As school districts across the country dig into the hard work of combating chronic absenteeism, they have gained an important ally: the local pediatrician.
The American Academy of Pediatrics (AAP) this week released guidance for its 67,000 doctors on how to help children and families improve school attendance. The policy statement, authored by pediatricians Mandy A. Allison and Elliot Attisha of the organization’s Council on School Health, urges doctors to use their access to children and families during office visits, as well as their roles as civic leaders to address underlying community-based causes of absenteeism.
It makes sense, given the role that student health plays in absenteeism. A study in central Texas by the Austin-based E3 Alliance, for instance, found that 52 percent of absences were due to chronic or acute illness. By contrast, skipping school accounted for 5 percent. Similarly, a study of Chicago preschoolers by the University of Chicago Consortium on Chicago School Research found 54 percent of the absences were due to illness, while transportation, child care and family-related factors together accounted for only 18 percent of missed days.
Research makes clear the academic cost of lost instructional time: weaker social skills in kindergarten, poorer reading scores in third grade and lower graduation rates in high school. The AAP guidance goes a step further, linking these weak academic outcomes to poorer health and economic conditions later in life. And it cites research connecting absenteeism with risky health behavior, such as cigarette use, substance abuse and teen pregnancy.
So what can pediatricians do about absenteeism?
AAP’s recommendations start with using office visits as an opportunity to talk about school attendance. That could mean asking children and their parents about how many days they’ve missed and why. Or talking about the importance of good attendance for academic attainment. Or exploring whether suspensions or disciplinary actions reflect mental health concerns that need more attention. The guidance includes handouts and a waiting room video focused on school attendance.
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Pediatricians also play a key role in helping parents assess when a child is too sick for school. The AAP guidance recommends giving this advice with an eye toward keeping students in school as much as possible. Teachers will tell you that there are doctors who “give out sick notes like candy.” The AAP recommends, “Avoid writing excuses for school absences when the absence was not appropriate and avoid backdating to justify absences.”
For children with chronic illnesses—asthma alone accounts for nearly 14 million missed school days a year—pediatricians should help families work with schools to develop management plans. The same goes for children with disabilities who need extra support at school.
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Beyond the doctor’s office, AAP urges its members to join broader community efforts to improve school attendance and academic outcomes. Pediatricians can work with school and public officials to identify health causes of absences and brainstorm responses. They can help enroll eligible children in Medicaid and CHIP and help all families find a medical home.
They can educate school staff about how to manage chronic illnesses. And they can argue against policies that keep kids home unnecessarily. Head lice is a prime example; many schools prohibit kids from coming to school if they have lice or nits, even though this is against recommended practice.
The AAP policy statement comes at a time when 36 states and the District of Columbia are holding schools accountable for their chronic absenteeism rates, generally defined as the share of students missing 10 percent or more of the school year for any reason, excused or unexcused. It also mirrors a growing awareness of the impact of physical and mental health on a child’s social, emotional and academic development. Educators will need all the help they can get in this work. Pediatricians are a logical partner.