Sick Day (Epic 80’s Anthem)

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Just relax for a “sick day”

Dimetapp, turn on Atari, Ginger Ale, a game of Sorry,
Chicken Soup, flat Coke, plug in Lite Brite
Settle down with Dr. Seuss, before YouTube and “Lose the Juice,”
grab TV Guide to find the Price is Right

Just relax for a sick day
When you’re feeling too ill to learn
But when you can participate
You are ready to return

Pepto-Bismol, sooth a cough, with Robitussin and Hasselhoff,
Play Mouse Trap, bathe in Quaker Oats
Sniff some Vicks or, check your temp, with mercury for, two minutes,
Search the Trapper Keeper for dittos 

Theme #1: Iconic childhood memories of “sick days”

Thanks to all of you who sent suggestions – I included almost all of them (except Perry Mason – sorry Jessica!).   For some more iconic 80’s memories, check out Rhett and Link’s awesome music video that at least partially inspired this one and Napoleon Dynamite, who inspired the ridiculous dance.

Very important: I am not endorsing over the counter cold medications such as Dimetapp and Robitussin (or TV shows, movies or music videos involving David Hasselhoff).  I am merely recalling memorable elements of sick days when I was a kid – who could forget the burning/soothing taste of cherry cough syrup or the sweet wintergreen flavor of Pepto-Bismol?  Of course, if you read this pediatric blog and others, you will find that times have changed (and they will continue to change!).  Now, it seems clear that over-the-counter cold medications are more likely to harm your child with side effects than actually help them with symptoms.  So I don’t recommend them – but more on that in my cold virus blog post – coming soon!

Fun family anachronism activity:

1) Look up the word “anachronism.”
2) Identify examples from my “Sick Day” video.
3) Document them in the comment box below (this should be a sure way to get a bunch of comments – I long ago threw out everything I had that was actually from the 80’s – and unlike Rhett and Link, I don’t have friends with DeLoreans or wood paneled TV’s).

Theme #2: Are you “that mom?”

“Ugh, I can’t believe SingingDrJosh brought his kids to school again looking like gremlins – you know, with green snot, red eyes, a monster voice and a rash.   Doesn’t he care about getting all of our kids sick? Wait, what kind of a doctor is he anyway?  Like Dr. Phil?  Hmm. . . I don’t know. . .let’s talk about him behind his back!”

Off to school or back to bed: when should your kid take a “sick day”?

So, which group do you fall into: “that mom,” “hypochondriac parent” or somewhere in between?   How do you decide whether your child is too sick for school?   Are lice a national emergency that requires parent pickup “stat”?  Are all fevers created equal?  How much poop is really “diarrhea?”  What about pink eye – can you really get it from just looking at someone?

This is a big deal – every year millions of school days are lost and $120 billion is spent on sick days, not to mention the average kid missing several days of kickball, show and tell and pizza parties!  Younger kids may miss even more days, as they are going to have up to 12 viral illnesses per year – most of them probably in the next few months!

Illness Chart
Number of illnesses per year for children ages 0 to 5. Click above to go to the article on which this data is based.

Good news – it doesn’t have to be so subjective.  There are actually national American Academy of Pediatrics (AAP) / American Public Health Association (APHA) guidelines that suggest which kids that should be excluded from childcare centers and schools.  They can provide you, the informed parent, with objective data to make a determination on whether you send your kid to school.  These guidelines are based on peer-reviewed research and expert opinions that determine the likelihood of your child harming himself or herself or other children due to their illness – and make recommendations to minimize these risks.

Here are some interesting examples of the data that people have gathered over MANY years about transmission of illnesses in child care settings (as you will see, I had to dig pretty deep):

1) In this 1990 study of 118 children that went to a day care full of sick kids, they didn’t seem to get any more sick than other kids that stayed at home.
2) A study from 1949 (as you can see, “that mom” has been around for a while!) suggests that more restrictive exclusion policies for sickness in day cares doesn’t seem to make a significant effect on spread of illness, but results in more sick days at home, missed work days and kids eventually leaving the more restrictive day cares.  Good luck finding the actual text of that old study – I was able to assess its findings only when quoted here.
3) This fun study from a childcare center at my alma mater (UNC-Chapel Hill) showed that in one day care, 10% of the healthy kids were culture positive for respiratory pathogens. The point is, you can’t avoid the viruses – even if you avoid the sick kids!

Thus, the AAP/APHA Caring For Our Children guidelines suggest that exclusion does little to stem the spread of respiratory illnesses.  As a result, they are pretty liberal with respiratory illnesses in childcare settings.  On the other hand, when it comes to GI illnesses, they are more conservative.  Below is an example of the guidelines – click on the image to see the 5 page spreadsheet.   The entire million page textbook is searchable here.

This is page 1 of 5, please click on the image for the full document.
Caring for Our Children national guidelines for child care exclusion.  This is page 1 of 5, please click on the image for the full document.

I just want to know who to avoid!

