Idiotic attendance policies, part 2: The preschoolers

The Pediatric Insider

© 2012 Roy Benaroch, MD

I’ve written about stupid school policies before—schools that set up carrots and sticks to prevent even genuinely sick kids from staying home. Dumb, dumb, dumb. But it did give me the opportunity to write, “If absences are outlawed, only outlaws will have absences.” I’m not sure exactly what that means, but it seems wise. Someone ought to put it on a bumper sticker.

Now I’m noticing more and more little kids being sent home (and often sent to my office) for equally dumb reasons. I don’t know why, but while the high schools seem to want to keep genuinely sick kids in the classrooms, child care centers for little ones want to send them home for next-to-nothing illnesses. Both extremes aren’t helping keep kids healthy.

The AmericanAcademyof Pediatrics has tried to offer guidance about sensible, science-based pre-school policies to protect the health of children. They’re summarized in this book, also available at Amazon. Owners and operators of preschools and government bodies that make health policies really ought to read that book, and keep it under their pillows at night to help absorb its wisdom. Instead, they seem to be making things up.

School exclusion rules ought to be designed to protect the health of children and staff. Children, in general, ought to stay home if:

• They can’t comfortably participate
• Their presence poses a health risk to themselves or others
• Their presence requires more support than the staff can offer

The AAP has specific suggestions for certain health problems that may surprise you. They certainly run counter to what I’m seeing from day cares in my community. Some of their recommendations:

Kids with the common cold, even if there is green snot, don’t need to be excluded from school. This is because the period of highest infectivity is before symptoms become obvious. Once a child has obvious cold symptoms, they’re no longer very contagious anymore—no matter the color of their snot. As long as they’re comfortable, they can go to school.

Fever, itself, isn’t a reason to keep kids home. Now, most kids with fever are uncomfortable—those kids shouldn’t go to school, since they can’t participate. But some kids with fevers, especially those with viral infections, feel just fine after a dose of ibuprofen. Excluding these children is unlikely to reduce the spread of disease, since most viral infections are spread by children who have no symptoms at all.

Pink eye? This seems to be the biggest boogeyman at preschool. Like the common cold, pink eye is contagious, but there is no evidence that treatment of pink eye reduces the spread of the bacteria or viruses that cause this common infection. The symptoms are quite mild, and will resolve in 5-6 days with or without treatment. The schools freak out, but kids do not go blind from garden-variety pink-eye, and most of them feel fine. As with other illnesses, if the child really feels bad she ought to stay home. Note that there are rare, more-serious occasional outbreaks of more-serious pink eye caused by adenovirus, so a classroom with multiple cases of severe pink eye needs to be reported to public health authorities. But the vast majority of pink eye that’s referred “emergently” to my office are very mild, nearly symptom-free infections.

Infections that really ought to stay home are those that include diarrhea that can’t be contained in a diaper or requires frequent changes, or vomiting. These symptoms really can’t be managed safely or comfortably in a group care setting.

Wrongheaded day care policies probably drive a lot of my business. Many centers seem to require a “note from a doctor” to return to school. Still, wrong is wrong. What we need is a more sensible approach to group care and school illnesses, rather than knee-jerk policies that keep children and parents home or send them to my office. Sick kids ought to stay home, but most kids with mild illnesses who feel pretty well can go to school safely.

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Tags: conjunctivitis, day care, daycare, school, upper respiratory infection, uri

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