Is a Sick Kid Better Than an Absent Kid?
In the post-COVID world of chronic absenteeism, schools have relaxed their health policies in an effort to boost attendance. But parents and teachers worry that sending kids to school with mild illnesses puts others at risk.
The kid was ill, clearly. Angela, a Brooklyn private-school teacher, dutifully sent her sick student to the school nurse, who indeed deemed the elementary-schooler unwell enough to be sent home. But the parents didn’t answer, and so the nurse sent the kid right back to Angela, who asked to use a pseudonym. “As soon as the child came back to class — vomit on the floor, in the doorway,” she said.
Disgusting, yes, but not actually the most disgusting thing she’s experienced this year as a teacher. “I’ve been coughed on in the face, I’ve had snot rubbed on me, I’ve been sneezed on,” said Angela, who ranks the mucus-related incidents ahead of the vomiting episode in terms of gross-out moments, perhaps because the former are so frequent. She estimates that this school year, about half of her students have shown up to school sick at least once.
Across New York City — and across the country — teachers and school nurses say they’re seeing more coughing, sneezing, generally unwell children showing up to school this school year compared to the past few years since 2020. And many parents admit that, yes, they’re sending them in this condition knowingly.
It’s not happening just because it’s difficult (or sometimes, impossible) for parents to stay home from work. In many cases, school officials themselves are encouraging parents to send mildly ill kids to school. And in California as well as certain districts in Massachusetts, Texas, and Maryland, for example, schools have loosened health policies — formally and informally — in a seeming bid to boost dismal attendance numbers. A nationally representative survey by C.S. Mott Children’s Hospital released on Monday, found that 22 percent of parents of middle- and high-schoolers believed their children’s school policy encourages parents to send children to school when sick.
It’s true that attendance rates have dropped dramatically since pre-pandemic days. During the 2017–18 school year, about 26 percent of students nationwide attended schools that reported high rates of chronic absenteeism, defined as missing 10 percent or more of the school year. That figure more than doubled during the 2021–22 school year, hitting 66 percent. The most recent figures available suggest a modest improvement in most states for the 2022–23 school year but show that attendance is still not back at those pre-COVID levels.
It’s an issue that’s been stumping researchers and attendance advocates alike, said Liz Cohen, policy director at Georgetown University’s Future Ed, which maintains an online tracking system showing rates of chronic absenteeism since the 2018–19 school year. “I don’t think there’s one shift that’s going to rapidly change the whole thing,” she said, though that hasn’t stopped states from trying. Rhode Island, for example, maintains a real-time dashboard tracking chronic absenteeism at each of its schools to keep the issue top of mind for parents. California has its eye on illness-related absences, and, earlier this school year, it announced that it had relaxed statewide guidance on when to keep kids home from school in times that they’re not feeling well.
In California, chronic absenteeism reached a high of 30 percent in the 2021–22 school year, up from 12 percent in 2018–19. In the 2022–23 school year — the most recent figure available — that number decreased to 25 percent, according to a January report from PACE, a nonprofit research center focused on education policy in California. Better, but still more than double that pre-pandemic figure. Parents in that state have been inundated with such numbers this year.
“One of the big things we have seen [this year] is a really intense banging on the drum of attendance,” said Lisa Howe, whose daughter is a sixth-grader at a San Diego public school. We spoke on a Wednesday, and she’d already gotten two emails about attendance that week. “People are being encouraged to send their kids to school sick — it is such a shortsighted suggestion.”
Her state’s new guidance on keeping sick kids at home is surprisingly — and, often, nauseatingly — specific. Children with pink eye, for example, may attend school as long as it isn’t causing them vision problems. Kids with diarrhea should show up to class as long as they’re able to make it to the bathroom in time to avoid an accident. A kid up at night vomiting is welcome back to school, provided they stopped throwing up some time during the night and are able to keep down food in the morning. Less obviously stomach churning but perhaps most eyebrow raising is the guidance around fever: Instead of being fever-free for 24 hours, as the American Academy of Pediatrics recommends, California students may return to school as long as their fever went away overnight, is still gone by morning, and their symptoms appear to be improving.
The change in policy has made it a somewhat confusing year, said Vanessa Gonsales, a mom of a fourth-grader and a second-grader, both of whom attend Sacramento-area public schools. She recognizes the health risk of sending coughing, sniffly kids to school but said, “It’s also really hard to keep them out of school, because they get behind.”
In New York City, by comparison, chronic absenteeism hit 40 percent in the 2021–22 school year and only improved to 36 percent in 2022–23. And while the attendance numbers here are a little worse than in California, the guidance around sick days for students is a little more vague.
