Anytime Rebecca Bain's daughter Courtnee has trouble rolling out of bed in the morning and complains, "Mom, I'm tired and don't want to go to school today," working mom Bain checks the 8-year-old for a fever, severe coughing, diarrhea or other apparent signs of illness.
If there are none she'll order: "Get up and get dressed. Let's go!"
On the other hand, a decision to keep Courtnee home means Bain also must stay home as her husband, Richard, can't afford a day off from his plumbing job.
"If she's running a fever, I don't want to send her to school sick and infect other kids," said Bain, an assistant manager at a storage facility. "These kids have working parents, too. Then what are they gonna do?"
Each day, many parents like Bain face an early-morning predicament: Should they keep their ailing youngsters home or send them to school or to day care?
Sometimes, the stay-home call is obvious: A child is feverish and flushed, or has been vomiting for hours and still feels shaky or groggy from lack of sleep.
Ivonne Areas, a single mother of three, automatically keeps her 9-year-old, Krystal, home when the tonsillitis-prone youngster gets fevers as high as 103.
"I know they'll send her home from school anyway," said Areas, a receptionist at the Children's Center of Riverside, Calif., which provides education and therapy from birth through age 6. "Everyone else I know works, so when she stays home I stay home."
Getting by
One or two sick children can throw an entire family off schedule and sometimes even jeopardize a working parent's advancement or job if family caregiving forces frequent absences.
Yet as more parents work, sick youngsters wind up going to school or day care anyway. School nurses say they are seeing more children than they used to with ailments such as diarrhea, serious colds and fevers.
Often parents defer making a decision on their own and send a child to school thinking mistakenly there's always a nurse on hand to evaluate or treat the youngster if symptoms get worse.
"But nurses come to each school site only once or twice a week," said Angela Jones, coordinator of health services for the San Bernardino City Unified School District in California. "Usually it's aides, who may be be clerks or secretaries, who look at a child. If there's any doubt, they'll send the child home."
To get by, some parents treat their children with all-day medications and hope the symptoms go unnoticed at school or in day care. They may feel OK out the door, only to crash by mid-morning.
Moreno Valley day care administrator Carl Rowe constantly watches working parents struggle with the decision to stay home with a mildly ill child or send them off and monitor the situation over the phone.
"It's a huge problem," Rowe said. "It can be agonizing to lose wages because a child is sick."
Parents also need to know when they can return their child to school or day care so they can get themselves back to work. Many fever-producing illnesses stem from viruses, which may take several days to run their course.
One alternative for working parents without supportive neighbors or family members is a day-care center with special rooms and staffing to care for mildly ill children.
For example, the ABC Child Care Center in Temecula has a "Chicken Soup" room where mildly ill children may spend part or all of the day. The area has its own separate bedroom, living room, patio, entrance and ventilation system to keep healthy and sick children separated.
"Some days there's no one in there, but other times we may have several," director Donna Roberts said. "It's costly (to run) because we need to have extra staff on hand in case someone has to go into the room."
Day care directors say the parents of healthy children get upset when sick children aren't kept home.
Going solo in the a.m.
School nurses like Jones in the San Bernardino school district also have observed more children fending for themselves in the morning with no adult to assess whether they should stay home. Many parents have left for work by the time children get up and dressed, Jones said.
"This means some children have to call mom at work and say they're not feeling well and need to stay home," Jones said.
Others wind up going to school when they should stay home.
Still, nurses aren't quick to send students home. They may take a temperature, check blood pressure and listen for symptoms such as chest wheezing that may suggest a serious ailment such as bronchitis or pneumonia.
If appropriate, a nurse may offer health education counseling or symptomatic treatment such as a salt water gargle so a student can stay in school. Unless there's a fever, vomiting or diarrhea, a nurse usually will send a child back to class, Jones said.
Sometimes a nutritious snack is all that's needed. A headache or stomachache frequently is caused by an empty stomach or fluctuating blood sugar if the child skipped breakfast or only had a bag of chips and soda for lunch, she explains.
"Some children may be affected by hot weather or running around too much," Jones said. "Lots of kids don't drink enough fluids, which may also affect their bowels."
Many children, especially those age 8 or older, are adept at feigning illness at school and at home, said Dr. Alan Kwasman, a Riverside pediatrician.
"Younger ones don't lie too well," he said, chuckling.
Kwasman often works with parents who acknowledge being duped by a wily child who just didn't want to go to school.
But more often than not, parents can figure out who should stay home.
When Rebecca Bain's older daughter, Miranda, 10, tells her she's sick, "she's usually really down," Bain said. "I can see it in her face and eyes.
"When she feels well she always wants to go to school."
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