September 27, 2012

How Sick Is Sick?

It’s 7 am. You are getting your children ready for school and yourself ready for work. You have a huge report to present to the boss, and your child has to take a test that can’t be missed.

“Mommy, I don’t feel so good! [cough, cough, sneeze, drip]” Maybe you find him covered in a rash. Or you are feeling feverish yourself.

This is a disaster. You can’t miss work, your child can’t miss school. No one will notice, right? If your kid gets really bad (or the teacher notices the rash), the school will call you. You can leave work early. Right? It’ll all work out.

I’ve been there! I’ve had a real job that paid hourly, and if I missed a day, there would be a bill that couldn’t be paid. I have two kids who spent enough time at home with typical kid sicknesses. Both kids AND my husband all got chicken pox within a 3-week time span. It was a nightmare.

Best-case scenario

There are good germs and bad germs. We have beneficial bacteria in our gut that keeps us healthy by keeping the bad bacteria in check. A round of antibiotics can kill off that good bacteria in short order, and we can end up pretty sick unless we replenish the good bacteria with some yogurt, kefir, and some probiotic capsules. Bacteria live in us and on us.

We have become obsessed with avoiding germs. Gerber for Medical Professionals explains that, “Exposure to common infectious pathogens thus has an important function in building the child’s healthy immune system via adaptive immunity. A variety of infectious agents, both viral and bacterial, are commonly encountered by children in daycare, resulting in a range of illnesses including upper and lower respiratory tract infections, acute otitis media, gastrointestinal illness, and certain skin ailments. The young child first entering daycare – especially a child with no older siblings – essentially encounters an assault on the immune system that is a direct result of increased environmental exposure. Children under 1 year of age may be particularly hard hit as they are still in the early stages of immune system development. Parents will often cite their frustrations with the on-again, off-again illnesses experienced by their child. Parents and siblings are often co-infected, further exacerbating the family’s frustrations with the cycles of illness and recovery that interfere with home, work, school and social routines.”

So kids and adults getting exposed to SOME germs is good and necessary, because they will create antibodies to those germs and hopefully not get sick again because of them. But they can sure cause chaos in the household at 7 am or halfway through your workday.

The other end of the spectrum

Then there are the major illnesses that require vaccinations, if available, because they are so communicable and devastating. Many daycare centers just won’t accept your child if they haven’t received their vaccinations. More parents are getting state approval to opt out of school-mandated vaccinations.

In ABC News’s article, Non-Medical Vaccination Opt-Outs on the Rise, “Dr. Saad Omer, author of the correspondence published in the New England Journal of Medicine, warned that this trend is leaving large populations of children at risk for developing potentially deadly illnesses that haven’t been seen in the United States in many years.”

Some parent have resorted to “Chickenpox parties,”  where they expose a group of children to a child with chickenpox, even though the most severe cases of chickenpox can be fatal, and having it predisposes the person to getting shingles later on in life. Chickenpox is caused by the varicella zoster virus, one of 8 herpes viruses, which, after a bout of chickenpox, lies dormant on a dermatome, an area of skin that is mainly supplied by a single spinal nerve. This dermatome is where the shingles (herpes zoster) can flare as an adult, causing extremely painful blisters and nerve pain. The chickenpox vaccine  reduces the risk of chickenpox and shingles.

How sick is sick?

WebMD advises that you keep a child (or adult) home:

  • Fever of 101º or more, and keep them home until they are fever-free. From personal experience with my kids, I’d like to mention that strep throat (see Sore throat below) doesn’t always cause a sore throat. It could just cause a fever that spikes over and over for days, with no other symptoms. It may need antibiotics.
  • Diarrhea can be a sign of infection, food poisoning, or medication side effect. Keep the child home until stools are well-formed and the doctor gives the okay.
  • If a child has vomited twice or more in 24 hours, keep them home until symptoms clear or the doctor says the child is not contagious.
  • Severe cough and cold symptoms should keep a child home from school. A serious cough could be a sign of a contagious condition like whooping cough (especially if you didn’t get your child vaccinated with the pertussis vaccine), croup, or viral bronchitis.
  • Sore throat – If your child has been diagnosed with strep throat, keep them home for the first 24 hours after treatment has started.
  • Pinkeye (conjunctivitis) is usually contagious (unless it’s allergic conjunctivitis – let the doctor decide), so children should stay home for the first 24 hours after treatment has begun.
  • Headache – opinions differ on whether a child should be kept home because of a headache, which can be a symptom of a contagious condition like viral gastroenteritis, flu, meningitis, or strep throat. If there are no other symptoms and your child feels otherwise okay, she can go to school.
  • Rashes can be a sign of contagious conditions like chickenpox, bacterial meningitis, impetigo (what some parents often incorrectly refer to as “infantigo”), or even the measles, for parents who haven’t vaccinated.
  • Earaches and mild cold or respiratory symptoms are usually no reason to keep a child at home, as long as he is not in that much pain, the nasal drainage is clear, and the cough is mild.

Mayo Clinic has guidelines on when to treat a fever (a fever is not bad in and of itself – it helps to kill what causing the illness. It’s usually best to let it run its course unless the person is uncomfortable). Mayo also has guidelines on how to take a temperature.

Before you step out that door

Be aware if a child in your child’s class or someone at your work is immunocompromised due to an immune deficiency, cancer treatment, medical steroid use, or post-organ transplant. They may not be sick, but your child’s or your own illness could infect them and make them extremely or fatally ill if they’re exposed. Methods of transmission vary widely, depending on the bug. Don’t assume it’s all handshakes and using someone’s phone.

According to the Children’s Physician Network, several illnesses are contagious for up to 2 weeks before there are any symptoms, so wash your hands often (regular soap and water is fine – you don’t need the antibacterial stuff), cough or sneeze into a tissue or your elbow, use sanitizer after shaking someone’s hands or cleaning up a snotty nose, wipe off your surfaces with bleach or rubbing alcohol, and don’t go nuts with fear.

You can’t avoid all germs, and you don’t want to, because germs also keep you healthy, but you need to know when you or your child are too sick to go anywhere but back to bed.

Image Credit: Photos.com

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