Is Your Kid Too Sick to Go to School? with Kristin Barrett, MD

Podcast Transcript

John Horton:

Hey there and welcome to another Health Essentials Podcast. I'm John Horton, your host. It's 15 minutes before the school bus is scheduled to roll up and your kid looks a little iffy. Their nose is drippy, they're coughing over their cereal, and they seem to be dragging even more than usual. So what do you do, keep them home for a sick day or send them on their way with the expectation they'll perk up during classes? It's a question every parent will face at some point, and the judgment call isn't always easy.

To help you make the best decision, we ask Pediatrician Kristin Barrett to join us and offer advice on determining when your kid is too sick to go to school. Dr. Barrett is one of the many experts at Cleveland Clinic who visit our weekly podcast, and share about issues common to so many families. So looking at the clock, the bus is getting closer. So let's find out whether your kid should stay or go. Welcome to the podcast, Dr. Barrett. Thanks for stopping by to tackle this topic with us.

Dr. Kristin Barrett:

Thank you so much for having me on the show today, John.

John Horton:

I would say this when to take a sick day question was always a tough one when my kids were growing up, in part because my daughter used to put on just Oscar-worthy performances in the morning to try to stay home from school. I mean, we are talking next-level acting. It did not make our decision making very easy.

Dr. Kristin Barrett:

Yeah, you would not believe some of the things I've seen kids try to pull to get an extra day off school, so I can definitely believe it.

John Horton:

Well, I would've liked to have had this information back then because then I would've been able to know when she was really pulling our leg. But we're going to get that out there now so the next round of parents don't have to deal with that. So like I said, while my daughter was... umm used to really flex her thespian muscles, I know there are plenty of kids who truly wake up feeling icky on a school day. If your child says they don't feel well, what's the first step in figuring out whether they might be too sick to head to class?

Dr. Kristin Barrett:

So I think a good first step in the algorithm is to take a temperature, and that's because typically if kids have a fever, we recommend that they stay home from school because they're also contagious to other people.

John Horton:

Because you hear all sorts of numbers, I think we all know the base one, the 98.6. It is I think 98.6, right?

Dr. Kristin Barrett:

Yeah.

John Horton:

Just wanted to make sure I wasn't throwing a radio station in there, but when is a fever a fever when they need to stay home?

Dr. Kristin Barrett:

So we typically consider a temperature of 100.4 or higher to be a fever. I know that kind of seems like a nebulous number, but in Celsius it's a nice round number of 38, but 100.4 Fahrenheit for our purposes is a fever.

John Horton:

So if you're hitting the triple digits, odds are you should look for your kid to probably stay home that day.

Dr. Kristin Barrett:

Yeah, that's a good rule of thumb.

John Horton:

And then once they get that, do they need to stay when you get it down, because you can give them some medications and things like that that will bring that number down? I take it you can't just push the meds on them and send them on their way.

Dr. Kristin Barrett:

Though it's true that they often look great after a dose of ibuprofen, we do not recommend dosing them and sending them to school. Those medications only work for about four to six hours and they'll feel pretty bad when they wear off. But, again, they're contagious to other people around them, so we don't want a whole first grade to be vomiting. So we typically say that a kid needs to be fever-free, so a temperature of less than 100.4, for 24 hours without needing antipyretics like Tylenol or Motrin before they can return to school.

John Horton:

Well, that's a good place to start. Obviously, kids, I don't care how well you act, it's tough to act a 100-degree fever, so that seems like a good starting point.

Dr. Kristin Barrett:

Yeah.

John Horton:

What else would kind of fall in that category where if you have it, you're staying home?

Dr. Kristin Barrett:

So I think a general good rule of thumb is that if you're leaking fluids from anywhere you shouldn't be, you should probably stay at home.

John Horton:

What a delicate way to word that.

Dr. Kristin Barrett:

So vomiting for me is considered a no-go. If you vomit, you should not go to school because that is a high risk of contagious spread, and also nobody wants to vomit in front of your class.

