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Providence Health & Services
Swedish Health System | Seattle, WA
Kadlec Regional Medical Center | Richland, WA
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How sick is too sick for school? What I learned, and what parents should know

Here's a scene that plays out in my house several times each school year: it’s crunch time for my family’s chaotic morning rush to get the kids to school and the adults to work. One of my kids has a runny nose that no amount of blowing seems to clear. The carpool leaves in 5 minutes.

My wife and I need to make a quick decision about whether or not to send our kid to school. Keeping her at home could set off a chain reaction of scheduling complications, not the least of which is one parent staying home from work. Sending her to school could mean infecting other kids, her runny nose developing into a full-blown cold, or worse.

If you’re also a parent of school-age kids, then you probably can relate to this struggle.

And, so does the University of Michigan’s C.S. Mott Children’s Hospital, who released a national poll in January, where parents were asked about how they make the decision to give their child a sick day.

Parents differ on decision factors

According to the national poll, the top reasons parents decide to keep a child home from school are concern about their kids getting sicker (60%) and not wanting to spread the illness to classmates (47%). These reasons were cited more often by parents children 6-9 years.

Parents also took into consideration what their kids may miss by taking a sick day. Nearly 40 percent of parents worried about their kids missing important lessons or tests at school, particularly parents of high schoolers.

A smaller poll

Out of curiosity, I decided to pose the same poll questions to seven of my colleagues who are parents. The results followed along similar lines as the national poll, but what was more interesting was the additional insight I gathered.

One parent had a protocol in place for monitoring her kids’ symptoms throughout the day via phone, but she said she errs on the side of caution since her kid’s school does not have a full-time nurse to depend on.

A parent of two younger children noted the struggle of not having enough vacation days to take off for every day her kids were sick. That meant enlisting her husband to stay home on some days.

What all of this data points to is a complicated calculus of deciding whether a child should stay home or not. It’s not easy, and it’s not the same for each parent.

So, what’s a parent to do?

Some Guidelines

“There are some symptoms that make a parent’s decision to keep a kid at home easy,” said Ken Kooser, M.D., a family practice physician with Providence Medical Group’s Multi-Service Clinic in Lacey, Wash. “And there are some that are more subjective.”

As a rule, Dr. Kooser recommends keeping kids home until 24 hours after the last episode of diarrhea, vomiting or a fever (without fever-reducing medication). Kids are likely contagious at that stage, and they are probably feeling pretty lousy. He also noted that fevers generally appear at the beginning of a viral illness, and it can get worse, so it’s best to keep feverish kids at home and monitor them, especially younger kids.

Dr. Kooser also recommends not sending kids to school who are experiencing severe ear or head pain.

Trickier Symptoms

When it comes to runny noses and coughing, Dr. Kooser said that deciding whether to keep a kid home from school is a little more difficult. If a child’s cough is uncontrollable, even if it’s dry, a kid should stay home until it starts improving. This is to help limit the spread of diseases like whooping cough.

For kids with runny noses, he recommends assessing the severity—noting that if it’s the first couple days of a running nose, and there is a lot of discharge, then they are probably contagious and should stay home.

With mild runny noses, sore throats or mild coughs, rather than looking at a single symptom, it’s best to look at the child’s overall behavior: Are they fatigued? Do they have a headache? Have their symptoms interfered with getting a good night’s sleep? Would they benefit from resting? If a kid is too uncomfortable to benefit from school, then they may be better off resting and recovering more quickly.

Do your best with what you know

When deciding whether to send your child to school, Dr. Kooser says that there is not always a right answer. He advises to “do the best you can with the knowledge you have.” The first two to three days of a virus is when it is most likely to be contagious. It is important to evaluate your kid’s condition during those days. Parents of younger kids may have a harder time since younger children are less precise about describing their symptoms.

It’s a judgment call and not an exact science. If a child gets sicker after having sent them to school, don’t be too hard on yourself. It can be difficult to know exactly how symptoms may progress or go away.

A handy tip

One way to help keep colds from spreading in your home and to your kids’ classmates is by practicing good hand hygiene. Hand washing can help prevent the spread of viruses from hands to objects like doorknobs, food and countertops.

Faking it?

Another concern that some parents have is that their child may be faking illness. Tummy aches and headaches are two symptoms that Dr. Kooser said are common complaints of children who are pretending to be ill. These two symptoms can be hard to measure. However, they can also potentially be symptoms of more serious illnesses. If you suspect your child is pretending to be sick, look for patterns such as feeling sick after weekends, not showing any other signs of illness, or if there is something your child is wanting to avoid at school.

Prepared for next time

Speaking with Dr. Kooser and gaining insight from his measured, informed approach has made me feel a little better prepared for the next time one of my kids is feeling sick. Even though there is no surefire way to always make the right decision on whether to send a sick kid to school, hopefully the guidelines and other information here will also be helpful to the readers of this blog.

When in doubt

One important message from Dr. Kooser is that if you are concerned about your child’s symptoms you should bring him or her to a doctor for evaluation.

So, what factors do you use to decide whether to send your kids to school when they’re not feeling 100 percent? Let us know in the comments section below.

Categories: Children's Health
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