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Why Is School Attendance Important? The Effects of Chronic Absenteeism

Chronic absenteeism is pervasive: as many as one in six students in the United States miss enough school to be considered chronically absent, according to the US Department of Education. The negative effects of absenteeism on a student’s education can be profound, and they often carry into adulthood.

The harmful impact of chronic absenteeism threatens all students, but the risks are not borne equally. Students of color, students who live in poverty, and students with chronic health conditions or disabilities all experience disproportionately high absence rates.

Examining the causes of absenteeism and the effects it has on school performance, and ultimately life outcomes, provides a deeper understanding of why school attendance is so important.

Why Is School Attendance Important?

School attendance is a powerful predictor of student outcomes. In fact, irregular attendance can be a better predictor of whether students will drop out of school before graduation than test scores, according to the US Department of Education.

The correlation between attendance and dropout rates has important ramifications that go beyond the classroom. Compared to their peers who graduate, students who fail to complete their high school education are more likely to live in poverty, suffer poor health, and become involved in the criminal justice system.

Defining and Assessing Chronic Absenteeism in Schools

Chronic absenteeism is widely defined as missing 10 percent or more of a school year. Schools generally recognize three categories of absences:

• Excused absences are those with a valid reason and that have been communicated to the school by a parent. Student illness or other medical conditions are the most common types of excused absence; other reasons include religious observances, medical appointments, and family emergencies.
• Unexcused absences, or truancy , occur when students miss school without a valid reason. Examples include deliberately skipping school as well as missing school for reasons deemed invalid by the school, such as oversleeping or missing the bus.
• Disciplinary absences are a result of school suspension.

While these categories of absences are relatively consistent from one institution to another, school attendance policies and practices vary. For example, some school policies make little or no distinction between excused and unexcused absences. Similarly, school suspensions may be counted as absences by some school districts but not by others.

Such discrepancies speak to the challenge of collecting accurate and consistent attendance data, which is critical for education researchers and policymakers. Two sources of US public school attendance data––the Civil Rights Data Collection and attendance reporting under the Every Student Succeeds Act of 2015––merit closer examination.

Civil Rights Data Collection

Arguably the most important study of absenteeism data collected in the US was the Civil Rights Data Collection (CRDC), a biennial report from the Department of Education’s Office for Civil Rights (OCR) division. The first CRDC study to collect absenteeism data was conducted during the 2013-2014 school year and released in 2016. It marked the first national study of chronic absences and provided hard evidence of the negative effects of chronic absenteeism.

Chronic absenteeism data is no longer collected by OCR (the Education Department continues to collect absence data through its EdFacts Division), but information collected about absences as part of the 2018 CRDC (2015-2016 school year data) continues to serve as a valuable resource for researchers and policymakers studying absenteeism.

The shift from OCR-collected data to EdFacts also marked an important change to attendance data: the definition of chronic absenteeism went from missing at least 15 days of school in a year to missing 10 percent or more of a school year. This change helps to standardize the metric used by federal, state, and local education authorities.

The Every Student Succeeds Act (ESSA) of 2015, a reauthorization of the landmark Elementary and Secondary Education Act of 1965, included important requirements for school absenteeism reporting. The law requires all states to include chronic absence data in their school report cards.

It also requires states to select five metrics by which to measure performance in their schools; four of the performance indicators must be focused on academic achievement, but the fifth is a nonacademic metric. Chronic absenteeism was chosen as the nonacademic indicator by 36 states and the District of Columbia.

Such a broad adoption of absenteeism as a performance indicator reflects growing recognition of the importance of attendance. It also lays the groundwork for addressing the problem. ESSA state plans include strategies for using federal funds to improve attendance through such measures as improved health services, greater family engagement, and teacher training.

School Attendance Facts

Even a cursory look at national attendance data reveals that the problem is widespread. The following attendance facts come from the CRDC that was released in 2018:

• More than seven million students in the US––16 percent of the student population––missed 15 or more days of school.
• Approximately 800 school districts reported more than 30 percent of their students missed at least three weeks of school.
• Chronic absenteeism rates are highest in high schools, where about one in five students is chronically absent.
• More than 20 percent of students were chronically absent in six states (Alaska, Nevada, New York, Oregon, Rhode Island, Washington) and the District of Columbia.
• Every state had schools that reported 10 percent or more of students as chronically absent.

Attendance Inequalities

A survey of national absenteeism data also highlights inequalities across school districts and among students. Many of the factors that are known to contribute to chronic absenteeism––limited transportation, poor health, lack of safety––are more prevalent in marginalized communities and areas of poverty.

The 2018 CRDC shows significant differences in the rates of absenteeism experienced by different races and ethnicities. Students of color generally have higher absenteeism than their white counterparts:

• White students, 14.5 percent
• Black students, 20.5 percent
• Hispanic students, 17 percent
• American Indian students, 26 percent

Asian students are the only nonwhite student population with an absenteeism rate, 8.6 percent, that is lower than that of white students.

While a clear correlation between poverty and absenteeism exists on average, not all high-poverty schools have high chronic absence rates. Some have been successful in helping families overcome attendance challenges by using prevention-oriented approaches, according to Attendance Works, an initiative that advocates for improved absence data collection and policy.

One prevention-oriented program that has proven effective is the formation of “attendance teams,” cross-functional groups that work to improve school attendance by monitoring attendance data, identifying causes for absenteeism, and coordinating prevention and support strategies. Typically led by a principal, an attendance team can include teachers, school nurses, guidance counselors, social workers, parent representatives, and other stakeholders.

