Sick School Syndrome
October 4, 2004, KidsHealth.org

Some days, it seems as if your child spends almost as much time at school as she does at home. As a parent, you worry about whether she does her homework, understands her lessons, and gets along with her classmates.

But should you be concerned about whether her school building is making her sick? The federal government, in a 1995 study, found that half of the nation's schools have poor ventilation and significant sources of pollution inside the buildings. For children with asthma, particularly, indoor pollutants can be a problem.

What Is Sick School Syndrome?
When a building has indoor air problems, it is known as a sick building. Sick building syndrome (SBS) has gotten a lot of attention in the past decade or so, and it's no surprise that "sick schools" have also been put in the spotlight. When a school is deemed sick, it means that the people inside experience health problems that have no other obvious cause and that these symptoms or problems disappear or improve when they leave the building.

There are no strict criteria for diagnosing sick school syndrome; health experts make a diagnosis by examining the child and assessing whether her symptoms seem related to entering or leaving the school building. Sick school syndrome is often wrongly blamed for several illnesses and disorders ranging from winter flu outbreaks to attention deficit hyperactivity disorder. Therefore, it is important for health experts to look for other explanations for a child's symptoms before attributing them to the school environment.

Sick school syndrome is different from building-related illness (BRI), which is any illness that is associated with a building but that can be specifically diagnosed as caused by an identifiable biological or chemical agent. People who have BRI develop an illness related to something specific in the building, and they usually require time to recover from (or sometimes to develop symptoms of) the illness. Examples of building-related illnesses include carbon monoxide poisoning; asbestos, lead, or mercury poisoning; or legionnaires' disease.

Another similar illness is known as multiple chemical sensitivity (MCS). People with MCS get sick when they come into close contact with certain substances, including tobacco smoke, formaldehyde, pesticides, and other pollutants that don't significantly affect most other people. MCS is considered a chemical hypersensitivity or allergy.

With sick school syndrome, usually many people become ill, not just one. And the illness is not caused by a specifically identifiable factor; for example, if several kids get sick after a spill in chemistry class, it is not considered to be due to sick school syndrome.

What Causes It?
Sick school syndrome can be hard to nail down because there is usually no easily identifiable cause for the variety of problems and symptoms that people are experiencing. The most frequent contributing factor, though, is poor indoor air quality.

"The most common problem is that buildings don't have enough ventilation," said Kristy Miller, spokeswoman for the indoor environments division of the U.S. Environmental Protection Agency (EPA).

"Without ventilation, too much moisture leads to mold and bacteria," she says. "Also, using chemicals or paints and not ventilating properly can make people sick. Ventilating is fundamental."

Buildings are more tightly sealed today than they were 50 years ago, mainly because of energy concerns, and this can result in poorer air quality indoors. In addition, synthetic building materials and furnishings and pesticides add to indoor chemical pollution.

Both new and old buildings can be affected. With new buildings, the combination of the tight seal and the presence of chemical materials are often at fault. With older buildings, according to Miller, ventilation systems may have been turned off or allowed to fall into disrepair.

Moisture can also contribute to the development of a sick building, Miller notes. If a roof leaks and carpets are damp, they can become a breeding ground for bacteria, mold, and fungi that can make people sick. In addition, housekeeping supplies, copy machine chemicals, and pesticides can add to the problem.

The problem may also result from a simple miscalculation, like allowing school buses to idle outside an air vent that brings fresh air into the building.

Signs and Symptoms
The most common symptoms of sick school syndrome are headache, fatigue, and shortness of breath. Sinus congestion, sneezing, coughing, and nausea have also been reported, as well as eye, nose, throat, and skin irritation and dizziness.

Because the symptoms of sick school syndrome are similar to those of many other illnesses, it can be difficult to pinpoint indoor air pollutants as the cause. Children with asthma are particularly susceptible to indoor pollutants. The federal government estimates that one in 13 schoolchildren has asthma, and that the number of children with the condition is increasing. A parent may want to consider whether a child's asthma symptoms seem to flare when she is in school compared with when she is at home or outdoors.

Can Sick School Syndrome Be Treated?
There is no specific test for sick school syndrome. The most important way to diagnose the illness is to keep a written record of when your child experiences the symptoms in question - and whether they flare up when your child is at school.

The best way to treat the illnesses triggered by indoor air pollutants is to fix the environmental problem. The EPA has launched an "Indoor Air Quality Tools for Schools" program as a preventive measure that all schools should consider using to ensure good indoor air quality.

The six basic methods for getting rid of indoor air pollution are removal or relocation of the source of pollution; providing exhaust systems in rooms where there are pollutants, such as science labs, industrial arts classrooms, and copy machine rooms; improving ventilation throughout the school; planning use of chemicals for times when children aren't in school, such as waxing floors on the weekends; using clean air filters in ventilation systems; and making sure the school staff is familiar with the importance of clean indoor air.

How Can I Help My Child?
If you think your child might be suffering from symptoms related to poor indoor air quality at school, you should contact the school. Check to see if the school is participating in the "Tools for Schools" program or if they need information. Ask whether other parents have concerns and attend parent group meetings to find out if there are other children with symptoms.

Because sick school syndrome can be the result of many factors, it can be difficult to fix. If your child has asthma, make sure her medicine is available so that she'll be prepared if symptoms flare up at school.

When to Call the Doctor
If your child has possible symptoms of sick school syndrome - such as otherwise unexplained headache, fatigue, nausea, dizziness, shortness of breath, sinus congestion, or coughing - or if other children at the school are exhibiting symptoms, contact your child's doctor. Even if it turns out that they're not related to school, the symptoms could mean your child has another problem that needs medical attention.