It’s six-thirty in the morning. You go into your child’s room to wake her up for school, and you find a sniffling, coughing little one asking to stay home. Of course you have a huge presentation at work that morning and your husband is out of town on business. What should you do? Many parents face this question throughout the school year, and under the pressures of demanding careers, struggle to make the right decision.
There are times when the answer is obvious, but there is more often a gray area that results in stress, uncertainty, and guilt for us parents. As a school nurse, I frequently offer advice to parents on how to handle these unexpected early morning dilemmas.
Fever: Stay Home!
It is always amazing to me how many parents try to get around a fever. If your child has a temperature above a hundred, keep her home. This cannot mean give your child Tylenol at six and recheck the temperature at seven to see if the medicine has worked and the fever is gone. Your child must be fever-free for twenty-four hours without the use of an antipyretic, such as Tylenol or Advil, before sending her back to school. There truly is scientific research that supports this; it’s not just an arbitrary time period meant to make parents’ lives more difficult. An article published in the Journal of Infectious Disease (May 2010) addressed several key points regarding “viral shedding” – or the spread of a virus: viral shedding peaked one day prior to the resolution of fever; viral shedding decreased as symptoms decreased; and patients with a higher fever could be more contagious. So what does all of that mean? Keep your child home for twenty-four hours after a fever resolves.
Cold Symptoms: Go to School!
This one is tough, and parents really struggle with it, particularly if there’s a cough involved. If your child has a runny nose, cough, and no fever, it’s okay to send him to school. Don’t feel guilty. Even with a lingering cough, it’s okay. A cough with no other symptoms does not mean that your child is contagious. Coughs often remain longer than the illness itself due to the irritation caused to the lining of the lungs. If your child gets worse while at school, he will go to the nurse and you will be called. You can’t predict how his symptoms will progress. One piece of advice though: Do not tell your child that you will come get him if he feels worse. If you say this, there is a one hundred percent chance that you will end up coming to get him from school. These words become your child’s free pass to a place called home, even if he doesn’t feel that badly.
Diarrhea or Vomiting: Stay Home!
Surprisingly, vomiting and diarrhea can be somewhat vague. Kids often express their emotions through their GI tracts and are sensitive to many foods. Since you’ve been the one to change your child’s diaper since the day he was born, you know what’s normal for him. The issue is that your school nurse must treat all cases equally. If your child throws up or has one case of diarrhea at school, he’s going home; if he has one episode at home, he should stay there. Waiting to see if it’s something he ate is not an option. Period. No discussion. Even if your child has a history of GI issues, this could be the one time that it’s not just an upset tummy, but actually rotavirus. Other parents will thank you, and you’ll avoid an unpleasant call from the school nurse after your child tells all of his friends about his recent stomach troubles. Because he will tell them, and they will in turn tell their parents. You’ll then be known as the bad parent who sent her kid to school sick.
Sore Throat: Go to School!
A sore throat can be the result of numerous causes, not all of which are contagious. From allergies and a runny nose to strep throat, it can be hard to determine the cause at home. Once again, if the child is fever-free, it’s okay to send her to school. If your child is begging you to stay home, and you don’t think she’s that sick, the best way to encourage her to go to school is to say, “If you are too sick to go to school, then you are too sick to _______.” Fill in the blank with a favorite activity that is planned in the very near future. Try cotillion, a basketball game, or a sleepover. Most of the time, this will get your child out the door and willing to give school a try. Once a child is at school and if the sore throat is still bothering her, she will most certainly go to the nurse, who will be able to determine the next step. Keep in mind, if your child complains of a sore throat for several days, it’s worth a quick trip to the pediatrician. Untreated strep can have severe consequences, so it’s best to rule it out or get it treated appropriately.
Rashes and Skin Infections: Stay Home!
Parents give me a really hard time on this one. It’s important to understand that viruses and infections often present with a rash or skin irritation, and skin irritations themselves can frequently be contagious. Remember that it is beyond the scope of practice of your school nurse to diagnose the rash, yet parents amazingly obtain the ability to diagnose rashes as accurately as most pediatricians after reading one paragraph on WebMD. Trust me, they aren’t always so simple to diagnose. Doctors go through years of training for a reason. Once the rash or skin infection has an accurate diagnosis by a doctor or nurse practitioner, the child may be able to return to school immediately with a note from the doctor or after 24 hours of treatment. For some contagious skin infections, such as ringworm or impetigo, it is okay for the child to be at school as long as the affected area is covered with a bandage. Parents of children who have chronic skin conditions, such as eczema, should inform your child’s school nurse of the condition to avoid unnecessary phone calls from the school and trips to the pediatrician.
Pink Eye: Stay Home!
If your child wakes up with a goopy, red, itchy, and irritated eye, there’s a good chance she has pink eye. However, red eyes can result from a variety of causes, not all of which are contagious. A hallmark of pink eye is copious amounts of drainage from a red, irritated eye. Before you rinse your child’s eye with saline and send her to school, take her to the pediatrician’s office to get an accurate diagnosis. If it’s pink eye, after 24 hours of treatment, she may return to school. Also know that pink eye can show up quickly and unexpectedly, particularly bacterial conjunctivitis. Again, school nurses don’t make diagnoses, but if there’s a suspicion of pink eye, you will be called and asked to have your child examined by a doctor. Pink eye is highly contagious and is a major disruption in the lives of families. Linens must be washed daily, contacts thrown out, surfaces frequently cleaned. It’s a pain, and other parents will be thankful that you didn’t send it to their homes.
So how do parents avoid these special gifts of childhood? We don’t! We can certainly help prevent our children from developing an illness after every exposure, but we can’t keep our kids well all the time. Hand washing remains the best way to fight the spread of disease, so start early and teach your kids how to wash their hands properly. Don’t be afraid to use hand sanitizer! There’s been a lot of talk recently about the increase in food allergies and a possible link to our hyper-clean society, but this doesn’t mean we should stop all efforts at keeping our hands clean. The Centers for Disease Control recommends the use of hand sanitizer for routine hand cleaning unless the hand is visibly dirty. Just use common sense: If your child has been exposed to a surface that is known to be a hot spot for germs (shopping carts, pediatrician’s office), get some hand sanitizer on those hands. Parents can’t be at school to wash little hands when they are exposed to the infinite supply of germs found in schools, but teaching kids good hygiene and keeping them home when they are sick will ultimately create a healthier environment at school.
“Real Mom” Elizabeth Blanton is the lower school nurse at St. Catherine’s School. She lives with her husband and two young sons south of the river.