We’ve all experienced it: Waking up with that feeling of “I think I’m getting sick” — and then debating over and over in our heads about whether we’re well enough to go to work, or if we’d be better off staying home.
The same applies when our children don’t feel well and we have to determine whether to send them to school. The go/no-go conundrum is fraught with worry, guilt and sometimes influenced by outdated medical information.
It’s a dilemma: Keep ill children home and they risk falling behind in class work. Home care must be arranged. Send them to school and risk worsening conditions and infecting other children.
For working adults, the quandary is compounded by rising workloads and concerns about job security.
An adult decision
Working adults confront a catch-22 when deciding whether to call in sick or soldier on in to the office.
When Sue Sikora, a Chicago account manager, contracted a viral infection this year, early symptoms belied the seriousness of the condition. Recovery time is lengthy and physical exertion has dire health consequences; still, she worries how her work-at-home regimen — to eliminate stress of a commute — is viewed by co-workers.
“It’s the fear of ‘How does this look?’” Sikora said. “I did not want to be looked upon as a slacker or perceived as taking advantage of the situation by my manager.”
She’s not alone in her concern.
“A number of years ago, it seemed like employers had a mindset of: ‘If you are sick, stay at home.’ I don’t think that is as prevalent as it used to be,” said Dr. Tony Vancauwelaert, a family medicine physician at Swedish Covenant Hospital. “If you are just congested and you don’t have a fever, you can go into the office. If you have a [nonproductive] mild cough and it is not keeping you from sleeping at night, then you can go into the office.”
Adults may dismiss the seriousness of the flu, reasoning it has to run its course so they may as well report to work. However, Vancauwelaert said bringing the flu to work puts people with asthma or chronic obstructive pulmonary disease at serious risk.
Adults with a fever of 101 have a judgment call to make. If the job doesn’t involve a lot of contact with others and the fever is controlled, then it’s probably OK to head into work. When fever reaches 103 or higher, it’s time to see a doctor, he said.
“When it’s a constellation of symptoms —fever, sore throat, body aches, upset stomach — chances are it’s viral,” and over-the-counter treatment can ease symptoms, Vancauwelaert said.
However, if you have a fever and just one other thing bothering you — a sore throat or ear pain — it’s time to be evaluated, because that is more likely to be bacterial, and prescription antibiotics may be needed.
Whooping cough (pertussis), traditionally associated with children, is coming back in adults, he noted, because the vaccine’s immunity wanes over time. To steer clear of the acute respiratory tract infection, all adults should be given a one-time pertussis booster along with their tetanus booster, he said.
A kid conundrum
School-issued literature offers some guidelines about which health symptoms warrant a “keep ’em home” decision. Presence of fever is a chief cause to keep kids home.
Dr. Andy Sagan, director of Pediatrics at Swedish Covenant Hospital, said while schools vary regarding what temperature constitutes a fever, they do agree that children must not return to class until they’ve been fever-free for 24 hours.
Most pediatricians consider 101 degrees Fahrenheit and above a fever for school age children, he said.
When fever cannot be brought down with medicine or sponge baths, or if temperatures trend upward or are accompanied by pain, keeping kids home from school is not enough. It’s time to call a doctor.
Over-the-counter treatments can relieve congestion, bleary eyes and a mild cough. Kids can go to school so long as they feel well enough to participate. However, if fever rises and cough becomes productive with dark mucous, it’s possible that cold turned into a more serious sinus or ear infection, Sagan said.
Sore throat with fever is a “keep ‘em home” and see-a-doctor decision. The bacterial germ, strep (Streptococcus), is a common cause of sore throat and can lead to more severe illnesses if untreated, Sagan said.
Vomiting and diarrhea are reasons to keep young children away from classmates, he said. Even if the cause is not serious, schools will call parents to pick up a child if episodes continue.
Skin rashes are common in children, and ringworm is reason to keep a child out of school. Ringworm is a contagious skin infection caused by a fungus-like germ that produces the characteristic rash: a rough, pink expanding circle. Even though treatment does not require a doctor’s visit — over-the-counter antifungal cream will do the trick — some schools require a doctor’s note indicating treatment is complete before permitting children to return to class.
“Parents are very good at knowing how their child behaves when they are well, so they are good at knowing when they are not well,” Sagan said. “The difference is knowing when you need help. And they should never feel pressured to not make a doctor appointment or a phone call if they are worried. That is the doctor’s job.”
This article was originally printed in Well magazine, the precursor to this site, in September 2008.