The success of such strategies, particularly within schools that are at high risk for chronic absenteeism, underscores the importance of identifying schools at risk for high absence rates and taking steps to address the problem.

Causes of Poor School Attendance

Many factors are associated with poor school attendance:

• Physical health issues . Health conditions such as asthma, influenza, diabetes, tooth decay, and obesity are all associated with higher rates of student absenteeism. Nearly 10 percent of children aged four to14 are diagnosed with asthma, a leading cause of school absenteeism. Asthma accounts for a third of all days of missed instruction, according to Attendance Works.
• Bullying . Approximately 20 percent of students in the US aged 12 to 18 experience bullying. Bullying can include emotional abuse (name-calling, insults, teasing), the threat of harm or actual physical abuse (being pushed, tripped, or beaten), destruction of property, and ostracization (exclusion, being made the subject of rumors or lies). In the US, low socioeconomic status is a common factor in bullying, and immigrant youth are more likely to be bullied than locally born youth, according to the US Department of Health and Human Services.
• Socioeconomic hardship . Socioeconomic hardship can lead to unstable housing or homelessness, as well as limited transportation resources. One child in six lives in poverty in the US, according to Children International.

Academic struggles can also cause students to become disengaged with school, which is one of the reasons that students with learning differences struggle with absenteeism.

Developmental Delays, Learning Disabilities, and Related Disorders

A study conducted by the National Center on Educational Outcomes found that elementary school students with disabilities served by the Individuals with Disabilities Education Act (IDEA) were 1.5 times as likely to be chronically absent as their peers without disabilities. High school students with disabilities served by IDEA were 1.4 times as likely to be chronically absent. (IDEA addresses a broad range of mental and physical impairments, including developmental delays, learning disabilities, and related disorders.) Students with learning disabilities drop out of school at nearly three times the rate for all students, according to the National Center for Learning Disabilities (NCLD).

NCLD notes that students with learning and attention issues commonly experience bullying, struggle with feelings of failure, and often find it difficult to gain acceptance among their peers. All of these factors can put them at high risk for missing school.

A report from the US Department of Health and Human Services also links chronic school absenteeism and selected developmental disabilities. Children aged five to 17 with an intellectual disability had the highest prevalence of chronic school absenteeism at 14 percent, followed by children with autism spectrum disorder at 9 percent, those with other developmental delays at 7.2 percent, and those with attention-deficit/hyperactivity disorder (ADHD) at 5.2 percent.

Mental Health and School Attendance

Mental health issues are among the factors that contribute to chronic absences, according to Attendance Works. Diagnoses of anxiety disorder and depression are not uncommon in children, according to the Anxiety and Depression Association of America (ADAA), which reports that as many as 2.8 million children aged 12 to 17 in the US have at least one major depressive episode in a year. Approximately 80 percent of children with an anxiety order and 60 percent with depression are not treated, according to ADAA.

Chronic absenteeism has also been linked to trauma, which can include experiences ranging from abuse and neglect to the loss of a loved one. More than half of students will experience a traumatic event by the time they reach adulthood, according to Waterford.org.

Effects of Poor School Attendance

When children are absent from school, they miss out on consistent instruction that is needed to develop basic skills. Children in early grades are particularly susceptible to falling behind in fundamental reading skills, which can have a snowball effect that impacts future learning.

Children who have learning and thinking differences can be especially vulnerable to the impact of absenteeism because missing school reduces opportunities for any interventions that might be necessary. If teachers fail to realize that they need an intervention, they are more likely to attribute a learning difficulty to absenteeism, essentially confusing the symptom for the cause.

Students who fail to read at grade level by the end of third grade are four times more likely than students who achieve proficiency to drop out of high school, according to the National Conference of State Legislatures, citing a study by the Annie E. Casey Foundation. Adults without a high school education generally earn lower incomes and experience higher unemployment than their peers who do earn a high school diploma, putting them at greater risk for poverty.

Poor attendance can also have a negative effect on social and emotional development. For example, students who are chronically absent in the early years of their education may not learn crucial school readiness skills (abilities such as critical thinking, problem solving, and creative thinking), and can fall behind their peers in social-emotional development. Excessive absences are also associated with lower scores on standardized tests, which typically assess primary skills and concepts.

While students pay the highest cost if they miss too much school, high absence rates also put a burden on teachers. Making up for lost instruction adds to their workload, and the valuable classroom time it takes up is a detriment to all students.

Addressing Chronic Absenteeism

Just as chronic absenteeism has no single cause, it has no simple solution either. Parents, teachers, administrators, and policymakers can all play a role in addressing high absence rates and improving children’s chances of receiving complete and effective education.

Strategies for Parents

Parents who are concerned that their child has a problem with school attendance can employ several strategies:

• Talk with the child . Conversations are the first step to understanding root causes and working toward a solution.
• Contact the school . Teachers, counselors, and administrators may be able to provide additional information that helps determine what is causing a child to miss school. Contacting the school also starts a conversation that can be mutually beneficial, and it demonstrates engagement.
• Consider an evaluation for an Individualized Education Program (IEP) or 504 Plan . Both programs can provide special accommodations and support for students who are struggling with disabilities.
• Set attendance goals with the child . Creating a plan and tracking progress can encourage better attendance and provide opportunities for conversations and support. Simple steps such as making sure a child gets enough sleep and taking steps to prepare for school the day or night before can also be effective.

