Why Did We Ever Send Sick Kids to School?

An overemphasis on attendance puts students’ health at risk and instills the value of working through illness. The pandemic has made it clear how dangerous that is.

Staying home to avoid catching and spreading the coronavirus during the pandemic, for all the fear and anxiety it has caused, has come with one unexpected benefit for my family: My kids haven’t been sick once, not even with the common cold. My husband and I noticed this with a sense of relief after months of virtual schooling. We’re extremely fortunate that none of us have caught the coronavirus, but on top of that, our days and weeks hadn’t been upended by multiple colds or the flu over the past year. No missed work. No hospital bills. No sleepless nights.

During my oldest daughter’s kindergarten and first-grade years, I sent her to school several times with a runny nose or a slight cough, just like the parents of many of her classmates did. She was permitted to attend school as long as she was fever-free without the use of any medicine for 24 hours. But she has asthma, and it got progressively worse each grade, landing her in the hospital nearly every time she came down with “just a cold,” causing her to miss up to five days of school at a time, four times a year. Even if her asthma wasn’t flaring up during an infection, I had to monitor her closely for signs of an impending attack and administer several medications at precise times throughout the day. I didn’t want to sacrifice my child’s well-being to meet attendance expectations. So I started keeping her home, which meant playing catch-up with her assignments later.

Schools place a premium on attendance because it is associated with academic performance. Studies have shown that chronic absenteeism in middle school and high school hinders academic achievement and outcomes later in life, such as graduation rates and job opportunities. Less is known about the effects of frequent absences on elementary students, but a 2015 report out of the University of Wisconsin at Madison evaluated the impacts of first-grade absences on third-grade standardized-test scores: Chronically absent students scored lower on the tests, particularly in math. (The findings also showed that students who are Black, Hispanic, Native American, or from low-income households were more likely to be chronically absent.)

To motivate students, many schools award prizes for perfect attendance. And many schools’ policies are fairly lax about students coming to school with seemingly mild symptoms like a runny nose, sore throat, or cough. One of the largest attendance advocacy organizations, Attendance Works, affirms this behavior with their “How Sick Is Too Sick?” downloadable handout, which says as long as a child hasn’t had a fever or taken any fever-reducing medication for 24 hours, and hasn’t had diarrhea or vomited in 24 hours, he or she should not stay home. That advice is similar to my daughter’s school’s policy. (The organization has recommended suspending the use of these guidelines during the pandemic.)

Some school attendance policies punish both the kids and their parents when students miss too many days. In Georgia, after five unexcused absences—in which a parent or a medical doctor has not provided an approved excuse—parents are sent a letter informing them of misdemeanor educational-neglect charges that could be filed against them. Under the law, fines or jail time could be imposed, though the codes encourage schools and courts to take less punitive approaches. Many schools aren’t required to offer chronically absent students make-up work, and allow individual teachers the discretion of when and how to enforce this measure, which can hurt students’ grade average. All of this makes school more difficult for children who get sick, especially those who get sick frequently, and encourages parents to send their kids to school while ill. The collective effect is a harmful, but normalized, pressure on students (and their parents) to prioritize attendance above their own health and that of their peers.

Wendy Wisner, 42, is an editor and mother of two who lives on Long Island, New York. Her children, 8 and 13 years old, both have asthma that gets provoked by common viral illnesses, just like my daughter. While they were attending in-person school (pre-pandemic), Wisner had to rush her kids to the hospital after they contracted seemingly mild illnesses. “As someone whose kid has a vulnerability, you get really frustrated with people who send their kids to school with snot everywhere,” she told me. She understands that parents often get stuck between school expectations and work expectations, and that people sometimes make honest mistakes and don’t realize their kid might be ill. But, she said, “there are definitely parents who disregard symptoms and send their kids in anyway.”

Although her school district started offering in-person classes and hybrid learning options in September 2020, both of Wisner’s children have participated in virtual schooling since the start of the pandemic out of an abundance of caution for their conditions. As a result, like my kids, neither of her children has been sick all year, with anything. “I’ve lost sleep over a lot of things during this pandemic, but not over being up with a sick child or worrying that they’re not breathing properly,” Wisner said.

Abisola Olulade, a family-medicine doctor based in San Diego, says it’s always dangerous when districts send the message that sick children should still come to school, but even more so during a pandemic: “A sniffle is something that can have ripple effects. If a child has mild symptoms and is infected with COVID-19, and they go to school, they could infect other children. If there’s a kid that’s immunocompromised, that could mean death.”

