By JOSEPH BROWNSTEIN
ABC News Medical Unit
The morning begins, and you slowly pull yourself out of bed, getting ready for a day at the office, when you hear the familiar refrain, "Mommy, Daddy, I don't feel good."
And soon, you will have to evaluate, how sick is she? Is he really sick, or just trying to get out of school? And why don't schools teach them that the proper grammar is to say that they don't "feel well" anymore?
There may be no way to know if your child is really sick -- even after seeing a doctor -- but pediatricians have several suggestions to help you make the right call on taking your child in to the doctor, keeping them home or sending them in to school for the day.
One thing doctors stress is that parents tend to be the best judges of their children's health because they are most familiar with their usual patterns and how they are when they become ill.
"Parents usually know their children pretty well, and they can often tell if something is bothering their child or their teenager," said Dr. Tanya Remer Altmann, a pediatrician with the Community Pediatric Medical Group in Westlake, Calif., and author of "Mommy Calls," which deals with parents' questions about their infants and toddlers.
That understanding can become especially important when children aren't themselves, because sometimes, even in a genuinely sick child, a doctor won't be able to find the source of the pain.
"Sometimes children can have symptoms that we may not be able to find an organic cause for. It doesn't mean necessarily that children don't have pain or discomfort, it may mean there are other causes than infection or inflammatory processes causing the problem," said Dr. Gary Freed, director of the division of general pediatrics at the University of Michigan.
"Sometimes anxiety, depression, or other issues can create problems for children that may manifest themselves in a variety of ways. Parents and physicians need to be sensitive to all causes of pain and discomfort."
Of course, there are some definite signs that a child should be kept home, which include fever (temperature above 100.4 Fahrenheit), vomiting, diarrhea, persistent pain or a bad, wet cough.
But those aren't always signs that they need to see a doctor right away.
"Every time your child's ill and you keep them home from school, it doesn't necessarily mean that you have to see the doctor," said Altmann.
Parents should be concerned if their child has a fever lasting several days or is very ill and complaining of pain. At the same time, Altmann said, "As long as they're drinking fluids and they don't look really sick, you can keep them home and keep an eye on them. If they're looking worse after a few days, give the doctor a call."
Even some symptoms that don't keep them home, like a phlegmy cough, might warrant a doctor's visit if they persist.
"In children, I probably say within 4 or 5 days, if it's getting worse or it's not starting to improve, then I'd check in with your doctor. Even an adult, I think, if you have a wet cough getting worse after 4, 5 days, you may want to see a doctor," Altmann said.
And just as knowing your child is important in making your decisions, knowing what the disease is can be, as well, especially when trying to gauge if your child's illness is still contagious.
"You wouldn't want somebody else coming in and infecting your child," said Dr. Jon Abramson, chair of the pediatric department of Brenner Children's Hospital of Wake Forest University Baptist Medical Center.
One example he gives is strep throat, where a child can go back to school once they have been on antibiotics for 24 hours, because they are no longer contagious.
Parents should also have a few other questions in mind when they make their decision to send their child to school.
"Are there other children in the house who have just been through the same illness? Is there something going around that school that this fits?"
Abramson said that by spending some time thinking about it, parents may be able to make a more informed decision about how to handle their sick child.
Of course, sometimes the children are just trying to get out of school for a few days.
"Occasionally, we get admitted kids who supposedly had fever for a long period of time," said Abramson.
In these cases, he said he often asks if the parent is taking the temperature and if they stay in the room the whole time.
Years ago, he said, he recalls having one child where the parent would leave the room and the child would dash to the sink to run the thermometer under hot water.
Parents need to know, Abramson said, "What is the level of sophistication in the child?"
Other things he said to look out for are children who act better once they are told they don't have to go to school, as well as children who are sick frequently, but never ill on weekends.
He also said that the main thing is not to give children an incentive to stay home.
"Don't give gifts," said Abramson. "You don't want to incentivize them to stay home. Be sympathetic and make sure they're comfortable, but don't give them gifts."
Altmann also recommends restricting many activities, such as watching television or any trips to the park.
he said that when a child is sick, they may need an extra bit of TLC, but while that may mean that a parent reads them some extra stories, it will mean they can't do certain other things.
Altmann said parents have to let their children know that, "When we get better, then we get to go back to all the usual fun activities."
But on the flip side of the illness coin, parents should also watch out for children who may be sick but not tell their parents because they don't want to miss a certain activity.
Abramson notes that this may be common among student athletes who don't want to miss a game. In this case, parents may want to watch if their child is unusually sluggish or showing other signs of illness, even if they aren't complaining.
"You have to understand what their motivation is to make the decision," he said.
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