Strategies for Educators

Teachers, administrators, and policymakers can work together to address chronic absenteeism. Such efforts begin with gaining a better understanding of the importance of attendance:

• Raise awareness . Training programs can help educators and administrators understand the importance of attendance and the long-term effects of chronic absenteeism.
• Report and study absenteeism data . Identifying students at high risk and the most prevalent causes of absenteeism helps create evidence-based solutions to attendance problems. Identifying problems early is crucial for success.
• Develop trauma-informed practices . Schools equipped to provide emotional support and resources to students who have suffered trauma can address a major cause of absenteeism.
• Set clear expectations . Both students and their parents need clear guidelines about attendance rules and the consequences for missing school.
• Schedule a meeting or visit with family . Reaching out to families personally (in person or using technology that allows social distancing) can be used to develop an individualized attendance plan for families.
• Recognize good attendance . Celebrating students with good attendance and demonstrating concern (rather than frustration or dismissiveness) when students struggle with attendance creates a positive environment that encourages students.
• Implement intervention programs . Some students may require counseling, mentorship, or behavioral interventions.
• Engage with specialists for case management . Specialists who can offer assistance might include child welfare agency staff, mental health professionals, or other social support system employees.

Turning Negatives Into Positives

Parents and educators who do the difficult work of improving student attendance have powerful motivation. Every negative impact associated with chronic absenteeism has a positive corollary for high attendance. Students who regularly attend school and graduate from high school build a foundation for more positive life outcomes:

• Better academic performance
• More work options and earning potential
• Greater opportunities for higher education
• Higher civic engagement
• More developed life skills that positively influence health and economic decisions

However great the challenge, improving attendance directly contributes to more equitable education and better student outcomes.

Empowering More Effective and Equitable Education

Chronic absenteeism is one of the most critical challenges facing educators. Addressing such a prevalent and significant barrier to education requires administrators with exceptional leadership and policy expertise.

American University’s School of Education prepares educators to create equitable learning environments and effect positive change. It promotes modern education that addresses more than just what students learn––it provides students with opportunities to reach their full potential and lead positive social change.

Suited for education leaders who believe in progressive change in education, American University’s Online Doctorate in Education Policy and Leadership (EdD) program develops students in four primary domains: systems change, personal leadership, social justice and antiracism, and policy and research.

Discover how the Online Doctorate in Education Policy and Leadership at American University enhances practical experience and theoretical knowledge, advances education careers, and develops professionals who transform education.

Education Policy Issues in 2020 and Beyond

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American Academy of Pediatrics, School Attendance, Truancy & Chronic Absenteeism: What Parents Need to Know

Anxiety and Depression Association of America, Anxiety and Depression in Children

Attendance Works, 10 Facts About School Attendance

Attendance Works, “Data Matters: Using Chronic Absence to Accelerate Action for Student Success”

Children International, Child Poverty in the U.S. Attendance Works, “Mapping the Early Attendance Gap”

The Classroom, “The Effects of Excessive Absenteeism in Schools”

Economic Policy Institute, “Student Absenteeism: Who Misses School and How Missing School Matters for Performance”

National Center for Learning Disabilities, “The State of LD: Introduction”

National Center on Educational Outcomes, “Students With Disabilities & Chronic Absenteeism”

National Conference of State Legislatures, “Pre-Kindergarten-Third Grade Literacy”

PACER Center, “School Attendance Makes a Difference”

Stopbullying.gov, Facts About Bullying

Understood, “Chronic Absenteeism: What You Need to Know”

US Department of Education, 2017–18 Civil Rights Data Collection: General Overview, Changes, and List of Data Elements

US Department of Education, “Chronic Absenteeism in the Nation’s Schools”

US Department of Education, Office for Civil Rights, Protecting Students With Disabilities

US Department of Health and Human Services, National Health Statistics Reports, “Chronic School Absenteeism Among Children With Selected Developmental Disabilities: National Health Interview Survey, 2014–2016”

Waterford.org, “What Your School Needs to Know About Trauma-Informed Practices”

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Why School Attendance Matters and Strategies to Improve It

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School attendance matters. It is arguably one of the most important indicators of school success. You cannot learn what you are not there to learn. Students who attend school regularly improve their chances of being academically successful. There are obvious exceptions to both sides of the rule. There are a few students deemed academically successful who also have attendance issues and a few students who struggle academically who are always present. However, in most cases, strong attendance correlates with academic success, and poor attendance correlates with academic struggles.

To understand the importance of attendance and the influence the lack thereof has, we must first define what constitutes both satisfactory and poor attendance.  Attendance Works , a non-profit dedicated to improving school attendance, has categorized school attendance into three distinct categories. Students who have 9 or fewer absences are satisfactory. Those with 10-17 absences are exhibiting warning signs for potential attendance issues.  Students with 18 or more absences have a clear cut chronic attendance issue. These numbers are based on the traditional 180-day school calendar.

Teachers and administrators will agree that the students who need to be at school the most are the ones that are seemingly seldom there. Poor attendance creates significant learning gaps. Even if students complete the make-up work, they most likely will not learn and retain the information as well as if they had been there.

Make-up work can pile up very quickly. When students return from an extended hiatus, they not only have to complete the make-up work, but they also have to contend with their regular classroom assignments. Students often make the decision to rush through or completely ignore the make-up work so that they can keep pace with their regular class studies.  Doing this naturally creates a learning gap and causes the student’s grades to drop. Over time, this learning gap increases to the point where it becomes nearly impossible to close.

Chronic absenteeism will lead to frustration for the student. The more they miss, the more difficult it becomes to catch up. Eventually, the student gives up altogether putting them on a path towards being a high school dropout. Chronic absenteeism is a key indicator that a student will drop out. This makes it even more critical to find early intervention strategies to prevent attendance from ever becoming an issue.

