we dig further into his recent asthma history, David's mother
acknowledges that the family has struggled with daily adherence to his
inhaled corticosteroid and his medication supply has now run out. He
has had several asthma exacerbations with acute illnesses this year and
suffers from some daily limitations in activities. Further, as the year
has progressed, he has felt less engaged at school and reports being
on days like today, when David wakes up with chest tightness and cough,
his mother describes doing mental gymnastics to navigate the logistics
and emotions of a safe arrangement for him and his siblings. Would he
have access to his inhaler if he had symptoms during the school day?
Would kids pick on him for needing to go to the nurse's office? Does
his school nurse know his full asthma history and plan of care? If he
got worse, who could pick him up from school?
His mother's work schedule is rigid, and transportation is challenging, especially with other children in the household. By
her calculation, with the complexity of their daily routines, it is
often safer and more convenient to keep him at home if he isn't feeling
family's experience illustrates some of the many factors at play when
it comes to school attendance: acute and chronic illness, school
connectedness and climate, communication between schools and health care
providers and the silos that exist between them, parental work
schedules, and transportation.What does this mean for David? First, he is at a critical pivot point in third grade. Feeling disconnected from his school, curriculum and classmates due to absences puts him at risk for repeating the grade. In addition, his chronic absenteeism this year increases his risk of chronic absenteeism in future years. Failure to graduate from high school puts him at greater risk of poor lifetime health outcomes, including chronic conditions like hypertension and diabetes.
"As pediatricians, we need to view school absenteeism among potential health hazards facing our patients.”
new policy statement cites research showing education to be a critical
social determinant of health, and chronic absenteeism a matter of health
equity. School absenteeism disproportionately impacts certain
communities, including children with chronic medical conditions and
disabilities, children of color, children from low income families or
those with housing instability, and children in the juvenile justice
system. The report outlines ways to support children and families in
managing health and social needs that impact school attendance and
long-term health outcomes.
pediatricians, we need to view school absenteeism among potential
health hazards facing our patients. During visits with families, we can
routinely ask about and reinforce the importance of school attendance,
and educate families on the appropriate reasons to exclude children from
school during an acute illness. Pediatric providers also play a
critical role in communicating and coordinating with school staff,
including school nurses, to manage chronic conditions in school and
assist with Individual Education Programs and 504 plans.
At the systems level, we can engage with local school officials and policymakers to advocate for policies, programs, and funding that support attendance, including positive school climate, supportive disciplinary practices, and school-based medical, oral, and behavioral health services. Practices can also consider offering extended hours after school and on weekends to limit the degree to which medical visits contribute to absenteeism.
So, how can we best support David? During the visit, we renew his Asthma Action Plan, refill his medications, and contact the school nurse. Additional screening reveals the family is also experiencing food insecurity, and we connect David's mother with our practice social worker to address transportation and food access. David's school offers mental health supports, and we refer him for services to help address his experiences with bullying. We also remind the family of the evening and weekend hours in our health center so they don't have to miss school and work for sick visits. Finally, a collaborative conversation with the family enables us to highlight the importance of school attendance for David and his academic performance and health, including access to school meals.
As pediatricians, we're committed to working across sectors to advance health equity for all children, and we can play a role in supporting school attendance. Every day counts for children.
*Name has been
changed to protect privacy
views expressed in this article are those of the author, and not necessarily
those of the American Academy of Pediatrics, the District of Columbia
government, and the Office of the State Superintendent of Education.
Schumacher, MD, FAAP is a member of the Executive Committee of the AAP Council
on School Health and serves as Secretary of the DC Chapter of the AAP.
She is a general pediatrician in Washington DC and the Assistant Superintendent
of Health and Wellness at the DC Office of the State Superintendent of
Dooley, MD, MPhil, FAAP serves as the AAP District III National Nominating
Committee Representative and is an active member of the Council on School
Health and the DC Chapter of the AAP. She is a general pediatrician and
Medical Director of Community Affairs and Population Health in the Child Health
Advocacy Institute at Children’s National Health System in Washington, DC.