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How to know if your child is truly sick

Mom looks worried as she reads a thermometer next to her coughing child.

Like many of the children I see in clinic each day, I didn’t necessarily love school growing up. Sure, I enjoyed seeing my friends, but the school lunches sometimes looked suspicious and I preferred watching cartoons. This led to random bouts of “stomach aches” and saying “I don’t feel good” both before and during school.

As an ER nurse, my mom knew what to look for. This usually resulted in me being sent (correctly) to school despite my best efforts. There is a balance to understanding if your child is “faking it,” should go to see their doctor, or if they just need some time at home to recover for a day or two. Below are a few common complaints as well as some ways to think about them if you hear one of these from your child.

First: What to ask?

No, we don’t want to ever accuse kids of faking sickness, but there are ways to ask questions to help us understand what is really going on without asking leading questions. Here are some ways to get more details.

  • Where does it hurt? Your belly, your throat or somewhere else?
  • Can you point and show me where you don’t feel good?
  • Does it hurt all the time or only when you drink water or eat?
  • Are you going to the bathroom more?


Your child having a temperature of 100.4 degrees Fahrenheit and above is what most pediatricians consider a true fever; however, your child’s school may consider a lower number of 100.0 and above a fever. Having a fever either at school or at home should be considered an automatic recovery day away from school and friends until they are 24 hours fever-free and without the need for fever-reducing medications.

To get the most accurate temperature reading, make sure your child does not have anything warm or cold to drink 15 to 20 minutes before taking their temperature by mouth, as this can give a false reading. Also, taking your child’s temperature after they have been running around may also result in a falsely higher temperature.


A tummy ache is a bit more challenging to check than a fever. As a good rule of thumb, tummy aches involving diarrhea, vomiting or nausea should not go to school, because it’s most likely infectious.

Not seeing any of these symptoms and your child is still complaining of a stomachache? Try checking if they want to eat. An appetite loss is one of the first symptoms of a stomach bug, so if your child launches into their favorite cereal or waffles for breakfast, they may be fine to go to school. If your child complains of stomach pain a lot, don’t ignore it. Chronic stomach pains could be anything from constipation to gastritis or anxiety, and your child’s pediatrician should weigh in. Any severe abdominal pain should be immediately evaluated by a physician, as this can be something serious and needs emergent evaluation.

Sore throat

“My throat hurts” can be a more challenging symptom to manage from home or at school. Is it allergies? Is it strep throat? Is it a virus? Strep throat cannot be diagnosed by just looking in the throat, but also by taking into account the child’s age, medical history and other symptoms. A quick trip to your pediatrician’s office may be needed to see if they think your child needs a test or not, as strep throat is infectious, and your child would need to stay home for 24 hours on antibiotics before returning to class. Even though a viral illness does not need treatment with an antibiotic, it may be another illness such as influenza or COVID-19 that would also require your child to stay home to prevent others from becoming sick.

Could it be COVID-19?

Many of the COVID-19 virus symptoms are like those of other viruses. If you have any of the symptoms of COVID-19, it is important to be tested for COVID-19 and stay home if you are sick.

Generic “I just don’t feel good.”

Being sick can make you feel “off,” but how do you determine whether your child is using vague symptoms to avoid going to school? Before the COVID-19 pandemic, there were (and still are) many different types of viruses causing common colds. That being said, in these times, if you have a cough or runny nose, it’s best to be sure and take a COVID-19 test before to returning to school.

If you can’t see any signs of sickness from your child but they still are saying they don’t feel well, ask for specifics. Sometimes, even suggesting a visit to the doctor may result in a miraculous “recovery!” Frequent complaints of feeling “off” or “bad” for more than a few days in a row could be a sign of something more serious and should be investigated by your child’s doctor.

If you have any doubts about what you should do, please reach out to your child’s pediatrician or family physician.

The most important rule

Seek immediate medical treatment if a child is:

  • Unresponsive or not waking up.
  • Struggling to breathe, “belly breathing”, or unable to talk in full sentences due to needing to take a breath between words.
  • Wheezing or gasping for air.
  • Crying continuously due to pain or discomfort.
  • Vomiting blood.
  • Unable to hold down liquids or having bloody diarrhea.

You know your child best

You know your child best, and there is something to be said about a parent’s gut instinct. It’s powerful. Even if your child is too young to describe how he or she feels, use your parental intuition and observe their behavior. If you feel that “faking it” has become a pattern for your child, it is important to ask “why?”. Children who are being bullied or are experiencing notable stress at school may fake illness to avoid the trigger. Remember that a visit to your child’s doctor or school nurse is always a reasonable choice. 

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Clinical Assistant Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Clinical Assistant Professor of Pediatrics, University of Kansas School of Medicine