According to the New York City Department of Education’s policy for general illness (other than COVID), kids can be at school as long as they’ve been fever-free for 24 hours. For COVID-19, the DOE still adheres to five-day isolation, a recommendation the Centers for Disease Control and Prevention recently abandoned in favor of the 24-hour rule. Dr. Kenya Parks, a Mount Sinai pediatrician and the medical director of the Pediatric School Based Health Program, expects the DOE to update its guidelines in the 2024–25 school year.
In practice, many New York City teachers and school nurses say it’s been a pendulum swing back to pre-pandemic norms, when it just wasn’t that big of a deal to send a somewhat sick kid to school. “We want the children to be in school, even if they have mild illnesses,” said Dr. Parks. And, increasingly, they are.
Lizzette Lewis, a public-high-school teacher in Brooklyn, leads an after-school dance program for elementary-school kids, where she sees illness in action every day. “They’ll just have snot coming down their noses,” she said. After a while, she can’t stand it; her mom instincts kick in. “I’ll go grab a tissue. ‘Blow. Blow. All right, good, get back in line.’”
“I had one girl who was incredibly sick for weeks,” Tyler Moore, a seventh-grade teacher at a public school in Queens, said of the student who soldiered through classes with a loud, hacking cough. “You know what I’m talking about — it was that barking sound that some doctors classify as being ‘productive,’” he said.
A barking cough, a productive cough, a … familiar cough — the same cough Tyler’s own 3-year-old has had for weeks. On the one hand: How could he send his kid to school with a cough like that? On the other: Parents at his school do it all the time. So, off the hacking little girl goes to 3-K. “We sort of have been letting it fly under the radar until her teacher says something,” he said.
He sounds a little sheepish as he says it, but, officially speaking, it’s not the wrong call. A cough, as long as it isn’t accompanied by a fever, isn’t reason enough to keep a child home from school, according to the city’s sick-day guidance. It’s a notion attendance advocates tend to agree with. “Certainly we’re not advocating for kids to go to school to get everyone else infected,” said Hedy Chang, executive director of education advocacy nonprofit Attendance Works. That said, “at a certain point, a persistent cough is actually not contagious.”
The problem, some public-health experts say, is that this strategy largely leaves it up to parents to determine whether their child is contagious or not. “Most viral illnesses look similar, so it’s a lot on parents to try to tell them apart,” said Anna Bershteyn, an associate professor in the department of population health at NYU Grossman School of Medicine. “Especially if you just write down the symptom as a word, like, ‘cough’ — the lay person is not going to know.” In the C.S. Mott survey, only 4 percent of parents said they would call their child’s health-care provider for advice if it was unclear whether their child was sick enough to miss school. Fifty-three percent said they were most likely to keep their child home, and 25 percent said they would send them to school and hope for the best. About 20 percent of parents said they would let their kid decide for themselves.
This school year, Bershteyn’s 11-year-old son had a period of loud, incessant coughing. “But he was also going out into the courtyard doing cartwheels and asking if we could go for a run around the neighborhood,” said Bershteyn, who remembers thinking, What do I do with this child? She kept him home for a few days, then sent him back to school — only to get a midday call from the nurse to pick him up. From there, a visit to the pediatrician revealed the truth: She’d unknowingly sent her son to school with walking pneumonia (“or jumping and running and cartwheeling pneumonia,” Bershteyn said).
Her son is fine. But though his walking pneumonia was mild, it was also contagious and could have been harmful to those with weakened immune systems. “Not only are you exposing people in the classroom, now they’re taking it home to their family, to their grandparents, to the person in their home who may have some kind of chronic illness, who may get very sick,” said Dr. Taisha Benjamin, chief medical officer for Community Healthcare Network, which provides health care to underserved communities in the Bronx, Brooklyn, Manhattan, and Queens. “That’s the issue with leaving it up to the parent to decide what is a mild illness, especially when you have things that are very contagious.”
After all, mild illnesses can spread quickly, and sick kids at school often lead to more sick kids at school, suggesting that this strategy for attacking the chronic absence problem may in some cases only be exacerbating it. And while attendance experts agree that illness-related absences are a part of the attendance issue, they’re almost certainly not the main factor. “There has been a tremendous behavioral shift around decision-making around the relative importance of attending school on a regular basis,” Cohen said.
Recently, she visited a public charter school in Washington, D.C., on a rainy Friday. “And there were really not a lot of kids at school — it was clear every class was, like, 60 percent full,” she said. Where was everyone? “‘Well, it’s a rainy Friday,’” the principal said, by way of explanation.
In California, it’s been a tough year for parents like Howe, the San Diego mom. She has long COVID, and her husband is immunocompromised. They face real risks if their daughter catches something at school and brings it home. “One of the things that has been personally hardest for me is seeing that we had such an opportunity as a country,” she said. “It was like a blip, where we thought we would take care of each other, and that’s just over.”