AAP Voices Blog

When a student misses a significant amount of school for health reasons, it can lead to academic failure and even a court referral for the parents due to chronic absenteeism. Through no fault of their own, students who have serious illnesses or other barriers to school attendance often fall victim to a system that isn’t always geared to properly assist them. 

As primary care pediatricians, we are in a special position to help these children.
We often see patients who are chronically absent from school. These children, who have missed more than 15 days of school in a school year, are at significant risk of academic failure.

Unfortunately, we are usually unaware or learn about these situations when it is too late to act. We may learn about excessive absences during a well-child visit over the summer or at the end of the school year, when a family brings in a letter saying they have been referred to the courts because of truancy.

Each time, we shake our heads, because we did not know that the child and family were struggling with school attendance. We were not aware because we do not have access to school attendance data. We cannot provide high quality care to our patients if we continue to remain in the dark about student absence.

“Building systems to share data between schools and health care practitioners is more crucial than ever as the pandemic has exacerbated the chronic absenteeism crisis.”

Building systems to share data between schools and health care practitioners is more crucial than ever as the pandemic has exacerbated the chronic absenteeism crisis. It has long been the case that too many young people experience trauma and hardships in their lives that make it difficult for them to take full advantage of the opportunity to learn at school.

But the situation is now much worse. According to the National Center for Education Statistics, compared to a typical school year prior to COVID-19, 72% of U.S. public schools reported an increase in chronic absenteeism among their students during the 2021-2022 school year.

We have seen this in practice. During a clinic visit, we learned about a young patient who had missed more than 25 days of school during the first half of the 2021-2022 school year. The patient had abdominal pain and had interacted with the health care system many times, with multiple ER and urgent care visits, each time receiving an excused absence note for school. Because her attendance was tied to a health condition, it didn’t qualify as truancy, but she still encountered significant academic challenges resulting from missing so much school. This situation was entirely preventable.

If we are serious about reducing and ultimately eliminating chronic absenteeism, it is imperative that we dramatically improve the collaboration between the health and education sectors. And that starts with data sharing.

Pediatricians and school systems are beginning to take a more proactive approach to this issue. In Washington, D.C., for example, through a pilot led by Children’s National Hospital and D.C. Public Schools, called the Chronic Absenteeism Reduction Effort, families can provide a FERPA-compliant consent for their child’s attendance data to be securely shared with their medical provider.

Data is incorporated into the existing health information exchange for Washington, D.C., through which other health data are already shared. Participating pediatric practices are then supported through quality improvement cycles as they engage with families experiencing or at risk for chronic absenteeism. Early outcomes of this pilot are promising, and a more robust evaluation is planned.

This example of shared attendance data is a perfect illustration of the priority to “bolster the quality of local health care services to provide consistent high quality primary care,” one of the 10 primary issues highlighted in the recently published Healthy Schools Ten-Year Roadmap.

This blueprint calls for more data sharing partnerships between primary care providers and schools to provide secure access to shared data, such as attendance records. This is just one of many bold aims in the road map to support school communities into the next decade.

As we move to our third school year impacted by COVID-19, guidelines will continue to evolve to keep our school communities safe and keep as many children in the classroom as possible. The stakes are high and school attendance matters more than ever. There will be no room for any child to miss school for unexcused absences, or even worse, due to a health condition that could be addressed by their pediatrician.

But pediatricians need the full picture; we need to know which patients are most at risk and missing too much school.

Let’s not make school attendance another challenge that schools need to worry about alone. Let’s treat school attendance as a shared responsibility between our health and education systems.

*The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.