How to Tell if Your Child Is Really Sick

It’s 7 a.m., you’re rushing to get ready for work, and your child says he is too sick to go to school. Is he really sick, or just nervous about a geography test coming up that day?

In some cases, the diagnosis is obvious, pediatricians say, and it is clear the child should be kept home. Often, however, symptoms may be more subtle and parents have a tough decision to make.

There are, however, several “red flags” a parent should look for that will make that decision somewhat easier, pediatricians say. Those include a high fever, repeated diarrhea or vomiting, a sore throat, a severe cough, an earache and redness in the eyes.

* Repeated diarrhea and / or vomiting within the past 24 hours is a good clue that the child should be kept home. Younger children may not be able to make it to the bathroom or keep themselves clean. They may also become dehydrated because they are unable to keep fluids down. If a child has a severe episode of either symptom, a physician should be consulted, says Dr. Robert Hoekelman of the University of Rochester. Blood or mucus in diarrhea suggests a bacterial infection, which also requires a trip to the doctor.

* A fever in the range of 102 to 104 degrees, especially when the fever is accompanied by lethargy. Again, there is a high risk of dehydration. Lower temperatures require some discretion. If the child has a fever of 100 to 102 degrees and can’t function well, he or she should be kept home, says Dr. Connie Bartlett of Children’s Hospital of Orange County. “But if they are acting well, are eating and playing, and are able to do homework, give them a Tylenol and send them to school,” she says.

* A severe cold with fever, sneezing and thickened nasal discharge means stay at home. A younger child who cannot wipe his own nose, wash his own hands or remember to cover his mouth when he coughs should be kept at home longer than an older one who can practice better hygiene.

* A sore throat can be a red flag, especially if it is combined with a fever or swollen glands. If a child awakens with a sore throat without other symptoms, however, it could simply be the result of low humidity and should be relieved with a glass of water or juice.

* A cough that keeps a child awake at night, worsens with increased activity, or is combined with other symptoms generally merits a day off. But a sporadic, mild cough that represents the remnants of a cold is not a problem.

* A severe and persistent earache may be a sign of acute otitis media, a common ear infection, and merits a trip to the doctor.

* Redness in the whites of the eyes, yellow eye discharge and matted eyelashes are symptoms of conjunctivitis, commonly known as pinkeye. Again, call the doctor.

* “Rashes are very hard to interpret, but you should err on the side of conservative,” says Dr. Michael Bryant of Childrens Hospital Los Angeles. If they are all over the body, blistery, oozing or sore, they could be a sign of a contagious infection, such as chickenpox, measles or streptococcal infections.

A good first step in evaluating all of these symptoms, Hoekelman says, is for parents to ask themselves: “If my child were perfectly healthy, would I want him or her to sit next to a child with these symptoms?”

The flip side of the question is when can a sick child return to school. “In most cases, you can send them back soon,” Bryant says. “They tend to recover very quickly.”

For a condition such as head lice, they can return as soon as they are treated.

For bacterial infections, such as conjunctivitis, strep throat and others, the child can return to school 24 hours after antibiotic treatment is begun--although some physicians, such as Hoekelman, suggest 48 hours for impetigo.

Viral infections take longer, however. Chickenpox is contagious until all the pocks are crusted over, a process that takes six to nine days.