A-Z

Flu or Flu-like illness in chronically ill or disabled children

Impact on nursery and school

Recurrent episodes of flu or flu-like illness and complications can cause some children to be off school or nursery for long periods of time. Parents talked about the importance of their children’s education and weighed up the pros and cons of sending their child to school when they were ill. Sometimes it is a whole month that Rahma’s son cannot go to school because of flu or flu-like illness. Waj’s daughter has cerebral palsy and asthma. Because of flu or flu-like illness and complications, she only went to nursery for three months during one school year. Other parents we talked to said their child was off school or nursery frequently but for shorter periods of time. Daniel was frequently off school for two, three or four days at a time.
 

Rahma’s son could not have the Influenza (flu) vaccine when he was younger. He had long periods of time off school because of flu-like illness.

Rahma’s son could not have the Influenza (flu) vaccine when he was younger. He had long periods of time off school because of flu-like illness.

Age at interview: 58
Sex: Female
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They say he have asthma so and he was allergic with egg. So it was difficult for him to get vaccination because he have an egg. So I have to give him paracetamol when he’s sick and he was very bad chest cough, was dry. Until when he was vomiting so always he was vomiting. He can’t go to nursery school. I have to keep him home. So it was a very difficult when he was 

When he was little?

Four years.

The flu vaccine?

Yeah, flu yeah. They can’t give to him. So every winter it was difficult for him to go outside or go to school. He have to stay home. When he go to school he start to vomiting and fever so they have to, [whistle] I have to go to collect him to send him back home. So it was. I don’t understand because they say we can’t have flu jab without egg. But now this year I hear from people they have flu jab without egg but now he’s not with me. He, he’s with, under care.

Ok.

Yeah so

You said that when he has the flu or the flu-like illness it takes him longer to recover?

Yeah.

Yeah?

Yeah because he can’t go back to school. In school they say he have to stay 5 days or one week he have to stay home until he is recovered. Because when he go back he started to vomiting again so that’s why they say, “You have to keep him home.” Yeah.
Sarah, like Hazel noticed that as their children got older they had fewer flu or flu-like illness episodes and so they were off school for less time.
 

Oscar has complex medical needs and although his mum is concerned about using antibiotics too much (and avoids them for her other child and herself), she accepts that sometimes there is no alternative for Oscar.

Oscar has complex medical needs and although his mum is concerned about using antibiotics too much (and avoids them for her other child and herself), she accepts that sometimes there is no alternative for Oscar.

Age at interview: 41
Sex: Female
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I mean obviously you don’t want to give your child antibiotics all of the time and you know we understand the affect it has on the wider community as well. And you know people are getting used to antibiotics but in Oscar’s case it’s just there’s no alternative because everything is just a bit worse for him. So in some children if they had an ear infection you can just go. Ok they can bear it for a couple of days and it will work itself out. With Oscar it won’t and he’ll be in a huge amount of pain because it’s just always a bit worse for him. And so, you know, we have to use antibiotics. And also you don’t want things to escalate. What is, you know, at the start a small chest infection if you leave it becomes pneumonia. You know, and you have to. So for us we have to use antibiotics when it’s needed. With my other child for example if he got ill I would try harder to not give him antibiotics quite so quickly. And luckily he’s, he’s a very well person and very rarely needs these things. And also for myself I would try and hold off antibiotics a bit more but with Oscar it’s just, it has to be that way and, and we want him to be safe and antibiotics have helped him be safe.

Have you discussed with any health professionals antibiotic resistance or is it something you are worried about or?

It, yeah we have with the GPs but they always say in Oscar’s case just what I was saying. He just, he needs to have it when he needs to have it and…

And that’s it.

That’s it [ha ha] basically.
Parents appreciated being told if there were colds or flu virus going around school or nursery so that they could decide whether to send their child in. Sarah’s son is at nursery. She said, “I'd still send him in, because I think he's not going to build an immune system if he's not exposed to things as well.” Not everyone felt like this and Rebecca thought when her son starts school if there were “a class full of colds” she would keep him off school. 

Once a child starts full time school parents may struggle to decide what to do if the child has a cold. Parents told us that if the child was ill and had a temperature, they usually didn’t send them to school. Others decided, in an attempt to prevent illness developing further, to let their child rest at home for a day if they were under par.
 

