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Sick Kids I: “SHOULD MY KID GO TO SCHOOL?”

Every kid will get sick. No child escapes!

School children can easily catch from 6 to 9 respiratory infections per year which translates into one cold a month all winter long. Young children in child care outside their homes are exposed to infections before they reach school age. And young children at home get infected by their older siblings.

It’s a no-brainer that parents should use every means possible to prevent illness in their children:

  • Be sure your child’s immunizations are up to date.
  • Avoid contact with obviously sick people.
  • Become a compulsive hand-washer (and teach your kids this compulsion). Wash hands thoroughly after coming into contact with a sick person, blowing your nose, using the toilet, or changing a diaper.
  • Follow the basic principles of good health–nutrition, proper rest, and exercise.
  • Make your house a No-Smoking Zone–passive smoking definitely increases the frequency of respiratory infections in children. Children are also more susceptible to fumes from wood fires–avoid if your child is prone to respiratory infections.

Despite these efforts, some viruses will win and your child will come down with what’s going around.

Now what? How do parents make the necessary decisions? How do parents answer the three big questions: Should I call the doctor? Should I let my child go to school? Should I stay home with my child?

  1. Should I call the doctor? I recommend the three “P’s” to help parents decide.
  • PERSONAL RESPONSE TO ILLNESS. For example, does your child throw up with every cold or is vomiting unusual for your child?
  • PERSISTENCE. Is the symptom lasting longer than you would expect? Jenny usually sniffles for only two or three days but this time her cold has lasted for weeks.
  • PROGRESSION. Is the symptom getting worse?

Of course the time-honored advice pediatricians give to parents always holds. If you are worried, call the child’s doctor.

  • Should my child go to school or child care? Your decision will depend on the answers to three questions, not one.
  • Is it OK for the sick child to go out of doors? Generally children with colds will not be harmed by going out of doors to get to school or the sitter’s house. If it is cold outdoors, it’s a good idea to wrap a light scarf around the child’s face so he or she won’t have to breathe cold air because this can increase the nasal secretions and make the child miserable. Children with temperatures higher than 101 are usually in the throes of a major infection and should be kept quiet at home.
  • Warning! A sick child’s temperature will often go up in the afternoon and your own child’s way of reacting to fever (which usually takes a similar course with each infection) must be taken into account. If you know that every time the twins have a slight temperature in the morning they always spike to 103 by four pm, don’t take them out when the thermometer reads 100.8 at 8 am.
  • Is it OK for your child to be near other children? Never send a child with a communicable disease like chicken pox or measles to school, child care, or any place where there are other children. Generally children should be kept out of school for six days after the rash appears in the case of chickenpox (four days in the case of measles). All children with infectious hepatitis should be kept away from other children for a week after jaundice develops or the diagnosis is made. Young children with diarrhea or vomiting should also be kept away from other children.
  • It’s best to keep the child with a pouring nose or constant cough away from other children. Unfortunately, the child who today develops symptoms of a cold–or many other infections –was probably shedding virus yesterday when the only symptom was crankiness. A child with an infection like a strep throat being treated with antibiotics should be kept away from other children for the first 24 hours of treatment.
  • Sometimes I prescribe keeping a sick child at home in order to protect the child from exposure to other children because he or she is in a state of low resistance to infection. The child who always seems to get an otitis or asthma attack with every cold often does better if kept at home from when the first sniffle starts.
  • Will your child’s illness get worse if the child is at school or child care? This depends on the illness and the child — mostly the child. Some children seem to breeze through their share of infections easily and it does not seem to matter whether they are out doing their usual thing or kept quietly at home. Others seem to get worse with out-of-home activity, perhaps because they get overexcited or overtired.

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