Attending school is a critical, defining part of childhood, and provides children opportunities for academic skill building, social and emotional development, nutritious meals, physical activity and physical education, health services and more.  Research shows that healthy bodies and minds are the foundations of school attendance and success.

In school year 2021-22, more than 14 million children in the United States missed 10% or more of the days in the school year.  This represented more than one in four school-age students in the US, a nearly doubling of pre-pandemic levels. Chronic school absenteeism, starting as early as preschool and kindergarten, puts students at risk for poor school performance and school dropout, which in turn, puts them at risk for unhealthy behaviors as well as poor long-term health outcomes. Students of color, those of lower socioeconomic status, and those with disabilities are far more likely to regularly miss school than their peers.  Leaders in the field are increasingly referring to chronic absenteeism as a pediatric vital sign, noting its strong relationship to contributing health and social factors.

What is Chronic Absenteeism?

Chronic absenteeism broadly refers to missing too much school for any reason, including excused and unexcused absences as well as suspensions. Most researchers and a growing number of states have defined chronic absenteeism as missing 10% of the entire school year. This translates to, on average, 18 days missed per school year, or two missed days per month.

Why is it Important?

What happens when children don’t attend school regularly? Chronic absenteeism can occur as early as preschool and kindergarten and has been shown to be related to future chronic absenteeism, grade retention and poor academic achievement. 

Students with poor attendance score lower than their peers who attend school regularly on national skills assessments, regardless of race or ethnicity. Regular attendance can be a better predictor of school success and graduation rates than test scores.

How Can Pediatricians Make School Attendance a Priority? 

Pediatricians can address school attendance in their office-based practices and communities and/or states or nationally as advocates. Some important office-based strategies include (complete list found in the AAP Policy Statement):

  • Routinely ask at preventive care visits and sick visits about the number of absences a student has experienced
  • Praise patients and caregivers when patients are attending school
  • Support parents in addressing barriers to attendance
  • Assist families in documenting and interpreting their children’s medical needs or disability for an individualized education program or 504 plan
  • Encourage families to share their concerns about their children’s health with their school nurse
  • Place a focus on prevention measures to stay healthy and in school, including good nutrition, adequate sleep and physical activity, proper hygiene, etc
  • Provide firm guidance on when a child should stay home sick and how to avoid absences from minor illness or anxiety
  • Develop relationships with school personnel, including school nurses and mental health clinicians, to foster care coordination and data-sharing opportunities

AAP Policy and Trainings

The Link Between School Attendance and Good Health: This policy statement focuses on absenteeism related to students’ physical and mental health, as well as the role pediatricians play in promoting school attendance.

AAP Learning Burst: Short, self-paced learning module regarding addressing chronic absenteeism in clinical practice, aligned to the AAP policy statement.

Resources for Families

Additional Resources for Schools and Healthcare Providers

AAP Voices is the official blog of the American Academy of Pediatrics, where AAP member pediatricians and others share their perspective on a wide variety of topics relating to children’s health and wellness. The student attendance-related blog posts below are written by AAP’s Council on School Health members:

AAP Voices: Every Day Counts: The Role of the Pediatric Provider in School Attendance
Heidi Schumacher, MD, FAAP & Danielle Dooley, MD, MPhil, FAAP – 01/29/2019

AAP Voices: How Pediatricians Can Help Families Navigate the Unusual School Year
Heidi Schumacher, MD, FAAP – 09/14/2020

AAP Voices: Let’s Work With Schools to Help Address Absenteeism
Ryan Padrez, MD, FAAP, Danielle Dooley, MD, MPhil, FAAP & Heidi Schumacher, MD, FAAP – 11/7/2022

Playbook for School Attendance Data Sharing: Supported by the Bloomberg American Health Initiative, this playbook outlines how to plan and implement a school attendance data sharing initiative for cross-sector response.

National Academy of Medicine Vital Signs for Pediatric Health: Chronic Absenteeism: Seminal work from the National Academy of Medicine, defining chronic absenteeism as a pediatric vital sign given its close relationship to social and health factors.

America’s Promise Alliance, Grad Nation Campaign
American’s Promise Alliance launched the GradNation campaign in 2010, building on 105 dropout prevention summits we convened across the country to raise awareness and inspire action. GradNation is now a large and growing movement of dedicated individuals, organizations and communities working together to raise graduation rates and prepare all students for success.

Attendance Awareness Campaign
The Attendance Awareness Campaign is a nationwide recognition of the connection between school attendance and academic achievement. The goal is to mobilize schools and communities to promote the value of good attendance and to take concrete steps toward reducing chronic absence.

Attendance Works
Attendance Works’ mission is to advance student success and help close equity gaps by reducing chronic absence. Attendance Works’ resources for health care partners are accessible here.

Everyone Graduates Center
The Everyone Graduates Center works to develop and disseminate the know-how required to enable all students to graduate from high school prepared for college, career and civic life.

Healthy Schools Campaign
The Healthy Schools Campaign works to ensure that all children have access to healthy school environments where they can learn and thrive.

National Center for Education Statistics, Every School Day Counts (NCES)
The NCES is the primary federal entity for collecting and analyzing data related to education in the U.S. and other nations.

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American Academy of Pediatrics