When can your sick baby go back to nursery: rules and the 48-hour guideline
You are already managing a sick baby, lost sleep, and rearranged work. The last thing you need is to be unsure whether it is safe to send your child back to nursery. This guide brings together the UK's official exclusion guidelines from the UKHSA (UK Health Security Agency) and the NHS so you have clear, reliable answers for the most common illnesses.
The 48-hour rule explained
The best-known nursery return rule is the 48-hour guideline for vomiting and diarrhoea. The UK public health guidance is straightforward: your child should stay away from nursery or any group childcare setting for 48 hours after their last episode of vomiting or diarrhoea.
This rule applies regardless of how well your child appears or feels. A child who vomited once on Monday evening and feels perfectly cheerful by Tuesday morning still needs to stay home until Wednesday evening. The reason is that gastrointestinal viruses such as norovirus and rotavirus are shed in large quantities in stool for days after symptoms resolve, making children highly infectious even when they appear well. Following this rule protects other children, staff, and the families of everyone at the nursery.
Illness-specific return guidelines
Different illnesses have different exclusion periods. The following is based on UKHSA guidance, which is what UK nurseries and childcare settings are expected to follow.
Diarrhoea and vomiting: 48 hours after the last episode of either symptom, whichever came last.
Fever alone (without vomiting or diarrhoea): UKHSA guidance does not specify an exact exclusion period for fever alone, but the NHS advises keeping children home while they are unwell. Most nurseries ask for the child to be fever-free without the help of fever-reducing medicine (paracetamol or ibuprofen) for at least 24 hours before returning. Check your nursery's own written policy, as this is where most variation between settings occurs.
Conjunctivitis (pink eye): Policies vary. For bacterial conjunctivitis, many nurseries ask for 24 hours after antibiotic treatment has started, or until the discharge has fully cleared. For viral conjunctivitis, the usual expectation is that the child stays home until the discharge has resolved. Confirm with your specific nursery, as UKHSA guidance on this is less prescriptive than for gastrointestinal illness.
Impetigo: Children can return 24 to 48 hours after antibiotic treatment has been started and affected areas are covered. Impetigo is highly contagious, so do not send your child before this point.
Scarlet fever: Children can return 24 hours after starting antibiotic treatment, provided they feel well enough. Scarlet fever is a bacterial infection (group A streptococcus) and is notifiable to your local health protection team.
Hand, foot and mouth disease: Children can usually return to nursery once they feel well enough to do so. UKHSA guidance does not require exclusion until the blisters have fully healed. Children are most infectious in the first few days of illness, but the guidance recognises that exclusion for the full duration of the rash is not necessary or practical.
Chickenpox: Children must stay away from nursery until all spots have fully crusted over. This typically takes about 5 to 7 days from the appearance of the first spots. They must not return while any spots are still fluid-filled or open, as these are the infectious stage. A child with crusted-over spots only is no longer considered infectious.
Ringworm: Children can attend nursery as normal, provided the affected area is covered with clothing or a dressing. Treatment should be started promptly.
Molluscum contagiosum: No exclusion is required. Children with molluscum can attend nursery without any restriction, as it spreads very slowly and only through close prolonged skin contact.
Cold or cough without fever, vomiting, or diarrhoea: No exclusion is required under UKHSA guidance. Children with a runny nose and mild cough who are otherwise well and fever-free do not need to stay home. Individual nurseries may have their own more cautious policies, so it is worth knowing what yours says.
Why these rules exist
Nursery exclusion rules exist to protect children who are most vulnerable to complications from infections: very young babies who may be siblings at home, children who are immunocompromised due to illness or treatment, and children with heart or lung conditions who cope less well with respiratory or gastrointestinal infections. When you follow the exclusion guidelines, you are protecting those children, not just managing an administrative requirement.
Notifiable diseases
Some infections must by law be reported to public health authorities. Your nursery has a statutory obligation to notify their local health protection team if a notifiable disease is confirmed in a child at the setting. Notifiable diseases relevant to nurseries include measles, whooping cough (pertussis), meningococcal disease, and scarlet fever. If your child is diagnosed with a notifiable disease, inform your nursery promptly so they can take the appropriate steps.
Getting clarity on your nursery's policy
Nursery exclusion policies must be available to parents. If you are not sure what your nursery's policy says, ask for it in writing when you first enrol, rather than trying to find it at 7am on a day when your child is ill and you have a meeting at 9. Knowing the policy in advance removes one source of stress from an already difficult morning.
If your nursery's policy is more restrictive than UKHSA guidance (for example, requiring a longer exclusion period than the guidelines recommend), they are permitted to do this. If it appears less restrictive than guidelines recommend, it is worth a polite conversation with the nursery manager.
Do you need a GP letter to return to nursery?
The NHS does not recommend that nurseries require a GP letter before a child can return after a routine illness. If your nursery is asking for one, this is their own policy rather than a clinical or legal requirement, and GP surgeries are increasingly declining to write these letters as they take clinical time without adding medical value. If you are being asked for a GP letter for a straightforward viral illness, it is reasonable to raise this with nursery management and refer them to NHS and UKHSA guidance.
Frequently asked questions
What is the 48-hour rule for nursery return?
The UK guideline is that children should stay away from nursery or childcare for 48 hours after the last episode of vomiting or diarrhoea. This applies even when the child feels and looks completely well, because they remain infectious for this window. If the last episode was Monday evening at 6pm, the earliest your child can return is Wednesday evening, making Thursday morning the first practical nursery day.
Can my baby go to nursery with a cough and runny nose?
UKHSA guidance does not require exclusion from nursery for a cough or cold without fever, vomiting, or diarrhoea. Your child can attend if they feel well enough. However, individual nurseries may have their own more cautious policies. Check with your nursery if you are unsure, and use your own judgement about whether your baby is genuinely well enough for a full nursery day.
When can my baby go back to nursery after chickenpox?
Once all the spots have crusted over, which typically takes 5 to 7 days from when the first spots appeared. Your child must not return while any spots are still fluid-filled or open blisters, as that is the infectious stage. A child with only crusted spots is no longer considered infectious and can return to nursery.
Does my baby need to be fully well before returning to nursery?
Not for every illness. The rules are illness-specific. For vomiting and diarrhoea it is 48 hours after the last episode. For fever alone, most nurseries require 24 hours fever-free without medicine. For a cough and cold with no other symptoms and no fever, UKHSA guidance requires no exclusion at all. Your nursery's written policy will give you their specific requirements.
What if my baby gets sent home from nursery with a fever?
Manage your baby's comfort at home with paracetamol or ibuprofen if needed, monitor their symptoms, and ensure they are well hydrated. Follow your nursery's return policy, which typically requires your child to be fever-free without the help of fever-reducing medicine for at least 24 hours before returning. If you are concerned about how your baby is doing, call 111 or your GP.
Does my baby need a letter from the doctor to return to nursery?
The NHS does not recommend requiring a GP letter for return to nursery after a routine illness. If your nursery is asking for one, this is their own policy rather than a clinical or legal requirement. GP surgeries are increasingly declining to write these letters. It is reasonable to refer your nursery to UKHSA guidance if they are requesting a letter for a standard viral illness.
Know exactly when to go back
Cubby logs your baby's last symptom with time and date, so you can calculate the 48-hour return window without any guesswork.
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