It's 7 a.m., and 10-year-old Joey is looking a little pale and complaining he doesn't feel well. It's a stomachache, he says. Mom takes his temperature. No fever.
She's skeptical. "Where exactly does it hurt?"
"Here and here and here," he says, looking at her as pitifully as a wounded bird. "I just can't go to school today. Please . . ."
She starts the mental calculations.
"His color is a little off. Maybe he's coming down with something. If he rests today, maybe he'll shake it off. Do I have any more sick leave at work? Hey, wait a minute, today's his math test . . ."
"Mom," Joey screeches, "I think I'm going to throw up!"
Alas, it's that time again when parents must assume the roles of doctor and child psychologist. The "Is He Too Sick to Go to School" question arises in thousands of households throughout the country on any given day. But it's most likely to occur when school first starts. That's when schoolphobia is most prevalent in students, and also when a host of germs and bugs are freely circulating.
"It's just a matter of common sense," said school nurse Edie Gold, when asked how parents should judge their children's state of health.
Easy for her to say. But for many non-medical parents, the home-or-school judgment is based on a mixture of intuition, guilt and Dr. Spock.
That's why Dr. Howard Taras, a pediatrician at the University of California at San Diego Medical Center and a medical consultant to the school district, suggests the "Lego test."
"If a child can concentrate on his Legos or a television program and there aren't any major obvious symptoms, then chances are he is probably well enough to go to school."
More specifically, low-grade fever, minor cold symptoms, ear infections, infrequent diarrhea and vague "I don't feel good" symptoms should not prevent a child from going to school. A child with these symptoms should stay home only if he is so miserable that he can't concentrate in school.
"A school-age child may get as many as six to nine colds a year, and each can last 10 days or more," said Dr. Taras.
"That's far too much time to lose in educational benefit. And as far as the communicability of those illnesses, colds are transmitted the day or two before you get any symptoms. So you're not preventing the spread of these diseases by insisting that the children stay home."
A child who complains repeatedly of vague symptoms may have psychological pains, rather than medical ones. School reluctance is a fairly common phenomenon, affecting at least 5 percent of all elementary school students.
A school-phobic child may complain of stomachaches, nausea and tiredness -- stress symptoms brought on by a change in school, a strict teacher or a bullying classmate.
No matter the difficulty, the child should be made to go to school every day, insisted Dr. Taras, even with a stomachache.
"It works to the parents' disadvantage to keep the child at home. Eventually the child learns how to worry the parents enough not to send them. Then the child doesn't get through whatever difficulty he may be facing."
This is not to say, Dr. Taras cautioned, that the child's symptoms are imaginary: A child's nervous tummy ache is as real as an adult's tension headache. Never should a child be told his stomachache "is all in your head."
Instead, Dr. Taras suggested, ask the child if he knows where the pain is coming from, or if he is worried about something.
Teachers can often alter a classroom structure to help a child deal with the fear of speaking aloud in class or with bullies or learning problems. Meanwhile, parents must insist their children go to school.
One proviso: Should the symptoms intensify -- a child doubling over in pain, for instance -- the child's doctor should be consulted. If the doctor finds no medical problems, the child should be taken directly back to school.
For every parent inclined to keep the child at home, there are others who err on the other side. Dr. Taras explained that children who are obviously uncomfortable and unable to concentrate -- for whatever reason -- should be kept at home or at a day-care center specifically designed for sick children.
"If a child is stoic and doesn't tell the teacher he's not feeling well, then she may think he's slipping, that he's not trying hard enough, that he's not being good -- when really it's not their fault," Dr. Taras said. "This is plus the fact that a sick child needs extra attention and extra cuddling."
***When they're sick
* For contagious illnesses such as strep throat, skin and eye infections, children may return to school after 24 hours on antibiotics.
* Ear infections are not contagious and should not keep children out of school.
* Children with fever, vomiting or diarrhea should stay home until their symptoms have subsided for 24 hours.
* Students with scabies or lice may return to classes once treatment has been initiated.
Source: Dr. Howard Taras, a pediatrician at the University of California at San Diego Medical Center.