Too Sick to go to School?
By Glen Herbert
Photograph by: iStockphoto.com/madisonwi
Throwing up, diarrhea, anything requiring surgery – those are easy calls. But how bad does a runny nose or a cough need to be to warrant a sick day? Or a rash? Or lice? Most things, with the exception of lice (but not for the reason you think) aren’t nearly as cut and dry as we might like them to be.
“It would be so easy if every time children got something, they just stayed home,” says Dr. Sharon Carson, a paediatrician in Burlington, Ontario. However, the reality is that most bugs are most contagious before any symptoms appear. So, we should be asking ourselves whether, at school, our child would receive the level of care they need in order not to get worse. Here’s a good tip: it’s more often the fever, not the sniffles or the cough, that should tip the scales in favour of a home day.
Stay-at-home parents will tend to keep their child home when it’s a marginal decision. It’s a harder call when both parents work and loss of pay or work obligations are a factor.
HOW LONG IS LONG ENOUGH?
If your child has... You're going to be home for a little while...
CHICKEN POX Wait until all the vesicles have crusted over. It usually takes about a week.
HAND, FOOT This is a viral illness of infants and children. There is a risk of dehydration.
AND MOUTH The fever alone would keep them out of school. It’s very contagious,
so they should stay out until the legions are crusted over.
CROUP Keep them out the next day, but they could go back 24 hours after a croup episode.
RINGWORM Should be treated with an antifungal before the child returns to school.
SYMPTOM: Fever
COMMENT: Fever is something we are most at risk of underestimating, or overestimating, and often both at the same time.
WHEN TO GO: The fever is less than 38.3ºC (101ºF)
WHEN TO STAY: If it’s more than 38.3ºC (101ºF)
DR. CARSON SAYS: “If you are concerned about your child’s behaviour – meaning they are irritable, you can’t console them, they aren’t drinking –they should stay home.”
SYMPTOM: Sniffles, runny nose - your basic cold
COMMENT: Colds are common. For kids entering daycare, you can expect 10 to 12 over the course of the winter.
WHEN TO GO: The symptoms are mild, no fever, and aren’t too disruptive.
WHEN TO STAY: If there is also a fever.
DR. CARSON SAYS: “If the cold is preventing the child from remaining hydrated, then they should stay home.”
SYMPTOM: Sore throat
COMMENT: Could be anything from strep to shouting at the hockey game on TV.
WHEN TO GO: It doesn’t show up with any other symptoms.
WHEN TO STAY: If it’s accompanied by a fever, which could indicate strep throat.
DR. CARSON SAYS: “Strep is not highly contagious but most kids feel pretty lousy. I use the general rule that your child should be on antibiotics for 48 hours before you go back.”
SYMPTOM: Rash
COMMENT: Most rashes in younger kids are the result of a virus and most aren’t contagious.
WHEN TO GO: Small bumps, not too itchy, not on the face, not oozing.
WHEN TO STAY: Big bumps, itchy, yellowy, on the face, oozing. If its all of that, see the doctor as it could be impetigo. If it is, stay home for a day after beginning treatment.
DR. CARSON SAYS: “I wouldn’t so much keep them out for the rash, per se, but for the other symptoms that are associated with the rash.”
SYMPTOM: Bloodshot eyes
COMMENT: Pinkeye would be the worry. It can be caused by either a virus or bacteria, though public health policy requires all cases be treated
WHEN TO GO: Bloodshot eyes, both of them and no discharge.
WHEN TO STAY: Bloodshot eyes and a yellowy discharge: Treat today, school tomorrow.
DR. CARSON SAYS: “You should get eye drops. Children should be out for 24 hours before they go back.”
SYMPTOM: Diarrhea
COMMENT: It can be due to many things, and can often be highly infectious as long as it persists.
WHEN TO GO: If it’s not extreme.
WHEN TO STAY: If it’s extreme and not easily controlled, and you are unable to keep the child fully hydrated.
DR. CARSON SAYS: “The general rule is to stay home until the stools become more solid. Most daycares want that to be 24 hours after the last diarrhea stool.”
SYMPTOM: Vomiting
COMMENT: It can be a symptom of many, many things, from nerves to a tropical disease!
WHEN TO GO: It happened just once, hasn’t happened in a while, and the child otherwise seems well.
WHEN TO STAY: If it happens twice.
DR. CARSON SAYS: “I think you should keep them home if the child is vomiting, is definitely infectious to her friends and feels lousy.”
SYMPTOM: Ear Infection
COMMENT: We’ve all had them, and they aren’t fun. Some kids, for whatever reason, get lots of them.