John Horton:

The janitors will be very, very happy for you to stay home too, I'm sure.

Dr. Kristin Barrett:

Yeah. So same rule as the fever, we usually recommend that you are done vomiting for 24 hours before you would return to your normal activities. Diarrhea can be a little trickier because sometimes that is a symptom that lingers for even weeks after viral illnesses, so we usually say that as long as you're not having accidents and the child is kind of able to take care of themselves and wash their hands well afterwards, that as long as it's not explosive, they can return to school.

Facial fluids are a little harder because we all know kids who are constantly leaking out their nose, but I typically say if it's needing frequent intervention, meaning somebody is having to come up and wipe their nose, wipe their eyes recurrently throughout the day, and then they don't have access to be able to wash their hands well after that, that would be a reason I'd consider keeping a kid home.

John Horton:

And I think the stuff we've talked about, the fever, the vomiting, the diarrhea, all seem like clear-cut things where it's like, "Yeah, this is probably a you-might-stay-home sort of deal." Like you said, the other leakage, the runny noses and things like that are where things get so much more tough to make that call. So how do you gauge those basic kind of run-of-the-mill cold symptoms like coughing, sneezing, and a runny nose to go, "It's bad enough where you should stay home," or, "Hey man, you're fine, just wash your hands a little bit more today and try not to cough on anybody"?

Dr. Kristin Barrett:

Yeah. So usually if the symptoms are starting to improve, let's say you've had a runny nose for three or four days and today it's better, you're not having a fever, you're feeling better, generally we'll say as long as you can manage to blow your nose in a napkin or a tissue and then wash your hands afterwards, you're probably okay to go back to school. Kids who can cover their mouth, the cough isn't going to be disruptive to their learning environment. Again, if symptoms are mild or generally improving and without fever, probably okay to return to normal activities.

John Horton:

It sounds like it's a matter of gauging where they're at.

Dr. Kristin Barrett:

Yeah.

John Horton:

If you have a kid who's coughing so much that they just can't focus, and we've all been in those spots where it comes in like waves, that's probably where you take them home. If that cough is just here and there throughout the day, maybe you can get away with going.

Dr. Kristin Barrett:

I think the other thing to consider too is let's say your kid is coughing, but you gave him some Robitussin before school and it helps a lot, if that's something that they're going to need dosed again during the school day, it might be too early to resume normal activities. I think most school days are six to eight hours, so you need to be able to function well without being re-medicated in that time.

John Horton:

I know a sore throat is another common symptom that could be the result of something minor like just allergies or a sign of something like strep. What's the best way to make a smart assessment on that?

Dr. Kristin Barrett:

Allergies almost never cause fever, so if a child has fever and a sore throat, it's almost always going to be some sort of infectious cause. When you're looking at is it viral or is it strep from a bacteria? It's a little bit harder to discern. They've actually done studies to see how good doctors were at identifying strep versus viral pharyngitis or throat infections, but we're not great at it, which is why everybody comes to the office to get the strep test. A general rule of thumb is that strep typically is not associated with other cold symptoms. So if you have a runny nose or if you have a cough, less likely to be strep throat and more likely to be a viral illness.

John Horton:

You have said looking in there. I have to tell you, my wife was just always, the kids had a sore throat, the flashlight was out and she was shining it back there. I have a son at college and he called and actually had her look with his phone on to see. Is there any benefit to doing that?

Dr. Kristin Barrett:

So there are some clues that I can see when I look in the back of the throat that make me think that strep might be more likely. So some of those include red little spots or splotches on the roof of the mouth, or if the tonsils are really big and they kind of have some white exudate or pus on them, those certainly can go along with strep. So if you're seeing those, it's probably not a bad idea to at least have a healthcare professional take a peek and maybe swab it and see what comes back.

John Horton:

Like I said, my wife always said, she'd be like, "Come and take a look." And I was, "No, I trust whatever your medical advice is on this, I don't need to go look in there."