The amount of schooling missed can quickly add up. Students who enter school at kindergarten and miss an average of 10 days per year until they graduate high school will miss 140 days. According to the definition above, this student would not have an attendance problem. However, all together that student would miss nearly an entire year of school when you add everything together. Now compare that student with another student who has a chronic attendance issue and misses an average of 25 days a year. The student with a chronic attendance issue has 350 missed days or almost two entire years. It is no wonder that those who have attendance issues are almost always further behind academically than their peers who have satisfactory attendance.

Strategies to Improve School Attendance

Improving school attendance can prove to be a difficult endeavor.  Schools often have very little direct control in this area. Most of the responsibility falls on the student’s parents or guardians, especially the elementary aged ones.  Many parents simply do not understand how important attendance is. They do not realize how quickly missing even a day a week can add up. Furthermore, they do not understand the unspoken message that they are relaying to their children by allowing them to miss school regularly.  Finally, they do not understand that they are not only setting their children up to fail in school, but also in life.

For these reasons, it is essential that elementary schools in particular focus on educating parents on the value of attendance.  Unfortunately, most schools operate under the assumption that all parents already understand how important attendance is, but that those whose children have a chronic attendance issue are simply ignoring it or do not value education. The truth is that most parents want what is best for their children, but have not learned or been taught what that is. Schools must invest a significant amount of their resources to educate their local community adequately on the importance of attendance.

Regular attendance should play a part in the daily anthem of a school and a critical role in defining the culture of a school. The fact is that every school has an attendance policy . In most cases, that policy is only punitive in nature meaning that it simply provides parents with an ultimatum that essentially says “get your child to school or else.”  Those policies, while effective for a few, will not deter many for whom it has become easier to skip school than it is to attend. For those, you have to show them and prove to them that attending school on a regular basis will help lead to a brighter future.

Schools should be challenged to develop attendance policies and programs that are more preventive in nature than they are punitive. This begins with getting to the root of the attendance issues on an individualized level. School officials must be willing to sit down with parents and listen to their reasons for why their children are absent without being judgmental. This allows the school to form a partnership with the parent wherein they can develop an individualized plan for improving attendance, a support system for follow through, and a connection to outside resources if necessary.

This approach will not be easy. It will take a lot of time and resources. However, it is an investment that we should be willing to make based on how important we know attendance to be.  Our goal should be to get every child to school so that the effective teachers we have in place can do their jobs. When that happens, the quality of our school systems will improve significantly .

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School attendance problems are complex, and our solutions need to be as well

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Over the past few years, the pandemic prompted school closures and remote learning that drew international attention to issues of students missing school — what researchers call “non-attendance.”

Millions of students across the world missing varying amounts of school raises concerns about students’ learning loss and mental health — and also about long-term implications, particularly for those already at-risk for poor educational outcomes.

But school non-attendance is not a new issue. Terms like “epidemic” have been used in relation to school attendance problems in many countries such as Canada, the United States and Australia for a long time. There have always been students who missed school.

School attendance problems are complex and often very challenging to address. And for responses to be effective in getting students to school more often, they need to reflect this .

Not a Hollywood picture

Popular culture is filled with examples of teenagers skipping classes — and in films like Ferris Bueller’s Day Off , this is framed by humour and a gleeful sense of freedom. But Ferris Bueller went back to school the next day without any major impact on his life. This isn’t the case for many.

Evidence shows worse outcomes for students who miss a lot of school, including lower academic achievement , lower graduation rates, higher rates of interaction with juvenile justice systems , mental and physical health issues and lower employment.

And certain life circumstances, such as poverty, increase the risk of chronic school attendance issues.

Chronic school attendance problems are usually defined as missing more than 10 per cent of school days.

School attendance in countries like Canada and Australia is mandatory until between 16 and 18 years of age, depending on the province or territory.

There are legal penalties for families whose children are chronically absent from school as well as for students themselves, and possible involvement of child protection services.

Many reasons students are absent, disengaged

There are many reasons why students miss school.

Some because they are disengaged, others because of significant anxiety or mental health and well-being concerns.

Some are absent because of frequent experiences of harassment, bullying and racism .

Others miss school because they have family responsibilities such as younger siblings, or because of disability-related needs that schools are struggling to support . Students may experience multiple types of school attendance problems, and these may vary over time.

Punishing attendance problems fails to address the issues students face, from family responsibilities to barriers related to racism or inadequate support for disabilities.

Complex, flexible approaches needed

There has been more evidence in recent years of the recognition of the complex, multilayered and flexible approaches necessary to improve school attendance. There have also been efforts to think about school attendance as more than just “present” or “absent.” Are students participating? Are they included? Are they engaged? Are they learning?

Many initiatives are still based on simplistic ideas of school attendance and punitive approaches that really don’t work well in the long run .

Read more: If I could change one thing in education: Community-school partnerships would be top priority

These fail to address the issues experienced by students that create the attendance problem in the first place. And these approaches often further punish students most at risk of school attendance problems.

There are four key points or “ABCDs” for schools, families and communities to consider:

1. Academics and well-being

Well-being supports, including mental health and addictions services, lunch programs, identity-based clubs, and opportunities for movement and physical activity are all important in promoting school attendance.

But if a child can’t read, or an adolescent is struggling to learn algebraic equations and falling behind their peers, well-being initiatives aren’t enough. An integrated approach to support academic success and well-being for students is essential.

2. Building relationships

A sense of belonging and connectedness is critical to engagement, learning and attendance for students. Students need to feel like they matter to someone at school — someone who notices when they’re not there but who also welcomes them when they are.

