Is Your Child Really Sick? 6 Signs Your Kid Could Be Faking It (and How to Tell)

Kids sometimes fake illness to get out of responsibilities, but how can you really tell if their symptoms aren't real? A pediatrician shares some telltale signs.

Medically reviewed by Natalie D. Muth, M.D.

It is not uncommon for a child to fake an illness. In fact, it almost seems like a rite of passage once they're old enough to attend school.

As a teenager, I found the premise hilarious, especially in iconic movies like Ferris Bueller's Day Off. But now that I have four school-age kids of my own, watching a young Matthew Broderick lick his palms to fake clammy skin mostly makes me wonder whether I’m ever being played like that. After all, how can you truly tell if your child is faking an illness or pain?

If I'm being played, it’s particularly embarrassing because I’m a pediatrician—but over the years, I’ve come up with several tactics for reaching a fair verdict. Borrow my strategies to get to the bottom of your own kids’ pleas to hole up at home, and learn whether your child is faking an illness.

Related: Should My Kid Stay Home From School or Daycare? An Age-By-Age Guide

Why Do Kids Fake Illness?

In elementary school, kids might fake illnesses to avoid dealing with something, whether it's a bully, a stressful class, a test, or locker-room intimidation. Kids also may fake an illness if they forget to do their homework, have to give a speech, or need to turn in an important project.

Even the state of a caregiver's health could cause kids to want to stay home. If someone close to them has a terminal illness, for example, your child could be afraid to go to school. Or, they may be missing you—especially if you have been traveling, working a lot, or if they have a new sibling at home thats occupying your attention.

Sometimes, however, the cause of faked illness is more benign—maybe they just want to stay home to play with a new toy, finish a book, watch movies, or binge on video games. Or, they just feel like they need a break. The key is finding out why your child may be faking it.

Do They Have School Avoidance?

Note that school avoidance is common in some cases, but it can develop into a phobia. The American Academy of Pediatrics (AAP) estimates that 5% of kids suffer from a school phobia or school refusal, and in some cases, it should be handled with professional help.

How to Tell If Your Kid Is Pretending to be Sick

While faking sick occasionally is expected, this doesn't mean you should let it slide or condone it. After all, the expectation should be that they attend school consistently. For this reason, it's important to know how to tell if your child is faking an illness. Here are some telltale signs.

Headache

Kids may have a hard time describing the severity of their pain, so health care providers often rely on a tool called the Wong-Baker FACES Pain Rating Scale—a series of pictures that range from smiling to crying—to gauge their distress.

Here's the abridged version: If your child is sobbing, closing their eyes, or unwilling to play or joke around, they're in bad shape. Indeed, if their headache persists for more than an hour or two and doesn’t respond to acetaminophen or ibuprofen, they not only need to miss school but also need to see their pediatrician.

Severe headaches that recur (particularly those that come with changes in vision, nausea, or an aversion to light or noise) could be migraines and warrant a diagnosis and pain relief. Take your child to the emergency department if they have these symptoms:

• Trouble moving their neck

• Difficulty talking, walking, thinking, or using their hands

• The headache awakens them from sleep

• The headache causes vomiting

For most kids, however, headaches are mild and will go away on their own within a couple of hours—making regular school drop-off (or, at the very least, a late arrival) a distinct possibility.

If your child doesn’t seem to be in that much pain—say, they're eating and comfortably watching TV—but insists their head still hurts, tell them you’re making a pediatrician appointment. Skipping school is no fun if it just means a trip to the doctor’s office. Your comment could spark a miraculous recovery!

Related: 12 Kids' Symptoms You Should Never Ignore

Stomach or Abdominal Problems

A stomach bug that comes with nausea, vomiting, and/or diarrhea should always keep your child out of school, and in most situations, you’ll be able to verify the illness with, shall we say, your own eyewitness account.

But what if your child just holds their belly and says it hurts? Then it's time to look for secondary symptoms. Abdominal pain stimulates the vagus nerve (a direct connection between the bowels and the brain), which slows the heart, makes skin pale and clammy, increases saliva production, and constricts the pupils.

Another easy tell is whether or not your child eats breakfast. Appetite is generally the first thing to go with a stomach bug, so if your kid digs right into their favorite pancakes, they're probably fine.

That said, never ignore chronic or repeated complaints of abdominal pain. Even if your kid can make it through the school day, they could be dealing with anything from constipation, reflux, or even anxiety and stress. Instead of toughing it out in the classroom, they may need to talk to a health care provider.

Related: What Your Child's Vomiting May Mean

Fever

Fever is your child’s guaranteed “Get Out of School Free” card, though the exact temperature that warrants staying home is somewhat up for debate. The number varies between schools; some say 101 degrees Fahrenheit, for example, and others say 100.