So when it comes to taking a sick day, I think a lot of us are programmed to just grind through whatever ails us and stick to our routines. I mean, nobody wants to fall behind by missing a day, but in the big picture, are we just adding to this swirl of illness in our communities by not listening to our bodies and just staying home to recover?

Dr. Kristin Barrett:

Yeah, so it's so interesting to think about how much our idea or mindset of taking a sick day has changed over the last five years and we've kind of gone back and forth and full circle, but I do think in general, rest is one of the most important things we can give our body when it doesn't feel good. We know that people who rest tend to have better recoveries and less complications. And so from a personal standpoint, I do think when you're sick, it is really important to give your body the rest you need and make sure that you're getting hydration during your time off. But then from a societal standpoint, it's also important that if you think that you could be an infectious stuff, that we're limiting the spread of the illness to others around us.

John Horton:

Yeah, there is a reason why you see whole classes get wiped out with a flu bug, or RSV, or some illness that comes down, and it's just that kids share.

Dr. Kristin Barrett:

The complicated thing is that many viral illnesses can be spread before people even have symptoms. So the influenza or flu virus, often people can start infecting those around them two to three days before they even have symptoms themselves. And so that's why we very often see small populations come in or get sick all around the same time.

John Horton:

So bottom line, I guess when you have this go or don't-go-to-school moment in the morning, what's the best approach for parents to take?

Dr. Kristin Barrett:

Well, like I said, I think checking for fever is the number one thing to do. If they have a fever, you have your answer, they should stay home from school. And then I think it's just assessing how well they'll be able to contain their symptoms and what impact their symptoms are going to have on their day. If it seems like they're in a lot of belly pain or they're having a hard time concentrating or talking because coughing so much, probably a day at home is going to offer more benefit than a day of them struggling to get through the school day. So I think you kind of have to look at it as, "Where am I going to get my most benefit from today?" If my kid's at school but they're not participating and they're causing disruption, that's not good for anyone.

John Horton:

Well, definitely, and it sounds like a lot of it is just knowing your kid and if you sense that they're not going to be able to make it through that day, you should probably keep them on the couch.

Dr. Kristin Barrett:

Yeah. Unfortunately, this is kind of a nebulous topic where our clearest guidelines are fever, and then from there it's just kind of, "How is the kid acting? Are they able to take care of themselves? Are they going to be able to interact throughout their school day?" As much as I never want to go back to COVID isolation era, it was so nice to have like, "You have this, stay home for 14 days, or you have this, you need to stay at home for five days and then wear a mask for five days." All those guidelines are kind of out the window and now the CDC just treats all viral illnesses the same, and their general guidance is you need to be fever-free for 24 hours, and in general, starting to feel better before you can return to your daily activities.

John Horton:

Well, that's just great advice that can be used in so many households, Dr. Barrett, so thank you. And before we say our goodbyes today, do you have anything else to add regarding what to do when you have an under-the-weather child?

Dr. Kristin Barrett:

So I think for the most part, if you're able to keep them home and provide good hydration and fever reduction, then oftentimes if it's a viral illness, there's probably not too much more that your pediatrician is going to recommend. And we're always happy to keep sick kids at home, but if you ever have any concerns that there could be something more serious going on or you feel like things are just not going in the right direction, then your pediatrician is always going to be happy to see you and answer any questions and make sure that your kid's getting the appropriate care.

John Horton:

Well, hopefully this season there are not that many calls that have to be made to you and everybody is healthy. I guess we can hope, right?

Dr. Kristin Barrett:

Yes, that would be great.

John Horton:

Thanks a lot for coming in today, Dr. Barrett. And as always, just an interesting and information-filled discussion.

Dr. Kristin Barrett:

Thanks so much for having me.

John Horton:

Is a case of the sniffles enough to keep your kid home from school? It might be. Trust your instincts as a parent and give your child a sick day if you suspect they'll have trouble making it through the day. By doing so, you might even help keep that ick from spreading and save another parent from wrestling with the same question. If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.