pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Keeping Sick Kids Home from School or Daycare

Oh, for the days when you were sick and you simply stayed in bed. Now, just as we seem to do with everything else, we over-think it to the point of complete distraction. Keeping sick kids home. What about school commitments, work commitments, baby sitters, getting to the doctors, the other kids – home, work, school, Aggghhhh!

Everything seems to interconnected to everything else and besides, are you/they REALLY that sick? How can you tell, has anyone figured this out already, are there any guidelines?

In all our worrying about dealing with the illness of our daily lives we often forget (or minimize) another aspect of concern and that’s the effect merely soldiering on will have on co-workers or co-schoolers. I just thought I’d throw that in the mix too because it should enter into any “algorithm” one invents to help with the decision making.

If you let some kids stay home from school every time they are a little ill they will miss up to a week of school every month. That’s right, the average child has about 100 illnesses before they are ten – just a little less than one a month.

The US Centers for Disease Control and Prevention (CDC) tells us that children typically contract 6 – 12 illnesses per year. They obviously cluster in the winter because of the increased proximity with others in enclosed spaces due to the weather.

Of course the CDC would be worried about the fact that most viruses spread through not only contact but even the air. And, we know that those little infectious “bugs” can even get through the masks worn by hospital workers. So, often you or your child staying home is as much about preventing contagion as it is healing from your illness.

So, what does one do? There are some guidelines, based upon scientific findings, which you can follow in making “does he/she go or stay home” decisions about school and daycare.

too-sick-4-school

  1. Your pediatrician and his office personnel are some of our best ally’s. They not only know what’s going around the community but have dealt with this all before. Most are happy to help when you are uncertain. One caveat – in larger offices you need to talk to some medical personnel, either the doctor or triage nurse, because receptionists often are more geared to merely finding an appointment slot.
  2. If your child complains of not feeling well (and passes the ‘do you have a test today’ interrogation questions) then do a quick physical exam yourself and decide if he has other definite symptoms – if not they probably can attend school. Of course the teacher and/or school nurse will most likely call you if things don’t go right during the day. Be sure to follow up with your child later in the day and contact your doctor if the complaint persists – do it early to avoid surprises tomorrow.
  3. Fever is another issue to consider. We’ve posted about it before and you know that it is not a disease of itself, it means that your body is fighting a disease and can occur even before other symptoms. If your child’s temperature is in the “fever zone” (above 100.5 Fahrenheit) they should stay away from school until it has been gone for 24 hours. Of course, see your pediatrician if there are other associated symptoms or findings or if the fever lasts longer than 2-3 days.
  4. Vomiting is usually an easy decision. If the child is vomiting they should stay home. Nobody, even those kindly nurses, likes a child to vomit at school. Usually the next thing to happen after the vomiting is diarrhea (see below), also not a good thing for obvious reasons. Return to school isn’t until they can tolerate a regular diet without symptoms.
  5. Diarrhea often follows vomiting but can occur on its own and pretty much makes school impossible. If there is blood, abdominal pain or fever see your pediatrician.
  6. A rash associated with fever and other signs is a finding that should probably keep a child home, at least until it can be diagnosed to not be representing something “contagious”. Once the cause can be established, it may be possible to attend school before it has fully resolved. If the rash is scaly or itchy or if there are other symptoms like trouble swallowing or breathing, fever or just “looking ill,” get an appointment with your doctor.
  7. A cough needs to be evaluated based on its severity and “depth.” A light “tickle,” dry cough that doesn’t interfere with sleep or school work and responds to cough drops is ok for school. On the other hand, a productive, deep cough that interferes with sleep, makes school work tough or has phlegm should stay at home. Especially if there is also a fever or trouble breathing which should be seen in the office.
  8. Sore throats don’t usually keep children from school. Most often they are merely a secondary symptom of the mucous running down the back of the throat during a cold. If, however, it is accompanied by painful swallowing, fever or abdominal pain or vomiting they should see the pediatrician before going back to school. There is a test now to check for strep throat which might be valuable, especially if the school or doctor sees the disease going around. Return to school in the case of strep throat is after being on antibiotics for 24 hours.
  9. Of course one of the things that makes us better than computers, who only know to follow guidelines, is simple judgment. If your child just plain looks “really sick” then bring them into the doctors office or even the emergency room.

Not much of what I’ve said above will help reschedule your busy life BUT there are some things that can keep it from getting even more hectic – do everything you can to keep the illness from schlepping around the family!

Do I even need to remind you about good and frequent handwashing, not sharing utensils, kissing, covering mouths (with your elbow) and keeping away from the sick kid as much as possible? In Europe and Japan it is expected custom to wear a mask when you are ill even in public.

Of course these guidelines are assuming that missed school days aren’t excessive – if they are, there are different guidelines for that; but, that’s another article.

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