Wednesday, April 25, 2018
Health

When is a child too sick to go to school?

By Carolyn butler

Washington Post

To send your snot-nosed, hacking child to school or not: That is the question. Whether 'tis nobler to miss yet another round of critical meetings, deadlines or social obligations to nurse him at home or suffer the slings and arrows of angry fellow parents . . . . Well, you get the picture.

The choice may seem obvious — it's certainly more ethical to keep the kid home for the full length of an illness — but it's not always respected, judging by the plethora of sniffling, sneezing, crusty-looking kids in my sons' classrooms. We've all been guilty now and then, though some friends with high schoolers shift blame to their ailing offspring, who fear falling behind on their work.

"It can be hard to know what to do," sympathizes Linda Davis-Alldritt, president of the National Association of School Nurses. She acknowledges that factors such as whether parents have sick leave or emergency child care options often play a huge role. For one thing, the average kid falls ill a lot — with an estimated two to six bouts of the common cold alone every year.

"If you tried to keep every kid home till they're not coughing anymore, there'd be so much missed school they wouldn't get much of an education; the same with runny noses," says Ivor Horn, a mother of two who works as a pediatrician at Children's National Medical Center.

Still, it's important to try to balance school attendance with making sure that an ill child gets the care, rest and attention he needs to recuperate. And then there's the broader obligation to prevent the spread of communicable illnesses.

"Kids are going to get colds and viruses and we can't panic, but you can try to do the right thing for your child, and for the larger community," says Horn.

Here are some pointers:

• Fever. While there is no definitive answer on what constitutes a worrisome fever, Horn says that she starts to get concerned when a child's temperature reaches 100 degrees and that she keeps her own elementary school-age children home when it reaches 101 or higher. And don't jump the gun as soon as the patient appears to rebound: Youngsters should be fever-free without any medication for at least 24 hours before they return to school.

• Vomiting and diarrhea. Kids should be kept home for the duration of gastrointestinal illnesses, plus 24 hours, says Davis-Alldritt.

• Cold symptoms. Typically, it's okay to send your child off to school with a mild sore throat, a cough or a stuffy or runny nose — even if that mucus is a shocking shade of green. Colored mucus really doesn't have anything to do with how contagious you are, explains Horn. But if a child can't control a cough or it's accompanied by phlegm, extra rest or a call to the doctor is probably in order before returning to school, says Davis-Alldritt.

• Energy level. "If your child has been up and not feeling well all night, really, how productive are they going to be in class?" says Horn. "But if they were feeling ill and still have a little bit of a runny nose, but now feel better and are back to running around, you can definitely consider sending them to school."

• Rashes, pinkeye, earaches. These should be checked out by a doctor and dealt with before a child goes to school.

And how about older kids who claim to be nauseated but look just fine, or who have frequent, vague symptoms, such as a headache every Monday morning?

"About 30 percent of children who come through a school nurse's door are there for stress or other mental health issues," Davis-Alldritt says.

Horn cites bullying and test anxiety as more reasons. "Sometimes teenagers are really, really busy; they have too much going on and they need a pause, and it's your parental right to allow them to take that break."

Not every parent is going to get it right every time, says Davis-Alldritt, a mom to three boys of her own. "Even as a nurse I made the wrong call, every now and then, and said, 'I don't see anything going on with you today' — and then I'd get the call to come get them," she says.

So from now on, I promise not to second-guess that parent who sends her son or daughter to school with a wildly contagious stomach virus if you'll cut me some slack the next time I miss a case of strep.

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