People with chronic respiratory issues, such as moderate to severe asthma, may be at higher risk for getting a severe case of COVID-19, which means a more prolonged course of illness and a greater possibility of getting hospitalized. How children with asthma are specifically affected by a coronavirus infection is still being determined, but COVID-19 is a respiratory illness, and like many respiratory illnesses, it’s considered a possible asthmatic trigger. The virus could also spread from students to family members or teachers, who might be at risk for severe cases. Even when it comes to milder diseases among children who aren’t particularly at risk, attending school while sick has always increased the likelihood of spread, leading to more kids getting sick, and more kids passing illnesses on to their family and community members who could have otherwise stayed healthy.

The fear of punishment for parents or students when kids have too many school absences is compounded by the fact that many parents have limited or no paid sick leave. In April 2020, Congress enacted the Families First Coronavirus Response Act (FFCRA) mandating that families have access to paid sick or family leave during the pandemic to support individuals who need to quarantine, people caring for someone with COVID-19, and caregivers who are faced with school and child-care shutdowns, but it has since expired. As of January, FFCRA pay is optional. Excluding emergency coronavirus provisions, only 13 states and Washington, D.C., have laws requiring employers to provide paid sick-time policies. That means many parents every day face the impossible task of choosing between a paycheck and staying home with their sick child.

This speaks to a broader problem in American culture, which places a high value on productivity, pushing yourself, and “soldiering through” illness in nearly every line of work. Strict school attendance policies likely result in part from these same norms. But that doesn’t mean school leadership and administrators are not responsible for fueling this cultural ill by instilling these values in a new generation. “It’s not a good message to send to our kids that when they get sick, they should keep going,” Olulade told me. “Humans get sick. It’s okay to take a break. It’s your body telling you to take time to heal itself, and we need to teach our children that.”

Even as the COVID-19 vaccines offer a glimmer of hope on the horizon, parents like Wisner and myself are left wondering whether, after the pandemic, things will go right back to the way they were or whether schools will embrace what they’ve learned and apply it to prevent the spread of illness in the future. The idea that nothing might change is distressing. “Understandably virtual schooling has been a nightmare for a lot of parents, but it’s been a godsend for some parents, and that’s something we need to realize. These are parallel experiences,” Olulade said. She suggests that, post-pandemic, schools could accommodate as many children as possible with online-learning tools while possibly cohorting immunocompromised children together so that there are always options available for those who can’t attend in person all of the time.

“Other teachers and I have been talking about that all year: how to do things differently, moving forward more humanly and putting more emphasis on building relationships with students, and less emphasis on attendance, grades, and work completion,” says Megan Vosk, who teaches English as an additional language at the American Embassy School in New Delhi, India. She’s worked in public schools in the U.S., as well as private American schools in Abu Dhabi and South Korea.

Vosk is currently teaching both virtual and in-person classes. Like many teachers, she’s seen the physical spaces where she works transform to reduce the risk of viral transmission. Temperature checks are done when someone enters the building, students must fill out symptom logs in the morning, desks are situated in appropriately distanced rows, and masks are worn all day.

At Vosk’s school, attendance taking is still being performed as best it can considering the virtual challenges of unreliable internet connections, turned-off cameras, and, at times, unresponsive students. But “right now we’re trying to be really gentle, form connections, and not get so worried or punish anyone for being absent,” she told me. “We’re asking, ‘Are you okay? How can we support you? What do you need?’ Let’s figure out what the barrier is [to attendance], not get kids in trouble.”

Vosk was hinting at the long-standing assumption that absenteeism is intentional or should be considered misbehavior on behalf of the student, when in fact there are a lot of reasons beyond students’ control that they may be absent. Illness is just one of those. “What we don’t ask that should be a necessary part of attendance policy is, ‘Why is a child absent?’” says Karen Gross, who was senior policy adviser at the U.S. Department of Education during the Obama administration. Gross thinks that recording attendance as a numeric calculation is too simplistic and flawed: “We would be way better if we used a case-management approach to our students. It brings everyone together to figure out what’s going on with a student and finding solutions that work for them individually.”

Vosk still believes that chronic absenteeism can be a signal that a student is having issues. Their home environment might not be conducive for learning; perhaps they’re struggling with depression or anxiety, or they aren’t getting the medical accommodations and treatments they need. But she doesn’t think punishing them for being absent will help, and notes that teachers should pay attention to signs other than attendance that a student might be struggling. “Sometimes we get so focused on attendance as if that’s a substitute for learning. Just because a student is there doesn’t mean they’re paying attention, engaged, or learning anything,” she said.