- The Washington Times - Sunday, February 9, 2003

School nurse Sue Righter sees all manner of sick and not so sick children in her clinic during the course of a day.

She cares for children with bellyaches, fevers, headaches and upset stomachs. In the spring and fall, she might receive children who have seasonal allergies and those who have sustained bug bites. Sometimes she asks parents to retrieve their children from school. Other times, she solely provides comfort.

"There are cut-and-dried issues of fever, vomiting and no stamina," says Mrs. Righter, who is based at Hollywood Elementary in College Park, "but then there are a lot of kids who are just feeling kind of blah, and it's questionable. If a child is able to participate at all in class, they are encouraged to be in class, but that's where the gray area is."

It can be a conundrum for a working parent facing an early-morning decision about a child's health in the context of school attendance to penetrate that gray area. It can be difficult to know whether to send the child or keep him or her home, and it even can be hard to know when children are faking, says Susan Wooley, executive director of the American School Health Association.

"There are definitely kids who come to school because their parents cannot take time off work," she says. "When a child is sick, there are economic consequences for families when all the adults in the family are employed, but even back in the '50s … there were still children who went to school sick."

Nearly 73 percent of all women with children under age 18 are in the labor force in the Washington-Baltimore consolidated metropolitan statistical area, which includes the District, Northern Virginia, Baltimore and parts of Maryland and West Virginia, says Martin O'Connell, chief of the Census Bureau's Fertility and Family Statistics branch.

About 45 percent of the more than 13,500 children ages 5 to 17 polled in a national survey said they had missed three or more days of school because of illness or injury in 1998, the most recent year for which such information has been published, says Jeff Lancashire of the National Center for Health Statistics.

Ultimately, the decision about how to care for a mildly ill child is left to the parent, Mrs. Righter says.

"If I see a kid whose fever is hovering at 101 or who says it was 101, but Mom gave them Tylenol and now they're OK, then I would call Mom and explain the situation: 'You know, your kid is just not up to being in school today,' " Mrs. Righter says. "Then comes the sticky issue whether there's anyone at home to care for the child that day."

The impact of illness

Parents sacrifice work time and money to take care of children who suffer from mild illnesses frequently because of the contagiousness factor, says Dr. Jacqueline W. Stewart, president of the National Association for Sick Child Daycare, based in Birmingham, Ala. Dr. Stewart, a pediatrician, owns several sick-child centers in the Birmingham area.

Sick children also are an economic liability to employers, who frequently must pinch-hit for employees who are absent without notice, hire temporary workers or require other employees to work overtime, she says.

A decade or so ago, the national advent of sick-child day care offered another option to working parents, says Gail Bjorklund, senior program manager at the Fairfax County Office for Children. Sick-child care opportunities ranged from the occasional hospital opening of an on-site sick bay or the provision of off-site nursing care to child care centers catering partially or exclusively to mildly ill children.

However, the higher cost of providing such care, the advent of the chicken-pox vaccine and the fact that such centers didn't see much business has rendered the practice scarce, says Ms. Bjorklund, who notes that the closest metropolitan-area sick-child center is in Richmond.

"It's hard for a parent to leave a sick child somewhere else," she says. "Usually children are sick for just a few days, and then it's over. Most parents can manage that."

Even so, parents often push the limits, sending their mildly ill children to school or day care with the hope that good health will weigh in as the day passes, says Dr. Regina Milteer, medical director for pediatric inpatient services at the Inova Fairfax Hospital for Children.

"There are many more working moms now, so the kids are going out when they should stay home," she says. "I'm a working mom, and I know that happens. Most of the time, parents don't have backup day care, and I can sympathize with parents who are caught off guard."

A director of a private Northern Virginia preschool isn't as magnanimous. She says many parents simply aren't willing to keep their children home when they're sick.

"It's just a really big issue, and it always has been," she says.

"Children will come in and tell us Mommy gave us Tylenol this morning," says the woman, who does not want her name used or her school identified. "You can smell it on their breath. We know what Tylenol and Motrin smell like. Years ago, if you gave Tylenol in the morning, it could buy the parent four hours of work time. Now, with Motrin and Advil, a sneaky parent can get away with six to eight hours of good work time before we find out.