WHEN TO GO: It doesn’t show up with other symptoms.
WHEN TO STAY: It shows up with other symptoms, most notably a fever.
DR. CARSON SAYS: “I don’t think a child needs to stay out with an ear infection unless there is an ear infection with a high fever.”
SYMPTOM: Cough
COMMENT: Coughing is one of nature’s ways of spreading germs.
WHEN TO GO: If it’s mild and that’s all there is. Remind kids to cover their mouths when they cough.
WHEN TO STAY: If it’s uncomfortable or disruptive, or kept them from having a good night’s sleep.
DR. CARSON SAYS: “If the cough keeps them up at night and you are starting to worry that it’s something beyond a cold, they should stay home.”
SYMPTOM: Nits, Eggs
COMMENT: Lice spread rapidly in closed spaces, so are common in childcare centres and schools. There’s also an easy fix, as lice respond quickly to over-the-counter treatment.
WHEN TO GO: After it’s treated.
WHEN TO STAY: Here’s the deal: If suspected at school, the child will be taken down to the office. Once identified, the rest of the class will be checked, too. You can get rid of the nits, but that’s a memory that will last a very, very long time.
DR. CARSON SAYS: “The smartest thing to do is go out, buy the shampoo, do the treatment and send your kid back to school the next day.”
SYMPTOM: "Just doesn't seem himself"
COMMENT: Any child who is sick is not going to seem like himself, or can seem lethargic.
WHEN TO GO: If tired is all it is.
WHEN TO STAY: If there are other symptoms, such as a fever, or if the tiredness is truly remarkable.
DR. CARSON SAYS: “Lethargy is a profound tiredness, and it is difficult to rouse your child. Any child that has a fever will drink less, will be less energetic, will want to lie on the couch, will have less energy... and will need to see a doctor.”
FAKING IT: Sometimes they just don't want to go
The physical symptoms are headache, stomachache and “I just don’t feel well”. The majority of those symptoms, in the absence of fever, rashes or other things that say there is an illness, usually are a manifestation of school problems, anxiety, or some other mood problem. The key is the seriousness of the symptoms. The first time they say it, give them the benefit of the doubt. But if you are getting this once a week and you look at your kid’s attendance and they’ve been sick 35 days of the year, there’s probably something else going on other than recurrent illness.
The Canadian Paediatric Society is an excellent resource whenever you find yourself scratching your head about
a health issue, especially the ‘When Your Child Is Sick’ page: cps.ca/caringforkids/whensick/index.htm
“It would be so easy if every time children got something, they just stayed home,” says Dr. Sharon Carson, a paediatrician in Burlington, Ontario. However, the reality is that most bugs are most contagious before any symptoms appear. So, we should be asking ourselves whether, at school, our child would receive the level of care they need in order not to get worse. Here’s a good tip: it’s more often the fever, not the sniffles or the cough, that should tip the scales in favour of a home day.
Stay-at-home parents will tend to keep their child home when it’s a marginal decision. It’s a harder call when both parents work and loss of pay or work obligations are a factor.
HOW LONG IS LONG ENOUGH?
If your child has... You're going to be home for a little while...
CHICKEN POX Wait until all the vesicles have crusted over. It usually takes about a week.
HAND, FOOT This is a viral illness of infants and children. There is a risk of dehydration.
AND MOUTH The fever alone would keep them out of school. It’s very contagious,
so they should stay out until the legions are crusted over.
CROUP Keep them out the next day, but they could go back 24 hours after a croup episode.
RINGWORM Should be treated with an antifungal before the child returns to school.
SYMPTOM: Fever
COMMENT: Fever is something we are most at risk of underestimating, or overestimating, and often both at the same time.
WHEN TO GO: The fever is less than 38.3ºC (101ºF)
WHEN TO STAY: If it’s more than 38.3ºC (101ºF)
DR. CARSON SAYS: “If you are concerned about your child’s behaviour – meaning they are irritable, you can’t console them, they aren’t drinking –they should stay home.”
SYMPTOM: Sniffles, runny nose - your basic cold
COMMENT: Colds are common. For kids entering daycare, you can expect 10 to 12 over the course of the winter.
WHEN TO GO: The symptoms are mild, no fever, and aren’t too disruptive.
WHEN TO STAY: If there is also a fever.
DR. CARSON SAYS: “If the cold is preventing the child from remaining hydrated, then they should stay home.”
SYMPTOM: Sore throat
COMMENT: Could be anything from strep to shouting at the hockey game on TV.
WHEN TO GO: It doesn’t show up with any other symptoms.
