Is Your Kid Sick or Just Faking It?

for attention, the thrill of it, or a zillion other
reasons.

At some point during their school days, up to 10% of kids try to dupe their
parents into letting them stay home by feigning illness, experts estimate.
Sometimes, the guise is relatively innocent; but sometimes it masks serious
problems, such as
anxiety ,
depression , or their wish to avoid a bully at school.

WebMD asked three experts who've seen their share of faking -- a
pediatrician, a child and adolescent psychologist, and a former school nurse --
to clue us in on how clueless parents can decide: Does your baby need chicken
soup, or marching orders to get to school? Of course, if your child looks and
acts truly sick, it's time to call the doctor or take them to urgent care.

But if you have your doubts and are trying to decide if the illness is
really called "don't-want-to-go-to-school-itis," here are our experts'
four best tips, short of hooking up a lie detector:

(Do you know when your
kids are faking sick ? Share your stories on WebMD's Parenting: Preschoolers
and Grade Schoolers message board.)

1. Check Out the Medical Evidence

Common flu symptoms include fever, extreme
fatigue , dry
cough , and body aches. Cold symptoms are typically milder, including a
runny or stuffy nose. Taking the body temperature is a good first step, says
JoAnn Rohyans, MD, a pediatrician in private practice who is also an associate
professor of pediatrics at Ohio State University College of Medicine, Columbus,
and a spokeswoman for the American Academy of Pediatrics.

Normal body temperature varies, she says. It can be about 97 degrees in the
morning and higher later. "Ninety-nine degrees at the end of the day is
still normal," she says. Pediatricians generally don't consider a fever
significant until temperature rises above 100.4 degrees Fahrenheit.

You can check out your kid's throat and tonsils if that's the origin of
complaints, Rohyans says, but in her experience parents think tonsils look
awful when they're actually normal. "Tonsils that are sick look like moldy
strawberries or raw hamburger," she tells WebMD.

2. Look for Telltale 'Faking' Signs

Fake symptoms typically don't have staying power. Be suspicious, Rohyans
says, if your teen is coughing her lungs out one moment but then talking
nonstop on the phone with friends.

Kids who are truly sick usually doze off while watching TV, she adds. So if
your offspring is glued to a TV-watching marathon, wide awake, it's a sign he
could be faking it.

Vague symptoms and those that move from one body part to the other may be a
sign of faking it, says Donna Mazyck, RN, president of the National Association
of School Nurses in Silver Spring, Md., and a high school nurse for 15 years.
 As in: "Oh, my head hurts. Now my stomach hurts." When the
complaints move to the foot, be very suspicious, she says. "That's a little
bit of a clue." Yet, she says, it's not foolproof, because sometimes
symptoms are vague.

3. Get to the Bottom of the Problem -- If There Is One

Once you've decided it's an act, try to figure out why. While some kids are
just feeling lazy, others may have a sense of entitlement, says Rohyans,
especially during cold and flu season. "They expect they deserve a few days
off because everyone else is sick," she tells WebMD.

But some kids who fake it have more serious underlying problems, not just
laziness or mischief.  A common reason for faking, says Mazyck, is being
bullied at school. Faking becomes a practical avoidance strategy, she says.

Anxiety about a looming test or other challenge is a common reason to fake
it. "It could be anxiety or fear, because of a test or some class that is
hard for them," Mazyck says.

Mazyck recalls a student in a school where she worked who would begin to
feel sick at the same time day after day. She discoveed it was always right
before math class and linked the symptoms to anxiety.

This is a case of psychological problems leading to physical symptoms, says
Barry Anton, PhD, a clinical child and adolescent psychologist at Rainier
Behavioral Health and professor of psychology at the University of Puget Sound
in Tacoma, Wash.  Faking becomes "malingering," he says.
"Malingering is defined as assuming a sick role to avoid
something."

The child in this case may not even be aware that the psychological problems
led to the physical ones, Anton says. "The
pain is real, the cause is psychological," he says.

These scenarios are more common, he says, in younger children who haven't
yet learned to verbalize their emotional feelings. "As they get older, they
have better coping skills," he says, and are better able to talk about
their anxiety and other problems instead of having it manifest in pain.

Depression might be another underlying reason for your child to fake
illness, Anton says. "It allows you to withdraw."

4. Decide if You're Contributing to the Problem

Children in "high achieving" families whose parents have very high
expectations often have high anxiety levels, Anton finds. "They may be much
more likely to fake it."

Children from "chaotic and disorganized families" in which the
parents themselves may complain about physical symptoms due to psychological
stresses are also more likely to fake it, he finds. They are modeling their
behavior after their parents' behavior, begging off school when the stresses
turn into physical problems. "The pain is real," Anton says. So to call
it faking isn't quite accurate. "But they can't identify that the pain is
from the anxiety."

Often, Anton finds in his practice, the child's symptoms mimic those of the
parents. So if a mother complains of a bad
headache the day before her salary review, her son may do the same before
an important math test.

If this sounds like your house, Anton says, consider getting professional
help -- for you and your child -- to learn to deal with the anxiety and
depression and other problems that may be leading to the physical symptoms.

If you are convinced the sick day request is just about playing hooky, don't
"reinforce" sick behavior, Anton says. What's reinforcement? "When
you go in and say, 'Here's some chicken soup, let's turn on your favorite TV
show," that makes staying home look way too good compared to school, and is
likely to encourage your child to try faking it again. If your child's really
sick, the chicken soup and love route is fine, he says, for that limited period
of illness.

By Kathleen Doheny
Reviewed by Louise Chang
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