"A lot of parents don't understand that Tylenol and Motrin mask the symptoms they don't take care of them, so the child is still sick. Another thing that really ticks us off is if you call the parent at work and they say they're coming to pick up their sick child and they don't get here for two or three hours, so the sick child is probably with the director, or one of the teachers has to come out of the classroom with the sick child."

Most preschools have a policy, she explains, that requires that children remain out of school until 24 hours have passed after the last symptom has presented.

"So if I call you at noon and you come by 1 o'clock, you cannot bring your child back for 24 hours after the symptom that made us call you ends. The state says that the temperature has to be 100 or above and then we have to call you and you have to come get them," she says.

She understands that some parents are not fortunate enough to work in family-friendly environments, "but they need to come pick up their children. The other children get sick and then the other parents get angry with us because 'I saw so-and-so here with a green runny nose yesterday and now my child is sick, and why didn't you call that parent?' What I want to tell them is we did call those parents, but they just didn't get here."

It's truly in everyone's best interest if children stay home when they're sick, Dr. Milteer says.

If they go to school or day care when ill, "they may not be well cared for … things like an increase in lethargy or fever might be missed," she says. "In addition, if they're contagious, they're going to spread their illness to other children. The most infectious diseases that children acquire are spread by respiratory droplets or hand to mouth: The child touches an infected source, such as a toy. Other types of illness, such as upper respiratory types, are spread by droplets, which are airborne.

"The biggies that really should keep a child home" include fever, vomiting, diarrhea, pinkeye, wheezy or rapid breathing, chicken pox or impetigo, scabies or active head lice, or any other untreated skin rashes, Dr. Milteer says.

Not a choice

Silver Spring mother Beverlie Brinson says she has sent her 6-year-old son to school with a sniffle or cough, "but if he's got a fever and is really out of it or is tired, I don't send him. I don't want it to get worse."

Ms. Brinson, a home-based communications consultant, says her son's infrequent illnesses usually don't impact her ability to work. However, at times she has outside meetings and then must rely on her mother-in-law, a retiree who lives nearby, to care for her son. If grandmother is unavailable, the meeting is sacrificed.

"I can't imagine having a job where you can't take care of your child if you need to," Ms. Brinson says. "If your kid is sick and you can't make it in … I feel for those people. I would never want to be put in a position where I felt I had to really be there. It's not like your kid is sick every day."

If children are so busy paying attention to the way they feel, "they're not going to be able to listen to what the teacher has to say," says Prince George's County school nurse Sandy Bishop, who is assigned to Marlton Elementary in Upper Marlboro. She says she sees an average of 25 to 30 children per day but she doesn't necessarily call parents to retrieve their children.

"If they don't have a fever and they're not throwing up, I let them rest for a little bit and then go back to class," Mrs. Bishop says. "If they come back a second time, my rule is that I make that call, and then the parents and child decide. However, if I have a child who has never been here before and never complains, I tend to call their parents on the first visit."

Debra Gersh Hernandez is vice president of external communication at the Newspaper Association of America, a Vienna-based nonprofit organization representing the newspaper industry. The mother of a 2-year-old girl, Ms. Hernandez says she doesn't react to every little stomachache her daughter reports. However, if her daughter is feverish or isn't feeling well, she'll keep the child home from day care.

Sending a sick child to day care or school is just not the right thing to do, she says.

"Not to sound too Pollyanna-ish, but it's not fair to the other kids, either. I don't appreciate other parents trying to get their kids in when they're sick, and I wouldn't do it to them. If I'm on deadline, it's a problem, but you do what you gotta do."

Working parents also should underscore the benefit of working for a boss who understands priorities, Ms. Hernandez says.

"If I say to [my boss] my daughter's sick and I need to go, I go. She also knows I'm not going to drop the ball on something it's going to get done," she says.

In addition, an understanding spouse is worth gold. At the Hernandez home, the parents often trade off sick days or split shifts in the event their child is ill and needs care.

"It's what you've got to do. It's part of being a parent. We don't get to do everything we want to do anymore," she says.

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