Ella loves school and her parents wouldn’t keep her at home just because there were viruses going round. But they know when she is too ill to go and needs to stay at home.

Ella loves school and her parents wouldn’t keep her at home just because there were viruses going round. But they know when she is too ill to go and needs to stay at home.

Age at interview: 32
Sex: Male
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But when it comes, we try to keep her in school as much as possible because we know it's important for your child to get a very good education. You know and, and the best thing for Ella is, she actually loves to go to school. That's all she wants to do. Even when she's ill, she still wants to go. Which I, I find amazing. But, you know, there's some times where you have to draw the line and you have to keep her off.  But where we can, we will let her go to school.  But when she's, when she's ill, like when she's had the chest infection and things, she's just not been well enough to really get out of bed, so she doesn't go.

And does the school let you know if there is a sort of a bug, an infection going around? And if there is a flu?

Sometimes. But we tend to know, because you hear parents in the school, saying "Ooh, my little one weren't well the other day, being sick all night." Or, "He's got a really bad cough." Or something like that. Then we know we need to be more, even more so looking out for Ella. And pay much more -

Okay. But you don't keep her at home?

Sorry?

You don't keep her at home?

No. No.

Okay. 

It seems a bit harsh. But as I said earlier, she loves to go to school. And to keep her away from school just because somebody in her class might have a bit of a cold, seems a bit harsh on her. So it'd be like we're punishing her, in a way. So we do try and send her when we can, and when we know she's not ill. But when she's at the point where she's not well, then that's when we don't send her at all. We know when not to send her.
Ruth was aware of her daughter’s pattern of illness so she knew when she might deteriorate and when to keep her off nursery. 

Good communication between parents and their children’s schools and nurseries was important. Parents talked to their child’s keyworker at nursery or teacher at school about what to do in case of deteriorating symptoms. A good relationship with the keyworker or teacher helped some parents to feel confident about taking their child to school or nursery at the beginning of an illness episode. Others preferred to keep their child at home so that they could monitor any change in their symptoms.
 

When Kwame was at nursery, Hyacinth didn’t send him in if he had a cold for more than two days. She knew he could deteriorate and she wanted to respond quickly to a change in his symptoms.

When Kwame was at nursery, Hyacinth didn’t send him in if he had a cold for more than two days. She knew he could deteriorate and she wanted to respond quickly to a change in his symptoms.

Age at interview: 42
Sex: Female
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Ill? I dunno. I mean really once he kind of had a cold that went on for more than probably two days at things like nursery I just wouldn’t send him in ‘cos I wouldn’t I’d want him to be at home if he either, I’d know after the third day whether he was gonna get worse or whether it’s gonna improve. If it’s improving I’d at least give him a day off anyway or two days off. Yeah but also I used to worry ‘cos if it’s, he starts going downhill I want to be able to, for him to access the hospital straightaway rather than kind of waiting or being delayed or people not sure and all that kind of thing. 
 

Mirella feels confident to send her son to nursery if he is starting to have a cold. She informs his keyworker about what to do if he starts wheezing.

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Mirella feels confident to send her son to nursery if he is starting to have a cold. She informs his keyworker about what to do if he starts wheezing.

Age at interview: 36
Sex: Female
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Yeah I mean obviously is if normally everything sort of sort of kicks off pretty quickly, when they get a cold or flu so I go, yeah by their symptoms. Obviously both the nursery and school they are very supportive. They know about his condition and we’ve talked through so they’ve got an inhaler, over there. So sometimes if he’s not really bad but he’s wheezy, wheezing when he has gone to nursery or now to school, I can then ask them would you please give him you know two puffs of the inhaler every two to three hours and if it looks like that he needs more could you give me a call. So obviously I wouldn’t take him to nursery if he’s really ill with the infection and having a temperature, but if you’ve got a mild cold and he starts getting wheezy and he’s happy and playing and eating then I would still let him to have a go and then just to sort of, working together quite closely with the keyworker at school, or in the nursery we’ve set sort of certain parameters that if this happens please call me. So that the decision making still is with me whether he should be there or not. But yeah again it’s comes to your sort of good relationship with the care provider.

