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Staying Home Sick


Dear Dr. Lanny:
How do I know when it is necessary to keep my child home sick from school? I know she should stay home if she has a fever, but what about sniffles or stomachache?

Somehow it seems that I always make the wrong decision. If I keep her home, she seems to feel better by midday, and if I send her, I get a phone call from the school nurse that she is not doing well!

I don’t want to send her to school sick, but it’s not easy taking a day off from work.

A: There are two principal reasons to decide to keep your child home from school: 1. Sending him to school will jeopardize his health; 2. Sending him to school will jeopardize the health of other students or teachers.

As is my tendency, I’d like to digress slightly at this time. Staying home from school should not be thought of as going to jail for the day. If your child has to stay home because she might infect other children that doesn’t mean she can’t go outdoors. I am a firm believer that the best medicine for body and soul is fresh air and sunshine. (Yes, this is Syracuse, so fresh air is sometimes all we can hope for but that’s still good.)

Nor does fever mean there is danger in going outside. There is nothing safer about being indoors. Make your judgment based on the child’s condition rather than his temperature.

Another factor is age. For the most part, older children can keep from sneezing, coughing or drooling on fellow students. Unlike a kindergarten student, sending a 15-year-old to school with an upper respiratory infection and a box of tissues is much less likely to infect others.

Similarly, older children with mild diarrhea are not likely to have accidents that could affect other students. There are, however, gastrointestinal illnesses that will make it hard for even the most responsible student to make it to the bathroom in time so, again, use your judgment.

Far and away the circumstance regarding school and day-care attendance that is most frustrating to the doctor is the dreaded “pink eye” or conjunctivitis. It can be caused by bacteria, virus, allergy or irritants like cigarette smoke.

Only the bacteria or virus is contagious and, again, is a lesser concern with older students’ better hygiene. Toddlers and younger children frequently will have very mild symptoms that may be allergic or irritant and will resolve in a day or two without treatment. Unfortunately, day-care centers and schools are very rigid in a policy of exclusion unless the conjunctivitis is treated, so we wind up medicating children who probably don’t need it.

The dilemma, of course, is the parent who can’t work if the child doesn’t go to day care. I am very conservative in my use of antibiotics but will knuckle under in this circumstance. Better the occasional antibiotic than no food on the table.

Stomachaches, headaches, fatigue or injuries are categories that are slightly different. They may not be a danger to your child or others but going to school when in pain or too tired to learn serves no good purpose.

When I was a kid growing up in the wilds of New York City, not only were there no cell phones, iPods or computers, there were no digital or ear thermometers. These hard-to-read (and breakable) alcohol or mercury types did have one great virtue: The thermometer could be rubbed on the sheets vigorously enough to produce a “temperature” adequate to get the day off.

While today’s young people are equally ingenious in faking illness, I would always err on the side of believing them if there is no hard evidence—such as a temperature of 110 degrees—to the contrary.                                                                      ■

Dr. Alan Freshman, father of two grown boys, practices at Syracuse Pediatrics. Consult your own physician before making decisions about your family’s health care. Send e-mail to him at editorial@familytimes.biz.

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