The scale of sickness: Schools, day care services may have different standards for ill kids

As the cold and flu season ushers in, parents often have to figure out when their kids are too sick to go to child care or school. Chills, aches and fever? That’s a bed beckoning.

But sometimes the call isn’t clear. Public schools have general illness guidelines allowing students to return to class with a doctor’s OK. But day care operators often have stricter policies that can send a kid home for 24 hours, regardless, as one Spokane mom recently learned.

Becca Wells said she got a call last week to pick up her 2-year-old son Avery from day care because of apparent pinkeye. The next morning, a pediatrician examined his eyes and gave her a medical note calling it viral pinkeye – rather than bacterial – saying it was safe for his return to school, she said.

“The pediatrician provided me with a note that said, yes, my son is healthy enough to be in day care,” Wells said. “But they refused to care for my child.”

She got one explanation that her son’s friend also went home with pinkeye, so the facility couldn’t take any chances. A Spokane Falls Community College student, the mother of three ended up taking her youngest to campus with her, and a trusted friend sat with him while she finished a class.

“I understand they have some guidelines they have to follow to keep their day care license,” Wells said. “I don’t know how much of that is affecting this ruling that they made.”

But it’s also the second time in the past year. Months back, she picked up Avery when the facility took his temperature and told her it was too high. She took him to urgent care where doctors found a normal temperature and no illness. Wells asked for a medical note confirming his good health.

“The rules are if they take their temperature, children aren’t allowed at the day care for 24 hours,” she said. “I get that. But I took him to urgent care. They took his temperature and said we don’t even see any signs he’s even had a temperature today.”

A nurse even used a different thermometer for a second reading, with diagnosis of healthy child. “So I take my son to day care and I provide them with the note, and they say sorry, we can’t have him here.

“This is the second time that their thermometer or their medical knowledge is apparently greater than the doctors or pediatricians that I send my children to.”

The American Academy of Pediatrics has guidelines for when children shouldn’t be in school or a child care setting because of illness. The list covers conditions for fever, diarrhea, vomiting, rash and for some specific illnesses such as strep throat, chickenpox and head lice.

A 2017 national survey of 1,442 parents of younger kids found the top factors in deciding to keep a child home are concerns that an illness will get worse or spread to classmates. But at the day care level, exclusion policies vary from state to state as well as center to center and don’t necessarily reflect the pediatric academy’s guidelines, a researcher told NPR.

The survey found that parents of older kids were more likely to be concerned about students missing tests or classes when making the decision about whether to send kids to school.

Becky Doughty, health services director for Spokane Public Schools, says parents usually trust a gut feeling about when their child isn’t well enough to sit in class. Illnesses tend to spike this time of year, too, when students return to closer quarters.

“We do see an uptick in fall and winter, especially as students come back to school,” she said. “You’re going to see it more at the elementary level where students are touching more common surfaces and sharing more enclosed space since they’re in the same classroom for most of the day.

“We encourage a lot of hand washing, and teaching them how to cover their cough appropriately.”

The district has a school flier on “when to keep your student home,” a list adapted from resources of Seattle Public Schools and Office of Superintendent of Public Instruction. The list starts with change in appearance and behavior, when a child is unusually tired, pale and isn’t eating.

“That’s a little bit of a grayer area,” Doughty said. “I know with my own kids if they’re hacking and coughing, it’s hard for them sit in class. If they have greenish discharge, they need to stay home or see a doctor.”

A higher fever is a common illness sign, which SPS lists as a temperature of 100 degrees Fahrenheit or higher. Students need to be fever-free for 24 hours before returning to school. However, even that cutoff can have some shades of gray.

“Around 100 to 100.4, the nurse is going to be pretty insistent that the parent come get the student,” Doughty added. “If it’s 99 degrees and a student is absolutely miserable, we’re calling a parent. If it’s 99 degrees and student feels OK being in class, we may or may not call a parent.”

One overreaching standard is that the child just feels too bad to concentrate. “If they’re looking miserable, it’s got to be hard to sit at a desk.”

Conjunctivitis – pinkeye – tends to warrant going home from a school if there is any green “goop” drainage and light sensitivity, so a child should see a doctor, she said.

But for any condition, the school district will accept a doctor’s note. “Yes, we’re going to honor whatever the doctor is saying. If something is not contagious, then the student needs to be in school.”