School attendance is essential to optimize children's education. Most minor illnesses and injuries do not warrant school exclusion, and children need to be excluded from school only for compelling medical reasons. Standardized School Health Offices (SHO) visit logs, from September to November 2010, were examined from 11 elementary and 4 middle schools in the Ocean View School District, Huntington Beach, California to determine incidence of school exclusion. Of 7,606 visits, 1,198 (15.75%) children were sent home from school due to medical reasons. The top 5 medical reasons include: (1) abdominal pain 22.62%, (2) nausea & vomiting 21.04%, (3) upper respiratory infections 14.02%, (4) headache 11.69%, and (5) injuries 7.85%. The number of exclusions in the elementary schools was significantly higher in October than in September or December. The pattern was not repeated in the middle schools. Gastrointestinal causes, conditions associated with significant pain, and contagious diseases were the top three most common reasons for exclusion from school, accounted for 89% of all exclusions. School health office personnel need to be educated on the appropriate evaluation and management of the above conditions. Over the counter pain medications should be allowed to be dispensed when indicated.