Has that worked well?

Yes, yeah. Yeah. Yeah I mean he’s just started school, literally three days ago so that’s a new environment, so I don’t know how it’s going to work over there, but in the nursery where he went from one year old until now, he’s three, it’s sort of been you know with the key workers and you have the meeting and sort of have to review the treatment plan if you like.

Yes but it’s, I guess it’s just, you know the keyworker that he’s got is brilliant but then I’d have to say that when he, she’s not in I might feel a bit anxious to leave him there because I’m not sure that the whole pool of the nursery nurses that are there, they might not be so aware of, of his situation or what has been agreed. So I guess then if I take him in and the keyworker is not there I might then ring and check or even say, “Well actually I think I’ll keep him home,” but again that comes to the good relationship with the people you sort of, who cares for your children really.

And just to follow up on that ‘cos he’s just started school?

Yes.

How did you approach, have you approached this yet with the school?

Yeah I mean we had the before the summer holidays, we had settling in sessions, we went there for two hours so he would sit down with the key, again they’ve given key workers ‘cos it’s still the nursery class.

Pre-school

At school, yeah. So I explained that this is his condition, what he’s got and, given inhalers and the spacer and everything, but I think probably him being there now and things starting to settle and the flu season kicking in, I think I will probably have to make an appointment just to sort of discuss it through and again sort of agree on some sort of plan, what to do and, but he would, he goes to the nursery in the morning, and the nursery drops him to school. So again then I would probably discuss with the nursery that if, at the point that they are walking him to school if they are not sure then they would ring me and then we go from there.
 

Now Kwame is at school, if he is really ill, Hyacinth keeps him at home because she would worry that the teachers might miss his symptoms getting worse.

Now Kwame is at school, if he is really ill, Hyacinth keeps him at home because she would worry that the teachers might miss his symptoms getting worse.

Age at interview: 42
Sex: Female
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The only thing it kind of used to impact really is school. And because I’ve spoken to the school really about his kind of  illnesses, as long as I end up with some kind of letter to say he’s been to the hospital, or

Okay.

Or he’s ill with a yeah with a illness, really that’s kind of it. 

So they’re quite supportive?

I mean they’re quite, yeah they are quite understanding actually.

But he did used to have a healthcare plan, which they called it at the time because he was on a lot of medication and seeing a lot of specialists, he used to have to take a lot of time off of school going to appointments…

Yeah.

…so he was kind of on the radar for that. But now I mean it hardly impacts on his school at all now really.

Yeah.

Just a few times a year and they know, I’ve said to them, the school also know and the local authority that if he’s really ill I’m not sending him into school because the same way like my own mother, who’s the main other person who used to care for him can miss symptoms a school teacher is not going to see those symptoms, so I’m not taking the chance.

Yeah, when they have 30 other children.

Yeah. And it’s not fair on the class or the teacher or anybody, or me.

Yeah.

I wouldn’t be able to rest. 
Getting back to school after flu or flu-like illness could be delayed because of changes in a child’s long term medical condition or disability or needing to complete a course of antibiotics. As Nia explained, teachers are not able to administer pain relief or antibiotics so although her son may be better, the practicalities of managing medicines or needing to complete a course of antibiotics can delay him returning to school.
 

Nia explains the practical difficulties for her son to finish a course of antibiotics when he is at school and she and her partner are at work.

Nia explains the practical difficulties for her son to finish a course of antibiotics when he is at school and she and her partner are at work.

Age at interview: 27
Sex: Female
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Whereas at school they will not administer any kind of pain relief, none at all. And if they have antibiotics, if they’re on three a day dosage regime they will not administer it in school.

Right.

You have to give it, bearing in mind it says, “Take at evenly spaced intervals,” this means you have to give it at sort of seven, half past seven in the morning before school, then nothing until half past three at the end of school, and they suddenly again at maybe six o’clock before bed. But you’ve got this big gap in the day. They would only give antibiotics if it was a four a day regime.

Okay.

For some antibiotics it’s four a day…

Yes

..regime but for amoxicillin it’s usually three a day, they refused point blank to give it in the middle of the day. Which isn’t helpful.

No, not at all. 

