It’s Time For Schools to Change their Sick Policies
A fever again? But they feel fine once I give them Advil.
Antibiotic eye drops for pink eye? But my doctor says it’s viral — they don’t need an antibiotic.
Sound familiar? These scenarios prevent thousands of kids from attending school during the height of viral season. SO FRUSTRATING!
If you’re a parent, you know exactly what I’m talking about. School policy — your child cannot return until they have not had a fever in the past 24 hours. Or — pink eye requires antibiotic eye drops to be given for at least 24 hours before your child can return.
On top of your kid being ill, you have to:
The list goes on and on…
And all the while, your kid’s fever is now gone because you gave them some tender loving…Advil or Tylenol. Right? Sure, they’re happy to stay home and watch TV all day while you figure out how to get some work done away from the office. But it’s just another cold — only with what is considered a “bad” symptom.
Why is it that school’s create these policies? They’re obviously not trying to make your day a living hell. Oh, but they did.
The truth is, school’s are misinformed. And it comes from the highest levels of government. Let’s dissect the reasons why these policies may have occurred.
Let’s be candid — if your child has a cold, they are contagious. It doesn’t matter what kind of cold. They’re all contagious. Viruses evolved to infect. They do not live outside of the body so they have to continuously infect new hosts.
Past belief was that humans are most infective during times of fever. Theoretically this makes sense. Fever is the body’s immune response to fighting an illness. So one must mount a fever when the viral count in the body is at its peak.
However, studies have shown that viral illnesses may be most contagious before the symptoms of the infection set in. This means that your kids are sharing germs in school before they ever get sick and that they may actually be less contagious once they develop a fever.
I know, this seems counterintuitive. But let’s say for the sake of argument that a viral illness is contagious before, during, and for a short time after the illness. Then does staying home during the period of fever make a huge difference?
Perhaps stepping into the shoes of health officials in the early to middle part of the 1900s would give better perspective. In a distant past when children were not immunized against some more significant viral infections such as measles, mumps, or the dreaded bacteria Haemophilus influenzae (a bacteria not related to the flu virus), there was more risk of developing complications from infection.
Vaccines have created a more immune competent society and have decreased the major complications that occurred in the past. If I were a health official dealing with viral outbreaks in the 1950s, I would probably err on the side of caution to mandate children stay home during illness. But we’re not in Kansas anymore.
There is also a host of new evidence showing how early childhood illness may be important to prevent serious and chronic disease as children grow older. Many parents remember the days when they themselves were sent to a friend’s house to play with a sick child so they could contract the illness. This was common with chicken pox. Maybe there is some truth to this forgotten practice.
Finally, would you send your child to school with a typical cold? Of course you would. Parents send kids to school and daycare every day with typical upper respiratory infections. What’s different when they have a fever? Nothing. They’re still contagious. They’re just showing that their immune system is working as it was meant to do. If we want to stop the spread of all contagious disease, then we would need new technology to detect the viral illness before it starts. I don’t see this happening in the near future.
Does it? There is some evidence to support high fevers causing a potential bacterial infection. Children who look awful with a high fever should be evaluated by a health professional. But fever is common in children. It is a part of mounting a normal immune response. There is very little evidence to support the notion that fever means a more severe illness in most upper respiratory infections.
In my practice, I see little difference between upper respiratory infections that present with a fever and without a fever. Every child mounts an immune response in a different way. Just because they have a low-grade fever does not mean the illness is more severe than another afebrile child.
A brief fever in an otherwise healthy-appearing child should not warrant a doctor’s appointment or missing school. If the child feels better with Advil or Tylenol, there is no harm allowing them the opportunity to attend school.
I hate to break it to you, but your child never needed antibiotics for their pink eye. Conjunctivitis is an extremely common illness that affects many children. It is contagious as is any other virus. But antibiotics will not cure the infection since most are not bacterial.
In an article from the Journal of the American Medical Association, researchers confirmed that the majority of conjunctival infections are viral. Moreover, even if the infection is bacterial, it usually resolves within a week whether given an antibiotic or not. Revolutionary.
I know there are a number of non-believers out there. It’s hard to change mindset when you’ve believed antibiotics were required your whole life. But do we really want to subject our children to antibiotics when they are unnecessary? I would venture to say no.
What can you do when Pink Eye strikes. For this, read my article here. In regards to school policies, I believe it’s time for change. Even the AAP guidelines do not recommend children stay home for uncomplicated pink eye.
Though in the end we are required to follow school policies, I think it’s time that they catch up with the evidence. That is to say, health departments and schools should stop following practices that are not evidence based.
Studies have shown that even in states where the AAP guidelines are endorsed, many schools do not follow the guidelines and actually create their own policies.
There is a serious drain to society when schools and daycares create unnecessary exclusions. Changing school policies could decrease healthcare spending and give parents back wasted time, not to mention provide MUCH better care for our children.
It’s Time For Schools to Change their Sick Policies
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