Ask the Doctor: WHEN IS IT OK FOR MY CHILD TO STAY HOME FROM SCHOOL IF HE’S SICK? Q: My daughter has small bumps covering both sides of her face. I first thought it was acne, but they look more like goosebumps that don’t go away. Could it be something else? A: Yes, bumps don’t always equal acne, says Rainbow pediatric dermatologist Joan E. Tamburro, DO. What you describe sounds like another common skin disorder characterized by small bumps called keratosis pilaris. This condition results from the buildup of adherent skin cells in the openings of hair follicles. This causes small, rough bumps on the skin — mostly found on the arms, face and thighs. “Keratosis pilaris isn’t harmful, but can be bothersome,” Dr. Tamburro says. “It tends to get aggravated when the skin is dry, like in the winter months.” Treatment includes exfoliation and keeping the skin hydrated. However, even with proper treatment, it can be stubborn to resolve. “Although the cause of keratosis pilaris isn’t known, it does appear to be hereditary and some children do outgrow it in their late teen years,” she says. “Talk to your doctor to examine whether this may be the cause of your child’s discomfort and to discuss a treatment plan.” JOAN E. TAMBURRO, DO, Pediatric Dermatologist, Rainbow Babies & Children’s Hospital Q: When is it OK for my kid to stay home from school if he says he’s sick? A: In general, the answer to this question should be “When they are sick!” Unfortunately, as any parent of a school-age child will tell you, it is not always so straightforward. Any child with signs or symptoms of obvious contagious illness should be kept home, advises Lyn Hollis Dickert-Leonard, MD, a University Hospitals Medical Practices pediatrician with offices in Solon and Shaker Heights. These symptoms include, but aren’t limited to fever, significant diarrhea (more than two to three times a day,) red or draining eyes, or a new rash associated with other symptoms such as headache or sore throat. “It’s also a good rule of thumb that if you wouldn’t want your son or daughter to be sitting across from a classmate with your child’s symptoms, he or she should probably not attend school that day,” Dr. Dickert-Leonard says. “A child with a disruptive cough, nausea or headache may not be able to benefit much from school instruction, and a day’s absence may also be in his or her best interest.” The more difficult situation is when symptoms are vague — “I don’t feel good” — or mild, but your child expresses a desire to stay home. If your child doesn’t appear to be as ill as he or she professes to be, other causes for school avoidance should be sought, Dr. Dickert- Leonard says. “For example, is your child the victim of bullying or suffering from test anxiety? If the answer is yes, those issues need to be addressed,” she says. “In most cases, and especially when no clear source of stress can be elicited, your child should usually be sent to school.” “Get out of school” passes should be doled out judiciously, since rewarding the avoidance behavior often will reinforce it without addressing the underlying issues, she says. LYN HOLLIS DICKERT-LEONARD, MD Pediatrician, University Hospitals Medical Practices pediatrician Q: My 10-year-old says she doesn’t have any friends, but she’s involved in several school activities and seems to have buddies. I don’t know if this is a self-esteem problem or some type of complex. Should I be concerned? A: Making friends is an important developmental task for children, which requires learning specific social skills such as making eye contact, cooperating, listening to others and sharing. A child’s ability to form and maintain friendships depends on how capable the child is using these skills and “reading” social cues from others, explains Rainbow pediatric psychologist Carin Cunningham, PhD. “These skills are typically learned naturally in settings such as preschool, elementary school and by participating in extracurricular activities such as scouts, sports teams or in art classes,” Dr. Cunningham says. “Some children learn these skills effortlessly, while others need special guidance. Your daughter’s perception of not having friends reflects a lack of confidence in her social skills.” You can help your daughter improve these social skills by working with her to understand her social problems in a supportive way, free from criticism or judgment. “Identify which behaviors need to be worked on,” Dr. Cunningham suggests. “The most effective way is to observe your daughter in social situations. Does she need to share or listen more — or hit, interrupt or tease less? Is she appropriately responding to peers’ social cues?” Explain, model and role-play social skills. Coach these skills in real-life situations, practicing regularly. It takes time for new skills to become comfortable and regular, she says. “Making friends and learning to interact well with others is hard work and a difficult skill for some children to learn; however, the rewards will be great for both you and your daughter,” Dr. Cunningham says. CARIN CUNNINGHAM, PhD Pediatric Psychologist, Rainbow Babies & Children’s Hospital