WHEN TO STAY: If it’s accompanied by a fever, which could indicate strep throat.
DR. CARSON SAYS: “Strep is not highly contagious but most kids feel pretty lousy. I use the general rule that your child should be on antibiotics for 48 hours before you go back.”
SYMPTOM: Rash
COMMENT: Most rashes in younger kids are the result of a virus and most aren’t contagious.
WHEN TO GO: Small bumps, not too itchy, not on the face, not oozing.
WHEN TO STAY: Big bumps, itchy, yellowy, on the face, oozing. If its all of that, see the doctor as it could be impetigo. If it is, stay home for a day after beginning treatment.
DR. CARSON SAYS: “I wouldn’t so much keep them out for the rash, per se, but for the other symptoms that are associated with the rash.”
SYMPTOM: Bloodshot eyes
COMMENT: Pinkeye would be the worry. It can be caused by either a virus or bacteria, though public health policy requires all cases be treated
WHEN TO GO: Bloodshot eyes, both of them and no discharge.
WHEN TO STAY: Bloodshot eyes and a yellowy discharge: Treat today, school tomorrow.
DR. CARSON SAYS: “You should get eye drops. Children should be out for 24 hours before they go back.”
SYMPTOM: Diarrhea
COMMENT: It can be due to many things, and can often be highly infectious as long as it persists.
WHEN TO GO: If it’s not extreme.
WHEN TO STAY: If it’s extreme and not easily controlled, and you are unable to keep the child fully hydrated.
DR. CARSON SAYS: “The general rule is to stay home until the stools become more solid. Most daycares want that to be 24 hours after the last diarrhea stool.”
SYMPTOM: Vomiting
COMMENT: It can be a symptom of many, many things, from nerves to a tropical disease!
WHEN TO GO: It happened just once, hasn’t happened in a while, and the child otherwise seems well.
WHEN TO STAY: If it happens twice.
DR. CARSON SAYS: “I think you should keep them home if the child is vomiting, is definitely infectious to her friends and feels lousy.”
SYMPTOM: Ear Infection
COMMENT: We’ve all had them, and they aren’t fun. Some kids, for whatever reason, get lots of them.
WHEN TO GO: It doesn’t show up with other symptoms.
WHEN TO STAY: It shows up with other symptoms, most notably a fever.
DR. CARSON SAYS: “I don’t think a child needs to stay out with an ear infection unless there is an ear infection with a high fever.”
SYMPTOM: Cough
COMMENT: Coughing is one of nature’s ways of spreading germs.
WHEN TO GO: If it’s mild and that’s all there is. Remind kids to cover their mouths when they cough.
WHEN TO STAY: If it’s uncomfortable or disruptive, or kept them from having a good night’s sleep.
DR. CARSON SAYS: “If the cough keeps them up at night and you are starting to worry that it’s something beyond a cold, they should stay home.”
SYMPTOM: Nits, Eggs
COMMENT: Lice spread rapidly in closed spaces, so are common in childcare centres and schools. There’s also an easy fix, as lice respond quickly to over-the-counter treatment.
WHEN TO GO: After it’s treated.
WHEN TO STAY: Here’s the deal: If suspected at school, the child will be taken down to the office. Once identified, the rest of the class will be checked, too. You can get rid of the nits, but that’s a memory that will last a very, very long time.
DR. CARSON SAYS: “The smartest thing to do is go out, buy the shampoo, do the treatment and send your kid back to school the next day.”
SYMPTOM: "Just doesn't seem himself"
COMMENT: Any child who is sick is not going to seem like himself, or can seem lethargic.
WHEN TO GO: If tired is all it is.
WHEN TO STAY: If there are other symptoms, such as a fever, or if the tiredness is truly remarkable.
DR. CARSON SAYS: “Lethargy is a profound tiredness, and it is difficult to rouse your child. Any child that has a fever will drink less, will be less energetic, will want to lie on the couch, will have less energy... and will need to see a doctor.”
FAKING IT: Sometimes they just don't want to go
The physical symptoms are headache, stomachache and “I just don’t feel well”. The majority of those symptoms, in the absence of fever, rashes or other things that say there is an illness, usually are a manifestation of school problems, anxiety, or some other mood problem. The key is the seriousness of the symptoms. The first time they say it, give them the benefit of the doubt. But if you are getting this once a week and you look at your kid’s attendance and they’ve been sick 35 days of the year, there’s probably something else going on other than recurrent illness.
The Canadian Paediatric Society is an excellent resource whenever you find yourself scratching your head about
a health issue, especially the ‘When Your Child Is Sick’ page: cps.ca/caringforkids/whensick/index.htm
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