your discretion. It’s okay to send your child to school even if they are not feeling 100%. Sometimes we all have to play a little hurt!



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