Stay Home Sick or Go to School?

“I don’t feel good. Can I stay home from school today?”
Parents who hear these words need to figure out, “Is my child really ill?  And, if so, is my child’s condition serious enough that he or she is too sick to be in the classroom?”  
Here are answers to common questions to help you navigate this often gray area.
 
How do I know if my child is too sick to go to school?
The truth is, it’s a judgment call that can be difficult. According to the American Academy of Pediatrics (AAP), more than half of children who miss class due to a possible illness are kept home by a parent unnecessarily.
I am often asked, “Should I keep my child home if he has a fever?” The AAP says “Yes.” Keeping your child home will make sure he won’t spread the infection to other children.  Also, if your son is fighting a fever, he may feel cranky, lethargic or fussy and have a harder time paying attention anyway.
A mild stomachache or upset is  not a reason that a child needs to skip school. However, if your child has severe stomach pains or vomits two or more times that morning, I would keep the child home.
Rashes are an important sign to look out for, as it may indicate a serious illness. Schools and daycare centers will not allow a child to attend if he or she is exhibiting a skin rash unless the rash is just an allergic reaction or some type of eczema or irritant that can’t be transmitted to another person. If you’re not sure, check with your doctor.
It all boils down to this: If you think your child is unable to learn because of the severity of the symptoms or if your child requires so much extra tender loving care that he or she will substantially take away resources from other kids, then it’s a good idea to keep your child home.
If I keep my daughter home when she is just beginning to feel sick – runny nose, a light cough or mild sore throat – will that prevent her from developing a full-blown cold?
No. Chances are she is already in an incubation period and there’s not much you can do. A seemingly healthy child may already have an illness for up to 48 hours before actual symptoms develop.
How long is my child contagious to others?
It depends on the illness. A diarrheal illness could be contagious for months. A cough or cold is probably infectious to other kids for only a few days after the cold has begun.
If your child has a strep infection, he or she can go back to class after starting a course of antibiotics. So if your child has seen the doctor at 3 p.m. and begun taking medication, it’s OK to go to school the following morning.
The problem is that sick children often feel worse in the afternoon. In the morning the child may say, “I feel fine.” But by lunchtime, she’s got her head down on her desk. That child needs to be home in bed getting some rest.
If my daughter is home sick, what can I do to help her feel better sooner?
Provide plenty of fluids to keep your child well hydrated. Try water, juice, broth and popsicles.
You can also shorten the duration of a cold by not treating a fever. A fever is the body’s natural response to an infection and is actually not harmful. By giving your daughter fever-reducing medication, you may actually extend her illness by a day.
That being said, your child’s fever can make her very uncomfortable. So your choice comes down to having a child who is sick and miserable for three days, or sick but fairly comfortable for four. As a rule of thumb, for school-age children, if the thermometer reads less than 102 degrees, no medication is needed. But if it’s more than 102 degrees and she’s uncomfortable, consider giving a fever reducer.
Common children’s fever reducers include acetaminophen (Tylenol) and ibuprofen (Advil or Motrin). Be sure to read the instructions or talk to your doctor about the correct dosage and frequency of treatment for your child. Never give aspirin to your child or teen because of the risk of Reye syndrome, a rare but serious disease. For a child of any age, call the doctor if the fever persists daily for more than four or five days.
For younger children, skip over-the-counter cold medicines entirely. These are not safe for children under 4 years of age and generally not advisable until a child is 6 or older. If your child is older than 6, you can try these medications, but they usually aren’t that effective at relieving symptoms. Always read cold medicine labels carefully, follow the dosage information and use the dosage cup supplied.
In general, I recommend parents keep a close eye on their child’s “Misery-Mometer.” If your child is really feeling awful, give her something and keep her warm and comfortable. But the best medicine is usually rest and lots of TLC while the illness runs its course.
Paul Protter, M.D. is a board-certified pediatrician at the Palo Alto Medical Foundation. Advice is not intended to take the place of an exam or diagnosis by a physician.