On my little brother’s first day at school, I was charged by my mother with watching out for him. I took the responsibility on with all the seriousness of a 6 year old and looked after him during break time. As the bell for the end of break rang and he was taken away from me, I became increasingly upset at being parted from him and not fulfilling the promise to my mum.
The next thing I recall, I was being asked by my teacher whether I was ok and if my tummy really hurt. Confused, but still upset, I went along with it and my unamused mother was called back from work to collect me! When I was put to bed once home, I stayed silent for a few minutes before uttering the immortal line that has remained a catchword in our family ever since: “Mummy, I’m skiving . . .”
Quite a lot of children get sent to school because their parents think they are ‘skiving’. However, Roz Hanby has a strong belief that happy, well children do not, on the whole, want time off school and if you get the emotional and physical health of children right they will flourish and give of their best. By knowing what to look for, taking time to listen to children and using her experience she can make judgments about how best to respond effectively. Here, she shares her expertise on helpful ways to make a quick assessment of your child.
So when should we keep our children home?
Even after years of working as a school nurse, I still feel this is a tricky question. I know that my own daughter would sometimes show a sad and peaky look at me just as we were getting ready for school, or would announce that she had a really, really sore throat/tummy/head!
It sounds obvious but it’s worth asking the child if they feel they can go to school, I’m amazed at the number of children who say I’d like to try and go back to class! Especially if they feel that their symptoms have been acknowledged and that they are able come back to sick bay or go home if they still feel unwell.
All schools differ in their ‘stay at home’ rules. Boarding schools are better equipped to deal with a child who feels unwell but obviously no schools are happy to accept children with any of the following:
- Diarrhoea and/or vomiting even if only one episode
- Temperatures above 37.5ºC
- Fits or blackouts that have not been assessed by a doctor
- Chicken Pox. Children can go back to school 5 days after the onset of the rash as long as they are feeling well
- Scabies – until medical treatment has started Impetigo – until medical treatment has started
What if they have a fungal infection, ringworm or Athletes’ Foot?
There is no need to keep children away from school. Treat with antifungal cream available over the counter or try washing feet in anti dandruff shampoo regularly to help treat and prevent Athletes’ Foot. It works brilliantly!
Can they go to school even with a temperature?
I recommend investing in an ‘ear thermometer’. They are accurate, quick and easy to use. It is worth remembering that a ‘normal’ temperature varies from person to person but most are within a range of 36.5–37ºC. I tend not to have hard and fast rules such as ‘if you haven’t got a temperature then you must go to school’. Some children are genuinely unwell particularly in the prodromal phase while sickening for a virus, while others play around happily with a temperature of 37.5ºC or more. Running around and hot weather also have an effect on body temperature. I’m a great believer in looking at your child and having confidence in your own instinct. It’s worth being aware that any child who has a temperature whether on and off or constant for more than 5 days should be seen by a doctor.
What are the obvious signs of sickness?
Obvious signs are:
- Skin colour – paler or more flushed than usual
- Breathing – breathless or wheezy
- Mood – lethargic, quiet, irritable or agitated
- Skin temperature – hot head, cold or bluish coloured hands and feet
- Vomiting and sickness – I have found a lot of children say that they have ‘been sick’ and when they are asked a little more, you find that they haven’t actually vomited but have felt sick (unwell ) and have a ‘nasty taste in their mouth’.
- Dizziness – another word that children use for feeling unwell. In order to differentiate I ask if the room is ‘going round’ or if their head feels fuzzy.
Can you differentiate between viral and bacterial infections?
How many of us have been sent home empty handed from the GP with a poorly child and the ‘it’s a virus’ diagnosis? There are still quite a lot of people who ask for antibiotics ‘just in case’.
Viruses can be serious but rest, plenty of fluids and time usually work their cure. Sometimes, bacterial infections set in ‘on the back’ of viral illness e.g. sinusitis after a cold. One diagnostic tool to differentiate between viral and bacterial infections in children is that temperatures remain consistently high in bacterial infections whilst in viral infections temperature tend to ‘spike’ (in an up and down pattern).
The threshold for antibiotic therapy has changed in the battle against resistant strains of bacteria and conditions like uncomplicated ear infections are often treated ‘conservatively’ with painkillers. In these cases, parents are often given a prescription to use if needed after a few days.
Can worrying make children ill?
In my experience, worries often manifest themselves in children looking and feeling unwell. With children who come to our sick bay regularly, once they have been checked physically, I often explain to them that worries can make tummies ache, and that I find sharing a worry can be a ‘miracle cure’. Worries can come from such things as being frightened by something on television to missing a parent when they first start school. Friendships also become increasingly important to children especially as they get older. Arguments at home, which I explain, are a normal part of family life, often worry children who sometimes feel that parental arguments are ‘their fault’. I have found that a short reassuring chat works wonders with children even as young as 6 or 7.
What about home remedies?
Paracetamol syrup is still the favourite painkiller in most households and is effective. Ibuprofen syrup is very good for inflammatory pain for throats and ears. These work very well together. You can give paracetamol 4 times a day and ibuprofen 3 times and if you alternate doses through the day, remembering to keep a dose for bedtime, this works very well. This combination can also be used to help bring temperature down, but NICE* now recommend not using medication for this reason alone if your child is otherwise well, there is now some research that shows that raised temperature in children may help their immune system. Medication should of course be given if the child feels or looks unwell.
LINKS
NHS Direct 0845 4647 http://www.nhsdirect.nhs.uk/ *NHS National Institute for Health and Clinical Excellence (NICE).
Quick reference guide ‘Feverish Illness in Children’ www.nice.org.uk/CG47
DVD ‘Spotting the Sick Child’, from the Department of Health and supported by the Royal College of Paediatrics and Child Health, £29.99 from www.ocbmedia.com