And when you work and it might have been one parent has dropped him off in the morning and the other, you’ve got to keep the amoxicillin in the fridge,

Yeah.

How are you then supposed to get him to school, so what usually happened is he didn’t get it at all until he managed to get home, which was usually by about four o’clock, so you’ve had seven, seven thirty, 4pm. and then you might as well give him two spoons at once because there’s no gap between the next dose. So I don’t think that was very helpful. And it almost encourages you not to send him back to school until the antibiotics are finished, even if he’s looking better and it’s just a case of finishing the course.
 

Louise is cautious about sending her son back to school after flu-like illness. She has learnt from experience that even though he looks well, his insulin still needs to be monitored and adjusted.

Louise is cautious about sending her son back to school after flu-like illness. She has learnt from experience that even though he looks well, his insulin still needs to be monitored and adjusted.

Age at interview: 37
Sex: Female
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Now, how long does it take for the diabetes to get under control, following a flu or flu-like illness episode?

It really takes a long time. So, we have high blood sugar levels prior to the flu kind of being kind of noticeable. And then we have high blood sugar levels in duration. And when he starts to pick it up his insulin needs drop dramatically and they go back to kind of the normal requirements. So that adjustment, from being on sick day kind of insulin needs to kind of normal needs is, is quite tricky one. And I have sent him to school for instance, after a bug thinking he’s been a week off, he’s fine now and he looks fine. Sent him to school Monday, but him suffering from continuous lows all day, because his body is still kind of, I don’t really understand it and is probably something a consultant can answer. But it’s gone, he’s gone from needing so much insulin to requiring less and the body is still adjusting to that. So, it’s all about being quick, you know, recognising these trends and seeing or have to kind of change the settings on the pump pull back the insulin, feed him more carbohydrates, so yeah, it is, you know, I’ve been more cautious about sending him back to school even when he looks well, because even though the symptoms have disappeared and he appears well, it’s still the adjustment of a different needs, if you like, yeah. 
Impact on school work

Parents were concerned about their child missing school and the impact this would have on their education. Teachers should be willing to discuss providing extra homework for the child to complete after they recover from the bout of illness. Sharon noted that secondary schools seemed to be better organised about sending work by email. Some primary schools didn’t seem to be as well organised in helping children to keep up with their work.
 

Karen said she agonised over deciding whether to allow Alex to go to school or nursery when flu or flu-like illness was going around.

Karen said she agonised over deciding whether to allow Alex to go to school or nursery when flu or flu-like illness was going around.

Age at interview: 50
Sex: Female
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And if there is a bad case of influenza at school, at his nursery what do you do? Do you try to keep him at home or there’s no point?

I’ve tried. I’ve agonised about that one cos the feeling of dread is, well ok well these other children might get flu and it, you know, it will be a few days of them feeling bad and it will be water off a duck’s back whereas if he gets it. But I’ve come down in the end on balance to saying, you know, I think it’s not, it’s not really practical to keep him away. So you just have to let him take his chances and if there is something going around he’ll probably get it and there you go [ha] just like all the other horrible things that go around.
Frequent periods of time off school can have an effect on school work. Sharon said that Henry was missing out on structured lessons at primary school and it was hard to catch up if a new topic was introduced while he was away. He also was aware now that he took more time off school than his peers and she felt this had a negative emotional impact.

When Daniel was off school frequently, his parents felt the school should have sent him work to do at home and he got behind. Henry and Daniels’s parents said they had negative feedback from the school about their child’s attendance levels.
 

Nia has asked her son’s school to send work home for him because he was frequently off school for a few days at a time. She has helped him catch up but she hasn’t felt that the school were very helpful.

Nia has asked her son’s school to send work home for him because he was frequently off school for a few days at a time. She has helped him catch up but she hasn’t felt that the school were very helpful.

Age at interview: 27
Sex: Female
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There has been quite an impact on his schooling, 

Yeah.

He’s always found maths a difficult subject, and I feel he has missed a lot of his maths particularly that he, I’ve had to do a lot of catch up with him at home myself. I’ve had to teach him a lot. The school that he’s been at has been both supportive and obstructive if that’s possible.

Right.