Obviously, sick kids do get sick from other sick kids.   However, since kids are contagious both before and after their actual symptoms (and sometimes when they have only mild symptoms or no symptoms at all!) and in all cases leave germs EVERYWHERE, besides the obvious measures of avoiding contact with body fluids and washing hands, my hunch is that trying to avoid sickness by avoiding sick kids may simply not be worth the effort – particularly when it comes to respiratory illnesses.  So, rather than pulling kids out of school and parents out of work and canceling playgroup and birthday parties when they have colds, rashes and mild fevers, I vote to let happy kids live their lives and let the chips fall where they may.   The vast majority of your child’s illnesses will probably come from situations that you had no control over, and no opportunity to avoid.  Additionally, with the number of respiratory illnesses that kids get in the first years of life, if you are more conservative than you need to be, you could find yourself stuck in your house for weeks (in sum) with essentially healthy kids!

So, here are the rules, summed up in one chorus:

Just relax for a sick day, when you’re feeling too ill to learn
But when you can participate, you are ready to return

In short, if your child is too sick to participate in school activities (whether due to just feeling bad, incessant cough, explosive diarrhea etc.) or is going to require excessive support from teachers (i.e. if they are going to need to be held for 8 straight hours) they should stay home.  But if they are ready to learn (i.e running around your house and driving you bonkers!), they should be at school – even with a rash, cough or runny nose (or even a fever without behavioral change – now you really think I’m crazy!).  Within those basic tenets – you will find a few clarifiers in the guidelines above:

1)     There are a bunch of caveats for diarrhea, but the basic point is – they can’t come to school if they can’t keep their poop to themselves (i.e. leaking diapers or toileting accidents for the bigger kids).
2)     Certain rashes (chicken pox, scabies and impetigo)
3)     Throwing up (two or more episodes in the past 24 hours)
4)     A lot of miscellany

Some interesting highlights

1)     Lice – They have never killed anyone (as far as I know), were likely there for days before discovered, and are only shared through close contact (like sleepovers or sharing brushes), not just sitting in the same class.  Thus, it is fine to keep them in school for the rest of day and then send them home for a treatment with lice shampoo (perhaps you might confiscate their brush!).  After being treated, they can return the next day.
2)     Pink eye – sometimes viral, sometimes bacterial, often related to just having a cold.  If uncomfortable enough to distract from learning, a child should stay home.  But if they are feeling fine, they should be at school.  Except for the most severe (eye scratches, lots of pus), no eye drops are going to hasten the resolution of the illness (thus, eye drops should not be considered necessary to return to childcare – I mean, how often do you really think you are going to get a therapeutic dose of antibiotic into the eye of a screaming 2 year old anyway?).  Sure – they are contagious – after all they are frequently viral (and kids like to rub their eyes and then touch their friends) – but no more dangerous than any of the other snotty noses running around the school.

You’re crazy, SingingDrJosh!

Having national guidelines based on peer-reviewed data doesn’t necessarily mean that everyone has to follow them.  My former residency director, Dr. Shope (his name is at the bottom of the guidelines above), literally wrote the book on infectious diseases in child care settings; most of these guidelines are drawn from his textbook and most of my references are pulled from the lecture he gave when I was a resident (you can find versions of it all over the internet). During the lecture, he shared an anecdote about the perception of the AAP/APHA guidelines among childcare professionals:

Dr. Shope had been invited to speak at a conference for over 600 childcare providers in Texas earlier that year.  After walking the audience through the most recent data, he then suggested criteria for excluding children from child care (apparently more liberal than his listeners were accustomed to).  After his thorough presentation, there was a period for questions.  After a several moments of silence, a man strode up the aisle from the back of the room to a microphone placed several yards in front of the podium.  He nodded at the audience as he confidently stated, “If my child ever had pink-eye and didn’t get sent home, I’d never send them back to that school again!”   His comment was followed by a standing ovation.  I don’t remember what Dr. Shope said; I recall that he was still awkwardly stuck at the podium.  But, I think that was pretty much the end of the question and answer session.   Point is, you are welcome to share these guidelines with your childcare provider or school nurse – and they are free to ignore them and send your kid home.  Old habits die hard.

In conclusion

The anecdote about my gremlin children shared in the opening is pretty realistic.  My kids rarely miss school, church or playgroup.  Hopefully, no one actually is calling my wife “that mom.”  Hopefully, you are not being called “that mom” or “hypochondriac mom” either.  However, as with everything in parenting – you kind of have to have thick skin, a little information, an appropriate dose of skepticism (but not too much!), and some humility.   I’ve given you the little information part (and I hope you’ll apply it to your “sick day” decision making); the rest of it, you’ll have to provide yourself!

Thanks to Dr. Tim Shope for the knowledge, Louise Therriault for the mercury thermometer, the Alsinas for the random shot glasses and the Atari joystick and my wife Rebecca for watching the video and then suggesting the word “anachronism.”

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