When to keep sick children out of school

PARENTS have mixed views on when to keep sick children out of school. Most agree that those with diarrhoea should stay home, but many would send a child who had thrown up or with slightly raised body temperature to school often basing decisions on their best guess.

Of course, parents have differing views about how sick is too sick. Or the importance of sick day consequences, such as parents missing work or children missing an examination or falling behind in class work.

Symptoms also make a difference. So, major considerations are based on whether attending school could negatively impact a child’s health or the health of classmates and if there is someone to stay home with their sick child.

Off to school or stay home? Well, when a child is sick, the ideal thing is to ask what is wrong with the child. The best way to do that is to take the child to the hospital for evaluation.

Dr Babatunde Ogunbosi, a consultant paediatrician, University College Hospital (UCH), Ibadan, said “if a child has a condition that is potentially infectious, it would not be ideal to send that child to school.”

Diseases that children have that are contagious include viral upper respiratory tract infections like the common cold, influenza or flu, tuberculosis, measles and chickenpox. These are very contagious conditions.

He declared, “we generally say that kids less than 6 years often do transmit Tuberculosis, but it has been shown in some settings that it does happen. So if a child has a condition like TB, it is better the child gets treatment for at least one month before the parent can consider sending such a child back to school.”

Certainly, there are other conditions like malaria that is not contagious. However, he said a child that is down with malaria is ill and apart from medication needs to have rest and other things that make recovery faster.

Even when they’re not sick, young children need a lot of sleep — at least 10 hours a night for school-aged kids. When a cold or the flu strikes, they may need even more.

Sick children may have little interest in eating or drinking, but the parent should still keep offering fluids for them to sip throughout the day to prevent dehydration.

No doubt, it is not all the time a parent would have access to the health facility for counsel and treatment if a child is sick, but Dr Ogunbosi declared, “parents should also understand that illness in children can progress rather fast, especially when they have conditions whose symptoms include high body temperature.”

Most pediatricians consider a fever to be a temperature above 101°F or 101.5°F. In babies one to three months, 100.4°F is a fever. But many parents believe, though, that fever starts around 99°F or 100°F, which is by definition simply an elevated temperature.

According to him, “it is not good to just give them paracetamol or some pain-relieving medications and send them off to school. If they need care, they need care.”

Even the idea of giving medications to an unwell child and then sending them to school, Dr Ogunbosin said may not be advisable in every circumstances.

“It depends on the condition of the disease, if it is potentially infectious then it is not advisable. But if the condition is like mild cough and catarrh from a viral infection, yes the child may stay away until he is better. But again not all cough and catarrh is due to infection, some are from allergic conditions.”

The paediatrician also added that children with asthma, when stable can go to school as well as those with a simple diarrhoea disease, depending on their age.

“If the child is of school-age and it is simple diarrhoea disease, he or she can go to school. But you need to let the teacher know so that they can observe contact precautions. Hand hygiene is very important but if it is frequent and the child is not fit to go to school, then the child stays home until it is cured.”

Children also develop different skin problems such as scabies and ringworm. He said skin conditions such as scabies or ringworm might not be a strict reason for keeping the child away from school but the school environment needs to understand that this child has this condition.

He added, “it is important that the child needs to start treatment and avoid contact with other children until the whole condition is healed.”

According to him, if  a child wakes up in the morning and  complains of  tummy ache, which sometimes some parents assume is a pretence so as not to go to school, it is still best that the child be made to see the doctor rather than go to school just to rule out something serious.

Dr Ogunbosi said it is understandable that parents often give consideration to children missing an examination or falling behind in their class work to guess if a sick child is sent to school.

However, “the truth is if the child is not in the frame of mind to write an examination, such examinations should be rescheduled for another time.

“I understand our situation, our setting is challenging but it is the child’s right to get proper health before he goes for an examination. As an adult, imagine how you feel if you are ill and writing an examination. We should such give such considerations to children as well.”

Illness can be scary for some children, especially if they have symptoms like vomiting or diarrhoea. Cuddling and holding the child can help her feel less anxious and more relaxed and secure. It may even help her sleep better.

When missing school due to an illness, the day should include coping strategies that can help children feel better. Avoid pairing sick days with activities they enjoy such as going to the movies and playing a video. This can reinforce any school avoidance.

Staying at home for long periods of time away from friends and activities could also lead to poor mood or even depression. But a little creativity like a cartoon, quiet games and stories might help keep the child more entertained — and distracted from her symptoms.

Many doctors offer guidelines to consider if your child is sick.

• A phone call or visit to the child’s health care provider can help you know whether the child has a serious illness, but may not clarify how long symptoms will last.
• Does your child has a runny nose but is in good spirits, playing and eating? Send them to school with extra tissues.
• A spike in temperature does not always mean something serious. If children are attentive and playing, a school day won’t likely hurt them.
• The cause of diarrhoea and vomiting could range from a virus to food poisoning. If symptoms that will disrupt the school day are accompanied by pain or fever or if the child is too young to manage symptoms keep your child home.