Yes, that’s right, kennel cough. Yes, I know that’s what puppies get when you lock them up all day in overcrowded conditions with many of them sick to begin with. So what does this have to do with pediatrics? I am glad you asked.
In my son’s school there is a big board where each class that has 100% attendance during a particular week gets a silver star for that week. So, presumably, 100% attendance is good, lack of it is bad. Granted, not getting a star is not much of a punishment for missing school, but there are others. Students can be left back for poor attendance — even if they know the material. Many other perks within the school system are predicated on attendance — not on knowledge. This alone, that success is not in the expanding of the mind but in the warming of a seat, is a bad enough concept, but this by itself would not incur a pediatrician’s wrath. What it does to children’s health is more of a problem.
My old mentor in my residency days, Dr Miller, coined a joke diagnosis. Any minor viral illness, respiratory or stomach, that did not come with easily recognizable signs and symptoms — like chickenpox or roseola — he called “Twiggar“. Short for That Which Is GoinG ARound. An acronym for a minor, insignificant, self-limited illness that will go away by itself. Eventually.
But what happens when many children with different Twiggars come together? The same that happens when they come together with different Yu-Gi-Oh cards. They trade them. Except, unlike cards, when you give someone an illness, you still keep yours. Kind of like illegal music trading on the Internet. So all of a sudden your child has seventeen thousand hours of heavy metal on his MP3 player, and a cold of similar duration. You get a long lasting uninterrupted “recording” of cough and misery with many complications, and unlike the player, you can’t turn it off.
So here we are in the office, many sick children, many of them freshly picked up from school — where they had all day to infect their classmates — many sick almost continuously for a month or more, many with pneumonia or ear infection, common complications of these Twiggars, and the flu season isn’t even here yet. And the ever-helpful school notes warning that if they miss any more school they will be penalized on their report card. Makes you glad to be a schoolboy, don’t it?
Now, there’s a lot of talk of overuse of antibiotics. I agree. But don’t forget, in many of these children antibiotics are a life saver (as in pneumonia and scarlet fever) or at least shorten the duration of pain and misery by a significant amount of time (as in ear infections and bronchitis) — and if we didn’t have the overcrowding that we have, and the pressure to come to school sick, the epidemics would be much more limited. Anyone remember the word “Quarantine”? They used to close schools during epidemics. Polio, measles and smallpox epidemics would burn out when kids stayed home and away from contagion. But no one thinks of a quarantine against “Twiggar”s. I guess misery and pain are not good reasons to interrupt the warming of the seats.
This is why, after 20 years, I am retiring the term “Twiggar”. Let’s call it what it is: kennel cough. Not because I can’t tell children from puppies; but because I can’t tell the conditions in which puppies get kennel cough from conditions in which our children get their illnesses. Solutions? Well, more classrooms and more teachers would be nice. A more liberal absence policy: maybe a little respect for the parents’ ability to decide whether to send their shildren to school that day, without having to come in for a doctor’s note. A little respect for parents’ judgement as to when to take a family vacation; perhaps the educational value of seeing Pompeii or the Louvre will make up for a missed week of Hardy Boys.
Perhaps it is too much to expect that we can, in Mark Twain’s words, “never let [our] school interfere with [our] education. But I can, and do, expect schools not to interfere with our health.