When I’ve rung and said Daniel’s ill he needs to be off school they’ve been, “oh tell him,” they’ve expressed concern, they’ve expressed upset, “Don’t worry about it blah, blah, blah.” But as he’s got older especially towards the sats that he did this year I’ve said, “Would you please send me work home. Would you tell me what the topic is in maths, or would you…” Even if he’s not fit to do the work at least I know what he’s missed and I can maybe do something about it when he’s feeling a bit better. And they didn’t send work home. I never got any work sent home at all. And at one point he’d had so much absence, this is in his final year, Year 6 this last year they actually reported me to the education welfare officer ‘cos his attendance was so low. And it’s because he’d been off with chest infections and pneumonias and all the rest of it and when I actually explained it to the education welfare officer she apologised and she said, “I’m really sorry that you know that you had to explain all this to me,” and I said, “Actually the school haven’t been sending work home. I’ve asked for them to send, I’ve encouraged them to send, you know at the end of the day I am a teacher. Okay I’m not a Maths teacher but I should be able to do primary school Maths and my husband is a Maths teacher. The other subjects we are able to help him with. Please will you tell the school we’d rather they were more supportive in sending work home and telling us what he’s missed?”

So I think it has impacted on his school. Fortunately he’s been able to catch up but mainly through our own efforts not through the schools effort.

Yes, yeah.

Through our efforts as parents.

And again many parents might not have the skills or the time or the ability to do that. So I think that there is a gap in many schools in supporting families when children are off. He’s not been off long term, he hasn’t been off for three and four weeks at a stretch, it’s usually three days here, four days there, two days here. It’s in bits but that, in some ways that’s even more disruptive than being off for a long period.
 

When her son’s primary school started giving her negative feedback about his low attendance, Sharon asked her GP to print out a list of Henry’s appointments and the reason for each one.

When her son’s primary school started giving her negative feedback about his low attendance, Sharon asked her GP to print out a list of Henry’s appointments and the reason for each one.

Age at interview: 44
Sex: Female
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I think, probably the biggest impact is time off school. Because it only sort of takes a few viruses throughout the school year that require time off and antibiotics. But then your attendance is obviously going down and school aren't always as supportive as what maybe they could be.

Yeah

Because they're obviously having to… they're concerned about their figures and their attendance rates and, that then puts an additional pressure normally on your children as well, that they're aware that  their attendance is lower than expected, and it can also then have a knock on effect to your academic ability as well. And that’s probably the biggest impact that I found.

Have you been able to come to any arrangements with school or?

With my older child being at secondary, yes.

OK

Much more support is available there remotely. So, email and work can be sent to her via email which she can get on with and that’s not so much of an issue. I think at primary it's a little bit more difficult, because you are missing out on the structured lessons of the day and then if a topic has been introduced and you’ve had a week off school and you go back again. Then it's very hard to catch up.

Yeh. Do you think it's affected him? 

Mm

Does he have a sense that he's…?

Definitely, yes he does yeah.

In what way?

I mean he doesn’t want to be ill.

Yeah sure

And although he doesn’t look forward to school particularly every single day he, you know, he never wants to go to school all the time. But, he equally doesn’t want to be away from school and not learning. You know he gets the bigger picture on why you're at school and that you need to learn. And I think if you're off in a term and you're off for maybe five/six/seven days of a term, that’s a lot of time out of school that you’ve missed, and he's aware of that being older. And I think that has just a bit of a negative impact on him really.

Do you think he feels the pressure?

Mm yeah. And then you also notice that your child thinks, 'Why me, why am I ill all the time?'

Really

Why am I catching everything?

Yeah. I mean, for my experience I've had very few supportive teachers with my primary school. I don’t think they understand that you can just catch as many viruses and, the one way which I've  recently, at a meeting at school, I've got my GP to print off a list of just basic date and incident of going to see the GP and what the reason was.

Yeah

And it's a two page A4 sheet; I think it was dated back to 2009 up to 2014. So that’s evidence. I just felt that it… comments and things that we'd had in meetings about attendance had got to that level where I needed to just say, "Look, this is what he's had; this is how many viruses and different illnesses that he's had over the course of time." And I wasn’t asked to do that but I felt that I needed to evidence that my child is only off if he's ill.

Mm yes, yeah

Because we've had some very negative feedback from class teachers.
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