Relationships need to be purposefully fostered between and among students, staff, families and communities. Mentorship programs , peer buddies, leadership opportunities, community experiential projects or attendance counsellors are some examples of ways to support relationship building.

3. Climate of school

A supportive and positive school climate is key for students, staff, families and communities. Schools can provide opportunities for shared decision-making, autonomy, support and valuing of student and family identities and strengths.

Extra-curriculars and high expectations need to be in place alongside supports to meet these. Families can be welcomed in a range of ways that reflect the needs of communities. Bullying and harassment, including anti-racist, homophobic and anti-Indigenous abuse, needs to be addressed.

4. Data needed

Data is important for understanding attendance — who is at school, who is not. And if not, what are the reasons? In shifting responses to attendance, schools can consider also shifting the ways they collect, use and report on data. For example, an early flag system to identify student attendance patterns can help to proactively support students and families before chronic issues arise.

Considering traditional attendance counts alongside school climate data, student records, academic profiles and student well-being indicators can tell a fuller story, and lead to more effective ways of getting students to school — and keeping them there.

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Statement of the Problem

What is chronic absenteeism, why does chronic absenteeism matter, causes of school absenteeism, evidence for physical and mental health interventions to improve school attendance, infection prevention, school nurses, school-based health centers, mental health care, school policies and programs, parent interventions, coordinated school health, recommendations, additional resources, organizations addressing school attendance, links to resources to share with patients and parents, lead authors, council on school health executive committee, 2017–2018, former executive committee members, consultants, former liaisons, the link between school attendance and good health.

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

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Mandy A. Allison , Elliott Attisha , COUNCIL ON SCHOOL HEALTH , Marc Lerner , Cheryl Duncan De Pinto , Nathaniel Savio Beers , Erica J. Gibson , Peter Gorski , Chris Kjolhede , Sonja C. O’Leary , Heidi Schumacher , Adrienne Weiss-Harrison; The Link Between School Attendance and Good Health. Pediatrics February 2019; 143 (2): e20183648. 10.1542/peds.2018-3648

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More than 6.5 million children in the United States, approximately 13% of all students, miss 15 or more days of school each year. The rates of chronic absenteeism vary between states, communities, and schools, with significant disparities based on income, race, and ethnicity. Chronic school absenteeism, starting as early as preschool and kindergarten, puts students at risk for poor school performance and school dropout, which in turn, put them at risk for unhealthy behaviors as adolescents and young adults as well as poor long-term health outcomes. Pediatricians and their colleagues caring for children in the medical setting have opportunities at the individual patient and/or family, practice, and population levels to promote school attendance and reduce chronic absenteeism and resulting health disparities. Although this policy statement is primarily focused on absenteeism related to students’ physical and mental health, pediatricians may play a role in addressing absenteeism attributable to a wide range of factors through individual interactions with patients and their parents and through community-, state-, and federal-level advocacy.

Chronic absenteeism broadly refers to missing too much school for any reason, including excused and unexcused absences as well as suspensions. The US Department of Education’s Office of Civil Rights has used a definition of missing 15 or more days over the course of a school year. 1 Most researchers and a growing number of states have defined chronic absenteeism as missing 10% (or around 18 days) of the entire school year. Some organizations suggest using 10%, because it promotes earlier identification of poor attendance throughout the school year. For example, identifying students who have missed just 2 days in the first month of school predicts chronic absence throughout the year. 2  

Chronic absence is different than truancy. The definition of truancy also varies but usually refers to when a student willfully misses school, and the absence is “unexcused.” 3 Although students who are truant may be chronically absent, focusing solely on truancy may miss those students who miss excessive amounts of school for “excused” reasons. Regardless of whether absences are unexcused or excused, chronic absenteeism typically results in poor academic outcomes and is linked to poor health outcomes.

Factors such as poverty, unstable housing conditions, poor parental health, and racial or ethnic minority status are associated with poor child health outcomes and are known in the medical and public health communities as social determinants of health. 4 , – 6 Students living in poverty are more likely than students from higher-income families to be chronically absent from school. 7 , 8 Factors associated with chronic absenteeism include poorer overall health, 9 , 10 unstable housing conditions, 11 transportation difficulties, and exposure to violence. 12 Students who change schools within the school year are also more likely to experience absenteeism. 13 In addition, youth may be called on to care for sick family members or stay home with younger siblings when a parent or primary caregiver is sick or cannot take time off work, and this is more likely to occur among low-income families. 14 Finally, authors of some studies have found that students from racial and ethnic minority groups and those who are English language learners are more likely to be chronically absent than students who are not in these groups. 1  

Children with a history of maltreatment or exposure to major trauma, such as witnessing domestic violence or experiencing a natural disaster, are more likely than those without these exposures to experience absenteeism, truancy, school suspension, and school dropout. 15 , – 17 These children are also more likely to experience other risk factors for chronic absenteeism, including poor mental and behavioral health, poverty, homelessness, and frequent school changes. 15 , 16 , 18 Children who are living in foster care are more likely to transfer schools within a year compared with the general school population; however, this effect is mitigated among children with more stable (3 months or longer) foster care placements. 16 Although reliable data are lacking regarding the effect of immigrant or refugee status on school attendance, immigrant and refugee children are likely to have 1 or more risk factors for poor school outcomes, including poverty, racial or ethnic minority status, and exposure to major trauma. 17 , 19  

