If you have a child and a job, you know the dilemma. Your child is sick and you have to go to work. What do you do?

For parents of seriously ill children it gets harder every day the child is sick.

Even in two-parent families in which one stays home, there is that pull. Millions of parents don't have the time or the money to stop working when their child is ill.

When Steven Travis' 1-year-old son needed a liver transplant, his employer immediately understood the situation.

Mr. Travis, of Munhall, works for Black Knight Security in the U.S. Steel Tower, where the owner of the company, Dennis Lejeck, used to coordinate the transportation of organs for transplant before he started his security company.

Mr. Travis said Mr. Lejeck immediately gave him a week off when his son got sick, then Mr. Travis, who was already on the night shift, was able to spend time with his son during the day. It also helped that Mr. Travis' wife, Crystal, is home with their seven children.

Mr. Lejeck said he never questioned doing whatever he could to help Mr. Travis and his family through their boy's health crisis.

Mr. Travis' son, Corey, received a liver within two days of being placed on the donor list. But before that was a sure thing, some co-workers offered to be living donors if their liver matched the baby.

Corey is now an active 3-year-old who takes just one drug a day. Mr. Travis said he was thankful Mr. Lejeck was accommodating. He also appreciates that his fellow guards were so supportive.

Lisa Katz, of Mt. Lebanon, whose daughter Amy was diagnosed with leukemia in 2003 said she couldn't keep her job. She wasn't fired. Instead, she said, the strain of having a sick child meant she could not focus on work or remember any of the new information she needed for work.

In her case, Mrs. Katz was lucky because her husband has a job that can support the family, so she was able to quit. "You re-evaluate," she said. "This job, it's not the end all, be all for my life."

While her daughter has been on a drug that causes a remission for the leukemia, the only cure is a bone marrow transplant. Mrs. Katz has spent years recruiting potential donors, 8,000 of them so far, but while she has found matches for 23 other people, none have been matched with Amy.

An article in the journal of the American Academy of Pediatrics last year said that chronically ill children and children with special health-care needs make up 15 percent of the child population. It also said that while only 47 percent of all workers qualify for the Family Medical Leave Act, in 2000 a survey of workers showed that 78 percent of the 3.5 million employees who needed a family leave but had not taken it cited the inability to afford to do so as their reason.

In the same article, the authors found that 81 percent of the parents of children with special health-care needs said they missed work because of their child's illness, but 41 percent reported not always missing work when their child needed them and that 40 percent of the people who did take leave said they went back too soon.

Laura Stabile, a social worker at Children's Hospital who works with families with children in the cardiac care unit, said those parents who fare best are those who don't have other children at home and those who are able to plan for their children to go into the hospital.

Families with other children have to meet the demands of both their employers and the other children to try to keep life as normal as possible for the siblings.

"It can be difficult for families who feel so torn," she said.

Her experiences with families echo the findings of the journal article that many families can't afford to take the time off allowed by the Family Medical Leave Act.

Mrs. Stabile has seen both ends of the employment spectrum for families. There are parents of patients who have been threatened with termination or fired for not being at work when their children are sick. And there are parents whose co-workers donate their own paid time off so that parent will be able to spend time with children. Another scenario when a parent has a sick child: first the employer is supportive, then as the illness drags on, they lose patience.