Editor’s note: The 2024 AAP National Conference & Exhibition will take place from Sept. 27-Oct. 1 in Orlando, Fla. For more coverage, visit https://bit.ly/AAPNationalConference2024 and follow @AAPNews on Facebook and X.
It’s back-to-school time, and pediatricians and educators again face the growing problem of chronic absenteeism.
Often defined as a child missing at least 10% (or about 18 days) of the school year for any reason, chronic absenteeism should be seen as a “pediatric vital sign,” according to a pediatrician who took part in a recent White House summit on the subject.
“Just like we consider fever to maybe signify an infection or inflammation underlying that fever, pediatricians can consider missed school as a vital sign under which might be unmet health and social needs,” said Heidi K. Schumacher, M.D., FAAP, who will give a plenary address on school attendance and a presentation on academic recovery at the 2024 AAP National Conference & Exhibition.
A study by the American Enterprise Institute found 28% of students were chronically absent in 2022. That’s up from 15% before the pandemic.
The AAP policy statement The Link Between School Attendance and Good Health points to a chain reaction that begins with chronic absences: Poor attendance can lead to lower educational attainment; which can lead to lower-paying, less-fulfilling jobs; which can lead to feelings of having no control or social support in one’s life.
Cause and effect
What causes chronic absenteeism in the first place?
Some causes grew out of the pandemic, like children caring for parents with long-term health problems after contracting COVID, or adolescents who kept their pandemic-era jobs to help their struggling families. Some absences can be attributed to bullying at school or neglect at home.
“We know mental health conditions have really increased for young people and families, and social factors — housing insecurity, food insecurity, lack of transportation — continue to introduce barriers,” Dr. Schumacher said.
Danielle G. Dooley, M.D., M.Phil., FAAP, who co-authored the AAP policy statement The Impact of Racism on Child an Adolescent Health, said many schools impacted by systemic racism and underfunding were also those hit hardest by the pandemic — and those schools are now expected to do more to improve attendance.
“When you’re asking a district that’s already underfunded to now go the extra mile and be knocking on people’s doors and providing lots of one-on-one outreach and assistance, we’re just sort of compounding the burdens on some of those school systems that have historically always struggled,” Dr. Dooley said.
What educators are doing
The “Every Day Counts” summit held in May at the White House invited educators, politicians and pediatricians from across the nation to present steps they’ve taken to stem the tide of chronic absenteeism.
Indiana Secretary of Education Katie Jenner, Ed.D., shared her state’s digital attendance dashboard, which sorts absences by student, school, grade and other factors. It also includes a map showing the percentage of each district’s students who are chronically absent and/or habitually truant.
“At the state level, everyone is able to see this,” Dr. Jenner said, and schools and communities soon will be privy to the data with the goal of working together “to hold each other accountable to chronic absenteeism.”
Bob Balfanz, Ph.D., of Johns Hopkins University in Baltimore, shared an action plan that tackles the four major challenges to attendance: barriers, aversion, disengagement and misconception (not realizing how many school days a student has missed).
Legislation to provide free school meals, which has been enacted in at least eight states, is among policies that can “encourage school attendance and support a really robust school day,” Dr. Dooley said. “We know that offering food in school can be a driver to help kids and families attend and value school.”
Students aren’t the only ones who need to be convinced of the importance of attendance, especially after the proliferation of remote learning in 2020.
“In this post-pandemic period, families’ and communities’ perception of school as ‘required’ seems to have really changed, and there is concern that that may impact us in the longer term,” Dr. Schumacher said.
A pediatric partnership
Health systems and schools must work together, and a doctor can help simply by keeping different office hours, said Dr. Dooley, who practices at Children’s National Hospital in Washington, D.C.
“We’re expanding our primary care service hours to include more evening availability and more weekend availability,” she said, allowing parents more time to get their children to and from school. Dr. Dooley also pointed to Children’s National Hospital’s mobile unit that delivers vaccinations across the region.
A partnership between doctors and schools also means improving messaging to families about when children should stay home if they are sick and for how long, she said.
Dr. Schumacher sees encouraging attendance as a more helpful approach than the threat of punishment for missing school.
“Almost never does it work to refer a kid to court and then expect them to come back every day and be ready to learn,” she said, pointing toward “multitiered, supportive, more holistic, family-focused interventions” as better ways to stem absenteeism.
Dr. Dooley said the medical sector historically had been “pretty uninvolved” in addressing school attendance, but that its participation as one of those tiers is essential.
“The AAP was really on the forefront, releasing the policy statement about the link between attendance and good health, really recognizing that we can’t stay out of this anymore,” Dr. Dooley said.