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, particularly for social skills and reading. 3 , 8 , 20 , 21 Among elementary school students, absenteeism is highest in kindergarten and first grade, then decreases until middle school. At least 10% of kindergarten and first-grade students miss a month or more of the school year. 21 Absenteeism tends to increase again in middle school and high school, with an estimated 19% of all high school students being chronically absent. 1 A national map of chronic absenteeism based on the US Department of Education’s 2013–2014 Civil Rights Data Collection reveals wide geographic variation in chronic absenteeism and describes variations on the basis of race and ethnicity, with African American, Hispanic, American Indian, and Pacific Islander students experiencing higher rates of chronic absenteeism than their white and Asian American peers. 22  

Students with poor attendance score lower than their peers who attend school regularly on national skills assessments, regardless of race or ethnicity. 3 Chronic absenteeism can be a better predictor of school failure than test scores. In 1 study, students with high test scores who missed at least 2 weeks of school during the semester were more likely to have failing grades than students with low test scores who regularly attended school. 23 Chronic absenteeism as early as sixth grade is predictive of dropping out of school. 3  

The literature reveals that poor school performance is associated with poor adult health outcomes. Compared with adults with higher educational attainment, those with low educational attainment are more likely to be unemployed or work at a part-time or lower-paying job. 24 Those with lower educational attainment are less likely to report having a fulfilling job, feeling that they have control over their lives, and feeling that they have high levels of social support. 24 , 25 This lack of control and social support is thought to be associated with poor health attributable to difficulty adhering to healthy behaviors, psychological processes such as depression, and biological processes such as increased inflammation and reduced immune system function. 26 Adults with lower educational attainment are also more likely to smoke and less likely to exercise, which are directly linked to poor health outcomes. 24 , 25 Not earning a high school diploma is associated with increased mortality risk or lower life expectancy. 27 Conversely, obtaining advanced degrees and additional years of education are associated with a reduced mortality risk. 27 Over the past 20 years, disparities in mortality rates based on educational attainment are worsening for preventable causes of death. 28  

Chronic absenteeism is associated with engaging in health risk behaviors, including smoking cigarettes or marijuana, alcohol and other drug use, and risky sexual behavior, such as having 4 or more sexual partners. 29 For every year a student delays alcohol or drug use, his or her odds of regular school attendance in subsequent quarters increase. 30 Students’ experiences of teenage pregnancy, violence, unintentional injury, and suicide attempts are associated with chronic absenteeism. 31 , – 33 Roughly 30% to 40% of female teenage dropouts are mothers, with teenage pregnancy being the number 1 cause of high school dropout for adolescent female students. 34 Poor school attendance is also associated with juvenile delinquency; in 1 study of youth in Mississippi from 2003 to 2013, authors found that those with chronic absenteeism had 3.5-times higher odds of being arrested or referred to the juvenile justice system. 35  

Students may be frequently absent from school for a wide variety of reasons. In the publication, “The Importance of Being in School: A Report on Absenteeism in the Nation’s Public Schools,” Balfanz and Byrnes 36 describe 3 broad categories of causes: “(1) students who cannot attend school due to illness, family responsibilities, housing instability, the need to work or involvement with the juvenile justice system; (2) students who will not attend school to avoid bullying, unsafe conditions, harassment and embarrassment; and (3) students who do not attend school because they, or their parents, do not see the value in attending school, they have something else they would rather do, or nothing stops them from skipping school.” 36 An additional category (ie, “myths”) is also thought to cause problem absenteeism. Myths include when students and their families do not realize that missing just 2 days a month can be a problem, think that it is a problem only if absences are unexcused, or do not think absences are a problem for younger children in preschool through grade school. 14 Finally, school suspension and expulsion, as early as preschool, have increasingly been identified as causes of chronic absenteeism that disproportionately affect African American students and students with emotional and behavioral disorders and attention-deficit/hyperactivity disorder. 37 , – 42  

Most studies of health-related causes of school absence have been conducted by authors focusing on a specific health condition and determining whether that condition is associated with missing school. Common health conditions that have been associated with school absenteeism include influenza infection, 43 , 44 group A streptococcal pharyngitis, 45 gastroenteritis, 46 fractures, 47 , – 49 poorly controlled asthma, 50 , – 54 type 1 diabetes mellitus, 55 chronic fatigue, 56 , 57 chronic pain 58 , – 62 (including headaches and abdominal pain), seizures, 63 poor oral health, 64 , – 67 dental pain, 68 , 69 and obesity. 70 , – 73 Experienced clinicians know that mental health conditions may present with physical health complaints, including some of those listed above that have been associated with frequent absences. Few studies have been conducted to identify groups of children with higher absenteeism and lower absenteeism and determine which health conditions are most prevalent among those with higher absenteeism. 74 Therefore, it is a challenge to clearly define which health conditions cause more absenteeism than others. In addition, although more data are needed, the data that exist and the authors’ clinical knowledge suggest that the most common health-related causes of school absenteeism likely vary among communities.

Although occasional absences attributable to health conditions can be expected, absences can quickly add up and lead to chronic absenteeism if a child experiences multiple health conditions, unrecognized or undertreated conditions, or lack of access to care. Absenteeism attributable to physical health conditions can be compounded by the presence of mental or behavioral health conditions and socioeconomic factors.

