From a runny nose to belly woes, it can sometimes be tough to tell if your kid is truly stay-at-home sick or feigning illness to get a free pass from class. Do you need to call the doctor or could your child be pulling a “Bueller” on you -- a reference to Ferris Bueller’s Day Off, the 1986 movie where a teen fakes the flu, only to head out for a day of mischief once his parents have left the house?
Here's how can you become a sickness super sleuth.
Examine the Scene
Daniel McGee, MD, a pediatrician in Grand Rapids, MI, says you should compare what you see to what your child says.
“If your child is eating pancakes and sausage and complaining of stomach pains, then that is something you should probably ignore,” McGee says. “But if he is refusing to eat or drink, then that is something that you need to be more concerned about.”
Collect the Evidence
Arm yourself with two basic tools to collect hard evidence about your child’s health: a thermometer and a small flashlight.
“The old wives’ tale about feeling for a fever by placing a hand on the forehead just doesn’t work,” says Donald Ford, MD, a family doctor at Cleveland Clinic Hillcrest Hospital. Your hand tells you the outer forehead temperature. But you want to check if your child has a raised internal temperature, or a fever.
“The difference between temperatures is like what an oven knob is set to versus the temperature actually inside a turkey that’s cooking. They can be two different things, as anybody who’s ever ruined a Thanksgiving dinner can tell you,” Ford says.
Things like scrunching up under a blanket or putting a hot water bottle on the forehead can make your child feel warm, and they might use such tricks to try and fool you. But these things don’t necessarily raise your internal temperature.
“You can’t fake a fever,” says Marc I. Leavey, MD, a primary care specialist. “If your kid has a fever, they don’t want them in school.”
Doctors define a fever as anything over 100.5 F. They aren’t worried about lower temperatures (although your school may be). Your child should have a normal temperature without using any type of fever-lowering medication, such as acetaminophen or ibuprofen, for 24 hours. Take your child’s temperature to be sure.
You can use the small flashlight to peer inside your child’s mouth. And make sure they say “Ahhh.” This pushes the tongue down so you can see the tonsils.
“If the child has white spots or white discharge coming from the back of the throat, the kid is probably sick,” Ford says. “It doesn’t tell you if he has strep, because you need a swab for that, but it’s still not normal.”
Prepare the Lie Detector
Like a fever or spots in the mouth, there are some other symptoms a kid can’t really lie about, but some they can. You want to hone your mom or dad skills if your kid comes to you with these woes:
Stomachache: This is the most common get-out-of-school complaint, and one of the most challenging to measure on the sick-or-faking-it scale.
“Pain that seems to wander is probably not real,” McGee says. Also be suspicious of pain that comes and goes that your child can still play through.
Still, stomach troubles can be from all sorts of ailments, from anxiety to constipation to something more serious, like appendicitis. If your child has severe pain in the right lower belly and hasn’t already had their appendix removed, get immediate medical help.
Headache: There’s no physical sign to tell if your kid’s head really hurts.
“That’s true for doctors, too, most of the time,” Ford says. “If a child comes into my office with a headache, I simply have to believe that they have one.”
If your child complains of blurry vision or eye pain, it could be a migraine, and they might need a day of rest. If your child has a stiff neck with a headache and fever, keep them out of school and see a doctor right away to rule out meningitis.
If your child is vomiting along with the headache, check with your doctor.
Rash: “You can’t fake a rash. It’s hard to make marks on your skin,” McGee says. “Obviously a rash is real, but it may not be an emergency. For example, you don’t need to stay home from school for sunburn.”
A little bit of redness in a skin fold, on the elbow, or groin is likely nothing. But dial up your doctor if your child has a rash that covers a large part of their body and appears as red dots, in a lacy pattern, or as little pimples.
“These types of rashes are worth having a look at,” Leavey says. “We still have the chickenpox. Measles are still out there. Kids are not always vaccinated. And depending on where you live, Lyme disease is also a problem. These things all cause rashes.”
Vomiting and diarrhea: Fluid coming from somewhere it shouldn’t be is a red flag. Don’t send your child to school if they have diarrhea or is throwing up.
“Chances are pretty low that kids are going to make themselves throw up just to stay home from school,” Ford says, talking about basic illnesses and not eating disorders. “They may tell you that they did, but if you can actually see or hear them doing so, then they are probably sick.”
Runny nose: This can be a symptom of many health problems, but not all of them are stay-home-from-school worthy. You need to consider what else is going on with the child.
“If I look at a snotty nose, I can’t tell if it’s a virus or an allergy, I have to put in context,” Ford says. “If this is the first time your kid ever had the symptoms, it’s very likely a virus or cold.”
On the flip side, if your child sneezes and sniffles a lot, it could be allergies. Look for black eyes or bags under the eyes.
Colds and allergies aren’t likely a reason to ditch school. But if your child has a runny nose and a fever and cough, it could be the flu. Keep them home from school.
Backache: Plenty of adults miss work due to back pain, but kids aren’t likely to unless they have a history of injury. If your child does complain of back pain, make an appointment with their doctor.
“Back pain in kids is one that goes in the never-ignore category,” McGee says. “Any time I see a child under 10 with back pain, then it's going to be something real and something not nice."
Have a Heart-to-Heart
Kids have faked illness to get out of taking a pop quiz. But sometimes, a child who says they’re too sick for school may be scared, worried, or anxious about something more serious.
“You have to turn up your parenting skills and try to listen to what’s really going on with your child,” Ford says. “Be aware that sometimes it’s not about faking it as much as it is about finding an excuse not to deal with an uncomfortable or even dangerous situation, such as getting teased or bullied.”
If You’re Not Sure
Sometimes, there’s not enough time in the morning before the school bus arrives to close your case. You might not know for sure if your child is faking it or not. You might need to wait an hour and see how they feel. Send them to school late if they perks up.
The bottom line: You have to know your kid.
“It’s not always easy to know if a child is faking sick or not, even for a trained professional. You just go with your gut,” Ford says. “It’s more about knowing your kid than knowing medical science.”