Households with 2+ Kids Are Sick 56% of the Year

But Americans only get 5 total sick days, if they’re lucky

I know it’s a bit weird writing about viral illnesses just as the weather is turning nice and the number of cases is starting to drop, but my kids don’t seem to follow any seasonal rules when it comes to getting sick. As far as they’re concerned, mid-June is as nice a time as any to bring home something extra nasty. To wit, we all just finished coughing up a lung earlier this week, and I expect we will catch something else before the school year finishes.

Before I had kids I got a bad cold about once a year, popped some pain-killers, hid under the covers and slept off the worst of it in 24 hours. If I was unlucky, I might have lingering symptoms for a week, but that was it. I didn’t need more than three to five sick days per year, because I wasn’t sick that often and I wasn’t responsible for taking care of anyone else when they were sick.

Since my second child was born about three years ago, I’ve been sick without fail almost once a month. In the winter, it’s not uncommon for me to barely recover from one cold before catching another. And when I am not completely out of commission, my kids are out of commission. They like to take turns, so just when one recovers and is ready to go back to school, the other is sick and needs to stay home. Yet the world expects me to work like I have no kids and still just get that one annual cold.

The burden of caring for sick children falls mostly on me, which is also why I am more often sick (more time in contact with snot and puke = higher viral load). My husband could, in theory, stay home and care for the kids some of the time when they have to miss school, but he doesn’t, because he earns more money than I do and therefore maintaining his job and income is more important to our family’s collective well-being. Is this “fair”? No, but sometimes you just gotta do what you gotta do.

All of this is made worse by the fact that whenever my son gets a cold (which feels like every other week), he gets so much chest congestion that he struggles to breathe. Sometime around day 4 or 5 in the lifecycle of the viral infection - the point at which most of us start to feel better - my poor little guy will be totally out of commission, lying on the coach and wheezing, with a bowl next to his head for when he needs to throw up copious amounts of mucus. He has missed so much school because of this that the state of California felt compelled to send me an official-looking letter denouncing his truancy.

My five-year-old, the truant.

The first time my son did this wheezy routine, I freaked out and rushed him to the doctor. Our pediatrician is himself a young father, definitely on the calm end of the personality spectrum, with a penchant for discussing primary scientific research during office visits. After he had carefully listened to my son’s breathing with a stethoscope, I asked him, “so, Doc, what’s going on?”

He thought for a moment and then said, “I feel totally comfortable telling you this because my wife is an immunologist: We know virtually nothing about the human immune system.”

I love nothing more than a humble physician. Still, his answer left me hungry. The constant cycle of illnesses is, for me, the number one reason why I will not be having a third child. I am sick of being sick. And I know I’m not the only one.

I also feel that, given the magnitude of the problem, it’s not getting nearly enough airtime, which I find incredibly frustrating. So I’ve decided to dedicate an entire mini series to the topic, in order to dig into questions like:

• Why are kids and parents sick all of the time?

• Is it normal for parents and kids to be sick all of the time?

• Was it normal for parents and kids to be sick all of the time in our evolutionary past?

• Are there any long-term consequences related to being sick this often?

• Is there anything we can do to prevent ourselves from being sick all of the time (no, I am not talking about Vitamin C quackery here, which does nothing unless you are deficient and take it regularly)?

The first article in this series (this one) will be free, but I’ve put in way too much time to give away the entire series, so expect future articles to be pay-walled. But as always, reach out if you really need a comp.

I hope you find this as interesting as I did.

It’s not just you

Before digging into the research for this piece, I had a general sense, based on conversations with mom friends, that it’s common for parents and children to be sick quite often. But I also tended to think that my family and I were especially unlucky–outliers on the number-of-colds-per-year continuum. The reason that I had convinced myself of our abnormality was that, consciously or unconsciously, I did not believe that other people could be dealing with what I was dealing with on a monthly basis and be silently putting up with it. The sheer lack of a REVOLUTION indicated to me that other people were obviously fairing better.

Unless they are all too sick and tired to be revolting.

It turns out that, in the modern Western context, it is normal for families to be sick as often as my family is. According to data from this NPR article, households with no children are sick only about 7% of the year (this was my experience), whereas households with one child are sick 35% of the year, and households with two children are sick 56% of the year. It keeps going up the more kids you have, to the point that if you were foolish (or optimistic) enough to have six children, your household will spend 87% of the year sick!

Find me better informational birth control and I will eat my shirt.

Being sick for over half of the year is punishment enough in and of itself, but to add insult to injury, society likes to further penalize working parents by making ridiculously minimal allowances for illnesses in the family. In the United States, companies with 5 or more employees are required to give their employees one hour off for every 30 hours worked, or up to 40 hours of sick leave per year (whichever is lower). Assuming you work a standard eight-hour workday, that’s five days of sick leave per year. (Companies with 100 or more employees have to give 56 hours, which is not much better).

