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TOO SICK FOR SCHOOL?
By Robert Needlman, M.D.

The top five illnesses that keep kids home—and how to treat them

Chances are, your child has already been too sick for school at least once this winter. The average preschooler has five or six minor illnesses each school year. Younger kids in school or group care are get the most illnesses, since their bodies have not yet built up immunity and they tend to spread germs more readily than older children. Even though the illnesses that cause children to miss school are the common, not-too-serious diseases like ear infections or colds, it can still be tough to know when to keep your child home, and for how long.

Schools have their own policies about which illnesses require children to stay home and for how long. Check with the director, principal, or school nurse to make sure that you don’t send your child in only to find out that the school requires more time at home. Here are the top five most common illnesses that might keep your child home.

1. Ear Infections

You probably won’t be surprised to learn that middle ear infection—otitis media—tops the list for most common illnesses leading to a visit to the doctor for children age 1 to 4. Of the 56,000 doctor visits by preschoolers nationally, 10,000 were for ear infections—more than any other category, including checkups.

The main sign a child has an ear infection is ear pain and/or decreased hearing. But very young children may not be able to tell you about these symptoms so you’ll have to rely on your own observations. Symptoms include: crankiness (especially when lying down, because that increases pressure in the middle ear), pulling at the ear, wanting to be held more than usual, decreased appetite, and fever. Not all children with ear infections run a fever, but a child who is feverish and is pulling at her ear probably has an ear infection.

Treatment: The treatment for ear infections has been changing, as doctors become more sensitive to the danger of bacteria developing resistance to common antibiotics, a risk which is particularly high among young children in group care or preschool. In most cases infections will get better on their own without antibiotics, so consult your doctor about this option. Standard practice is to prescribe a five- or 10-day course of antibiotics in the hope of shortening the illness and reducing the chance of complications such as infection spreading outside of the ear.

It’s important to give your child the full course of any antibiotics prescribed. If there is medicine left over, toss it out. Giving little doses of antibiotics from time to time when your child looks sick is a bad idea: It’s not likely to treat any real infection and actually increases the chance that your child will become infected with a difficult-to-treat germ.
When to keep him home: Many children will be too uncomfortable for school for a day or two. Ear infections are not very contagious, so children can return to school as soon as they’re feeling better. If they seem to be getting worse—more pain or fever, for example—call the doctor, since your child may need a different medication.

2. Coughs and Colds

The second most common cause for a trip to the doctor, and for staying home from school, is the ever-troublesome cold.

Treatment: There are no prescription medications that treat colds, although acetaminophen can help with fever and general achiness. Taking an antibiotic “just in case” actually increases the risk that your child will become infected with bacteria that are resistant to antibiotics. Although there is some evidence that the herbal supplement Echinacea may help in preventing or treating colds, there is still limited information about specific products or doses for children. (There also aren’t tight controls on the potency and purity of the preparations sold in stores, so you have to be very careful about what you purchase.) At one time, zinc supplements looked promising, but more recent research showed they only help children who have actual zinc deficiency to start with, which is rare among children who are otherwise well nourished.

The soundest approach is the old standard: Plenty of fluids, whatever mild foods a child wants, and moderate humidity to keep mucus in the nose from drying out.
When to keep her home: Most schools don’t exclude children with colds, because so many children carry and spread cold viruses—even when they aren’t ill—that keeping the sick ones home doesn’t help. The main reason to keep your child home is to give him extra rest and tender loving care and because he won’t learn much at school if he feels miserable. Most children with colds need to stay home one or two days, if at all.

3. Sore and Strep Throats

While sore throats account for only about 5% of doctor visits for children age 1 through 4, they account for more than their share of school absences. That’s because a child who has been diagnosed with a strep throat—an infection caused by the Group A streptococcus bacteria—has to be treated with antibiotics for at least 24 hours before he is no longer infectious. Preschool-age children seem to be especially susceptible to strep.

Strep throats make children miserable, usually with fever and headache or stomachache, along with pain when swallowing. Untreated, they can sometimes result in rheumatic heart disease or other serious complications.

Fortunately, most sore throats are not actually caused by strep, but rather by a variety of viruses (strep is not a virus, it is a bacterium). The only real way to tell the difference between strep and a virus is by testing, either with a throat culture (which can take two days) or with a rapid strep test, which only takes a few minutes but may be a little less accurate.

Treatment: Children with strep throat require antibiotics, either by mouth or (much less often) injection. Sore throats caused by viruses don’t respond to antibiotics or any of the antiviral medications that are available. The only treatment is soothing fluids, acetaminophen for pain and fever, and lots of love.

When to keep him home: Children with strep should stay home until they are no longer running a fever and have had at least 24 hours of antibiotics. Those with viral sore throats need to be feeling well enough to be up and about—which means they need to be eating again. To keep from passing the virus around, children should practice hand washing and coughing into their crooked elbows (not their hands).

4. Pink Eye (Conjunctivitis)

Most cases of pink eye are caused by the same kinds of viruses and bacteria that cause colds and ear infections. These illnesses are actually quite mild. But there are more serious forms of pink eye, some that can even threaten a child’s vision, so it’s wise to have a doctor examine your child, and not to take chances.

Treatment: For pink eye caused by bacteria, antibiotic eye drops speed healing.
When to keep her home: Many schools exclude children with pink eye, even though most cases are no more contagious than a cold. The concern is to prevent the rare but serious form from spreading. If your child is given eye drops, she will probably be allowed to return to school after 24 to 48 hours.

5. “Morning Sickness”

I’m not talking about what pregnant women suffer from, but rather when a child feels awful in the morning—usually with a stomachache, headache, or other complaint—but then feels fine as soon as it’s clear that he’s staying home. While you might suspect your child of faking the illness, often the symptoms are real enough. The cause is worry or tension about going to school or about leaving you—or both.

Treatment: If you can figure out what is making your child anxious—for example, being picked on by another child or not feeling comfortable with a substitute teacher—you can sometimes treat the cause of the “morning sickness.” But in any case, it’s important that your child gets back to school as soon as possible because the longer he stays out, the harder it is to return. Doctors can also be of help in sorting all of this out, if needed, and in reassuring a child that he is not sick.

When to keep him home: If you think your child has psychologically motivated illness, it’s important that he goes back to school the next day. On the other hand, consider planning a special day when your child gets to stay home with you without having to be sick. Going to school, as wonderful as it is, does take emotional energy. A special at-home day can help recharge both of your emotional batteries.

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