Children with disabilities are more likely to be chronically absent than children without disabilities. 1 Similarly, children and youth with special health care needs tend to have more school absences than children without. 75 , – 77 School performance, including absenteeism, of children and youth with special health care needs has been shown to be affected by risk and protective factors at the child, family, and system levels (eg, socioeconomic factors, the presence or absence of care coordination, and school climate and accommodations). 75 , 76 , 78 , – 80 Children with moderate-to-severe autism spectrum disorder may be at particular risk for disruptive behaviors that affect their own and other students’ learning. Students with autism spectrum disorder who display disruptive behaviors at school may be more likely to be excluded or absent from school. 81 , 82  

School absenteeism has been associated with mental health conditions and substance use disorders. 83 , – 86 Longitudinal cohort studies have revealed that conduct disorder and depressive symptoms can lead to frequent absenteeism and, conversely, that frequent absenteeism can lead to conduct disturbances and depressive symptoms. 87 Youth who are truant, defined as willfully refusing to attend school, are more likely than youth who attend school regularly to be diagnosed with oppositional defiant disorder, conduct disorder, depression, and tobacco, alcohol, and marijuana abuse.

Studies have been used to examine school absenteeism by using a socioecologic model considering individual-, family-, and school-level factors. Authors of these studies have found that individual factors (such as hyperactivity, conduct problems, and poor perceived health), family factors (such as low maternal education and high levels of unemployment), and school factors (such as not feeling safe or not feeling treated with respect at school) all contributed to students’ poor attendance. 88 Issues that are likely to be brought up during a visit to a health care provider include bullying, gender identity and sexuality, and adverse childhood experiences (ACEs). In-person and electronic bullying have been shown to be associated with school absenteeism. 89 Lesbian, gay, bisexual, transgender, queer, and questioning youth have been shown to be at risk for poor school connectedness, and poor school connectedness is a risk for poor attendance. 90 Finally, students with higher numbers of ACEs are more likely to have chronic absenteeism than students with fewer ACEs. 91  

Many organizations are making multidisciplinary efforts to promote school attendance at community, state, and national levels. Although the body of evidence about effective interventions to improve school attendance is growing, high-quality evaluation has been limited by the lack of routine measurement of chronic absenteeism and differences in how schools and local educational agencies measure and define absenteeism and attendance. 36 Several national organizations and collaborations are working to promote school attendance by bringing together stakeholders from diverse sectors, including education, law enforcement, juvenile justice, public health, and health care. Summaries of additional evidence and information about strategies to promote school attendance and address chronic absenteeism are available from these organizations and are listed in the Additional Resources section below.

Interventions used to improve hand hygiene practices in schools include increased frequency of hand-washing and use of hand sanitizers. It is suggested in a 2016 review of 18 randomized controlled trials that hand hygiene interventions can be used to promote good hand hygiene practices among children and school staff and can be used to reduce the incidence of respiratory tract illness symptoms, symptoms attributable to influenza, and school absenteeism. 92 Evidence was mixed for hand hygiene interventions to reduce absenteeism attributable to gastrointestinal tract illness. 92 The effects of school-based infection prevention measures have been best studied for influenza. In addition to studies of hand hygiene interventions, 93 school-located influenza vaccination programs have been shown to reduce school absenteeism during influenza season. 94 Finally, school immunization requirements have been shown to increase immunization coverage in the community, and high levels of coverage are necessary for the prevention of outbreaks of vaccine-preventable diseases that could lead to school absenteeism. 95  

School nurses play a significant role in student success and attendance. The American Academy of Pediatrics (AAP) and the National Association of School Nurses recommend a minimum of 1 full-time professional school nurse in every school, recognizing that the ideal nurse-to-student ratio varies depending on the needs of the student population. 96 , 97 Healthy People 2020 includes goals to have a school nurse-to-student ratio of 1:750 in elementary and secondary schools. 98 School nurses have the expertise to identify and intervene on health issues that may affect the learning environment and are critical team members for ensuring that students’ individualized education programs, 504 plans, or health care plans are appropriately designed and implemented. 96 , 97 , 99 Given the complexity of studying nursing services in the school setting and the paucity of research funding and researchers studying school nursing services, data regarding the effect of school nurses on school attendance are limited. One study revealed that 95% of students seen by a school nurse for illness or injury are able to return to class compared with 82% of students seen by an unlicensed school employee. 100 Studies have also revealed that the addition of full-time school nurses reduces illness-related absenteeism among children with asthma compared with children with asthma in schools with part-time school nurses. 101 , 102 One literature review revealed that school nurses can improve attendance among students with chronic absenteeism and that lower nurse-to-student ratios were associated with improved school-level attendance rates. 103 Many schools have nurse coverage only part-time, and some schools do not have nurse coverage at all 104 ; therefore, a health aide or other school personnel may provide some school health services. The services provided by health aides or other school personnel are essential when a nurse is not available, but these other providers typically do not have nursing training.

School-based health centers (SBHCs) have been shown to improve education outcomes, including grade point average and high school graduation, 105 and have been recommended by the Community Preventive Services Task Force to improve both education and health outcomes in low-income communities. 106 SBHCs provide health services to students who otherwise may have been sent home or missed school because of illnesses and injuries or attending medical appointments for management of chronic health problems. School-based health services can include preventive services, dental services, and mental or behavioral health services. 107 Research has shown SBHCs can reduce absenteeism. Authors of a study of SBHC users in Seattle found that those who used the clinic for medical purposes had a significant increase in attendance over nonusers. 108 , 109 African American male SBHC users were 3 times more likely to stay in school than their peers who did not use the SBHC. Authors of 2 studies in New York found that students enrolled in SBHCs had more time in class, better attendance, and fewer hospitalizations attributable to asthma. 110 , 111 Authors of another study found a 50% decrease in absenteeism and 25% decrease in tardiness for high school students who received school-based mental health services. 112 Overall, SBHCs have been shown to improve school attendance for students who use SBHCs for physical and mental health care, with greater improvement for those using SBHCs for physical health. 108 , 110 , 113  