That math just doesn’t add up. The most common family size in the United States is two children (the low birth rate is mostly due to a large percentage of people choosing to have no children at all), so that means that the majority of households with children will be sick 56% of the year. In other words, out of 260 workdays, during 130 of those workdays, someone in the family will be sick.

Of course, in a family with two working parents, theoretically there should be a total of 10 paid sick days (five for Mom and five for Dad), and parents would equally share the load of caring for sick children. Wouldn’t THAT be nice? But this is NOT what happens. According to this Atlantic piece, moms are TEN TIMES more likely to skip work to care for a sick child than their husbands. This isn’t just about income differences. It’s also about mom preference (something I talked about here with Cindy DiTiberio) that gets started during maternity leave and can be very hard to break. When my kids are sick, they need me (Dad just won’t do) and I am happy to be able to be there for them, but it makes holding down a traditional full-time job nearly impossible.

It’s also true that not every day of illness is out-of-commission illness, so let’s be generous and assume that only 25% of sick days are true stay-at-home sick days - that’s still about 33 out-of-commission sick days per family per year, which is STILL a whole lot more than the actual allowance of 5 (or 10 for both parents). I have spoken with mothers who have used every single one of their measly 11 allotted vacation days to stay home and care for sick children (and taking care of a sick child is NOT a vacation).

Given the impossibility of the math I just ran for you, I am personally convinced that caring for sick children is one of the major reasons that women are pushed out of the workforce, and yet it’s not something I hear talked about that often, and I certainly haven’t seen anyone try to throw political weight behind it.

But it’s not just about employment.

Caring for sick children, and being constantly sick yourself, is extraordinarily isolating. For as long as we have symptoms, we are expected to stay home. But 56% of the year spent in self-imposed quarantine will put a considerable damper on your social life. I cannot tell you the number of times that I have had to cancel a social engagement because of an illness in my family, nor can I count the number of times that I’ve been guilt-tripped by friends for bringing a symptomatic child to a social gathering (because at some point, you simply need to see people).

They say loneliness is the equivalent to smoking fifteen cigarettes per day, and we know that social isolation is a major risk factor for postpartum depression, but somehow these kinds of very real health costs get deeply discounted in comparison with the more tangible, but temporary cost of giving someone else a minor cold.

If you’re looking for evidence of just how low societal tolerance is for parents dealing with recurring illnesses and the extraordinary burden of caregiving that goes along with it, you can check out this infuriating reddit thread entitled, “I cannot stand how parents handle having sick children,” in which the author rails against “totally inconsiderate” parents who dare as for help with their sick children, thereby furthering the spread of viral illnesses. She adds that she understands “having two kids sick at once is highly stressful, but I’m sorry you decided to have children and this is the reality.” I can only hope she has children of her own some day.

I am also under the impression that tolerance for sick children (and sick people in general) has declined with the Covid-19 pandemic, even as many other areas of life have returned to normal. According to this Fortune article, “Widely varying guidance on when to keep children home [has created a lot of] confusion, which many see as a factor in the nationwide epidemic of chronic school absences [since the pandemic].” The American Academy of Pediatrics recommends staying home when there’s fever, vomiting or diarrhea, or when children “are not well enough to participate in class” and yet in my experience, since the pandemic, coughing or a runny nose is sometimes sufficient reason for a caregiver to ask the child to stay home, or for the local coffee shop clientele to give you the stink-eye if you dare to leave your home for a latte.

The thing is, I understand that people don’t want to get sick, and I understand that there are people out there with immunodeficiencies or other vulnerabilities. But something has to give. We cannot expect parents and families to stay home 56% of the year. Either we need to find innovative ways of bringing that number down, or societal and workplace tolerance has to go up (probably both).

Okay, so it’s a big problem. Now what?

I suspect that one of the reasons that this issue doesn’t get more air time is simply that it feels intractable. It’s true that there aren’t any obvious quick fixes, but that’s not a reason to avoid addressing it. Not to disappoint you, but I doubt this mini series will lead to any neatly packaged solutions. Rather, it risks raising more questions than it answers.

But, like so many topics explored in this newsletter, I suspect we aren’t being told the whole truth about what’s “normal” when it comes to viral illness in the contemporary context. Just because everyone is experiencing the same problem doesn’t make it normal. Mental illness, addiction and obesity have become very common problems in contemporary society, but these are not “normal” human conditions from an evolutionary perspective.

Is constant illness just the normal human condition? What kind of genetic evidence do we have for the antiquity of common colds? Do hunter-gatherer families spend half the year sick? Or is this yet another case of evolutionary mismatch? And if it is, then is there any wisdom to be gained from studying small-scale societies?

If you’re interested in exploring the research behind these questions and more, stay tuned!