Most schools insist that students remain fever-free for 24 hours (without the use of fever-reducing medications) before returning. They’re probably right to use this criterion: It’s objective and measurable, and kids with a fever rarely feel well enough to learn effectively.

It’s not easy to fake a fever, but it's possible. The first step to calling your kid’s bluff is getting an accurate temperature reading. Warm food and beverages can heat the mouth for up to 15 minutes, so if you suspect deception, make sure your child doesn’t just drink or eat.

Physical activity can also raise core temperature, so if your child seems winded, have them lie down for 20 minutes before taking their temperature. Also, don’t rely on touch (such as touching your hand or lips to their forehead) to gauge their temperature. Studies suggest that parents aren’t bad at detecting fever this way, but they’re not quite good enough to drive medical decision-making.

Confirm a fever with a thermometer (an oral one is easiest to use), and use 100.4 degrees Fahrenheit as your cutoff. This is the limit most pediatricians consider a fever, according to the AAP.

Related: What Is Considered a Fever for Babies, Toddlers, and Children?

Cough

Upper respiratory infections are one of the top causes of school absences, and they almost always come with a cough. That’s mainly because a cold increases mucus production in the airways, and coughing helps clear it. In fact, the cough reflex is so strong that no medicine has ever managed to suppress it completely.

Anyone can cough at will, but not all coughs sound the same. Real coughs often have a “productive” sound—that is, you can hear excess mucus leaving the airways. They are also extremely forceful (up to 50 miles per hour!) and occur more frequently than fake coughs.

After all, when you cough on purpose, you have to remember to keep coughing, but when you’re sick, you can’t help yourself. These are differences you should be able to pick up on if you listen carefully enough.

Of course, fake or not, a kid with a cough can usually go to school, provided they don't have other symptoms like a fever or a headache. (If you notice wheezing or shortness of breath, take your child to the doctor’s office or the emergency department.)

Related: 8 Types of Coughs in Children, Toddlers, and Babies

Sore Throat

About 70% to 95% of sore throats arise from viral infections. Typically, these types of sore throats shouldn’t keep kids home (provided they’re otherwise feeling fine) except for COVID-19. The remainder stems from bacterial infections, most often strep throat, which require 24 hours of antibiotics before your child will be ready to return to the classroom.

So how do you know if your child has strep? If they don't have a fever, but they do have a cough and a hoarse voice, a virus is a more likely culprit than strep. Ultimately, though, a health care provider will need to do a throat swab to confirm the diagnosis.

Your best bet: Swing by your pediatrician’s office for a rapid strep test on the way to school. The swab identifies up to 98% of cases and can take just minutes to get results. Once you get your answer, you can feel confident in your decision to send your child off to class or head back home to hunker down on the couch.

Related: I'm a Parent and a Pediatrician: Here's When I Worry About a Cold

Fatigue and Malaise

Malaise is the term doctors use to describe not feeling well, which can range from wanting to stay in bed to being on the verge of fainting. My own kids have confessed to using this excuse to weasel out of school since they know malaise can be a sign of anything, from the beginning of a cold to mononucleosis to a more serious illness. In short, it’s hard for a parent to know how to respond to it.

In my house, I now insist that in order to miss school, my children must have at least one other observable symptom. My usual choice of words: “Do you have a fever? Are you vomiting? No? Then you’re going to school.” If they just feel lousy, they can do that just as easily in a classroom as they can at home.

The tougher question is what to do if the symptom doesn’t go away. A child who often complains of malaise deserves a medical evaluation. The list of illnesses that cause malaise is long, and a thorough medical history and physical exam can help you narrow it down.

Related: What to Do About Recurring Illnesses

My Kid Fakes Illness All The Time—What Should I Do?

Although few children love every single day of school, the vast majority accept that attending is a non-negotiable part of life. So if your child is constantly trying to cough or sneeze their way off the school bus, it’s important to find out why.

If your child is reluctant to share what's going on, talk to their teachers and administrators. Ask how they are doing in school and if they have friends. If they started a new school, ask how they are adjusting.

You'll also want to find out if they're struggling with their studies in some way. Sometimes kids will have an undiagnosed learning disorder, which can often cause them to dislike school.

Armed with information from the teachers, you also may want to discuss their persistent illness with a health care provider or a mental health professional, especially if your child's "illness" is ongoing. They can help you get to the root of the cause. It may be something that needs to be addressed—or it may be that they simply want to be home.

Pediatricians call it “malingering” when a child fakes symptoms knowingly for some sort of gain. It's called “factitious disorder” when the symptoms are fake, but the child cannot say why. In other conditions, such as somatization disorder, conversion disorder, and pain syndromes, the symptoms seem real to the child even though there's no detectable underlying illness.

If your child seems persistently ill, you need to investigate why this might be happening. It could be a real issue that needs to be addressed, or it could be just a ploy to avoid the school setting.

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