Nation's Pediatricians Prescribe Plan to Boost School Attendance

New report from the American Academy of Pediatrics calls on health care providers to help curb chronic school absences in effort to improve students' long-term health.

Itasca, IL—Being absent from school too often, excused or not, can put a child's academic achievement—and future health—at risk. A new policy statement from the American Academy of Pediatrics (AAP) in the February 2019 Pediatrics, "The Link Between School Attendance and Good Health" (published online Jan. 28), recommends health care providers promote good school attendance as preventive medicine.

Defined as missing too much school for any reason, chronic absenteeism starting as early as preschool and kindergarten has been linked to poor educational and health outcomes, according to the AAP. Research shows that missing school a lot, whether from excused absences or truancy, makes students less likely to do well academically and more likely to drop out. This, in turn, puts them at risk for unhealthy behaviors by the time they reach their teens, and poor health as adults.

"School absences can add up quickly," said Mandy Allison, MD, MSPH, FAAP, lead author of the policy statement and a member of the AAP's Council on School Health, which developed the report. "Asking about school attendance and approaching chronic absenteeism as a health risk factor can have a big impact on patients' lives," she said.

More than 6.5 million U.S. children, about 13 percent of all students, miss 15 or more days of school each year, a benchmark for chronic absenteeism that's been used by the U.S. Department of Education.

At least 10 percent of kindergarten and first-grade students miss a month or more of the school year, while about 19 percent of all high school students are chronically absent.

Common, preventable causes of school absences range from infections such as influenza to poorly controlled chronic conditions like asthma. Socioeconomic factors tied to absenteeism include unstable housing conditions, transportation difficulties, a history of maltreatment, exposure to domestic violence, and being called on to care for younger family members.

Chronic absenteeism is linked with health risks like smoking and substance use. But poor school attendance and educational achievement also has more subtle health effects. Adults with less education are more likely to be unemployed, for example, and less likely to report feeling control over their lives and high levels of social support. This can leave them more vulnerable to the psychological and the physical tolls of stress, such as depression and reduced immune system function.

The report highlights proven measures to improve school attendance, including increased hand washing, school-located influenza vaccination programs, access to school nurses and counselors, and on-site medical, oral health and nutrition services. The AAP encourages pediatricians and their colleagues caring for children to promote school attendance. Among the AAP recommendations:

• Stress the value of developing strong school attendance habits as early as preschool. Ask about the number of school days missed in the past month at every visit, when appropriate.
• Document children's medical needs for an Individualized Education Program or 504 Plan when needed for access to services that optimize learning opportunities.
• Encourage families to share health concerns with their school nurse.
• Provide firm guidance on when a child should stay home sick and when a child can attend school. Lice, for example, is not a reason to stay home from school.
• Avoid writing excuses for school absences when the absence was not appropriate. Encourage patients who are well enough to return to school immediately after their medical appointments.
• Advocate for policies known to promote school attendance. These include programs that avoid suspension and expulsion and promote a positive school climate.

"Promoting good school attendance is simply good medicine," said Elliott Attisha, DO, FAAP, a co-author of the policy statement and a member of the AAP Council on School Health.

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org and follow us on Twitter @AmerAcadPeds