Authors of a recent review of children’s mental health services provided in schools or in other community-based or clinic settings found that educational outcomes, including school attendance, are infrequently measured. 114 The authors of this review did suggest that mental health treatment was associated with improved overall educational outcomes for children. Investigators found that providing cognitive behavioral therapy for students identified with “school refusing” can improve attendance as well as anxiety and depressive symptoms. 115 , 116 “Trauma-informed schools” are schools in which the adults in the school community are prepared to recognize and respond to those who have been affected by trauma. 117 These schools are focused on the life experiences of a student and how the experiences may affect the student’s behavior and performance at school. In addition, these schools provide individual mental health interventions for students and/or link students and families to services in the community. Although research in this area is new and ongoing, a trauma-informed approach at schools appears to reduce school suspensions and expulsions and improve attendance and school performance. 117 Overall, more evidence is needed, specifically regarding the effectiveness of school-based mental health services and trauma-informed approaches for improving school attendance. 118 , 119  

Policies that promote a positive school climate can promote attendance. 120 As defined by the National School Climate Center, “School climate refers to the quality and character of school life. School climate is based on patterns of students’, parents’ and school personnel’s experience of school life and reflects norms, goals, values, interpersonal relationships, teaching and learning practices, and organizational structures.” 121 The concepts of school climate and school connectedness are closely related, and research reveals that students who feel a connection with their school are more likely to attend and less likely to engage in risky behaviors. 32 The Centers for Disease Control and Prevention (CDC) has identified specific strategies to improve school connectedness. 122 The CDC also provides technical guidance regarding prevention of youth violence, including bullying, for schools and communities. This guidance suggests strategies including universal school-based programs for strengthening youth skills, connecting youth to caring adults and activities through mentoring and after-school programs, and creating protective community environments including a positive school climate. It is suggested in evidence that these strategies can be used to reduce youth violence and, in turn, improve school connectedness, attendance, and academic success. 123 Although many of these strategies are directed toward education professionals in the schools, they include engaging with community partners such as health care professionals. Some researchers suggest rewarding students for good attendance with parties, gift certificates, or other types of special recognition results in higher attendance rates. 124  

Schools that communicate effectively with all parents, regardless of language or culture, provide parents with a specific school contact person who can address their questions and concerns, and provide workshops about school attendance for parents have higher attendance rates. 124 , 125 Strong parental monitoring and parental involvement (eg, when a parent knows whether his or her child is attending school) are related to lower levels of delinquency, which is associated to better school attendance. 126 In 1 study conducted in 2014–2015 among students in kindergarten through 11th grade in Philadelphia, authors indicated that simply informing parents of their children’s absences from school can help reduce subsequent absenteeism; this may be partly because parents have misbeliefs about how much their child has been absent. 14 , 127 Schools that build strong partnerships with families and the community have shown improved student attendance. 125 In addition to school nurses and other members of the school health team, school counselors can play a key role in developing these partnerships. 128 , 129  

The CDC’s Whole School, Whole Community, Whole Child model provides a framework for health and educational professionals to promote students’ health and academic achievement. 130 , 131 The components of this model are health education; physical education and physical activity; nutrition environment and services; health services; counseling, psychological, and social services; social and emotional climate; physical environment; employee wellness; family engagement; and community involvement. Although not all of these components have been studied in relation to school attendance, authors of a recent comprehensive summary of the literature indicate that each component plays a role in improving children’s academic performance. 132 Aspects of nutrition services (breakfast at school); health services (nursing services); counseling, psychological, and social services (school-based mental health care); social and emotional school climate (school connectedness); physical environment (full-spectrum lighting, reduction of physical threats, indoor air quality); family engagement; and community involvement have all been associated with improved school attendance. 132  

Pediatricians could address school attendance in their office-based practices and communities and/or states or nationally as advocates using a tiered approach. The office-based approaches could include members of the health care team, such as front office staff, medical assistants, nurses, or care coordinators, to reduce the burden on the pediatrician.

These office-based and advocacy approaches promote school attendance for all youth.

Office-Based

Routinely ask at preventive care visits and sick visits about the number of absences a student has experienced. Consider adding questions about the number of missed school days in the previous month and the name of the school each patient is currently attending in templates in the paper or electronic medical record;

Encourage parents to bring copies of their child’s report card or share data available from their child’s online school information system during preventive visits. These data sources usually include information about school absences and tardiness;

Praise patients and caregivers when patients are regularly attending school, meaning they miss no more than a day per month on average;

Talk about the effects of school absences on school performance and future wellness. Talk about how absences can add up. Stress the value of developing strong attendance habits as early as preschool;

Support parents in addressing barriers to attendance;

Ask families of children with chronic health issues, such as asthma, allergies, and seizures, if they have an action plan at school. Help complete school action plans so that families feel secure sending their children to school. When needed, work with the school nurse to adjust the action plan when there is a change in a patient’s condition. Some states and national organizations or foundations have developed standardized forms for asthma, 133 allergy, 134 and seizure action plans 135 ;

Encourage families to share their concerns about their children’s health with their school nurse;

Assist families in documenting and interpreting their children’s medical needs or disability for an individualized education program or 504 plan to help them establish services to optimize learning opportunities 99 , 136 ;

Promote school attendance by using handouts, posters, or videos in your waiting area (see links to resources below), working with community partners (eg, during September Attendance Awareness Month campaigns: http://awareness.attendanceworks.org/ ), and communicating via your practice Web site or social media;

Educate yourself and your office staff about the appropriate and inappropriate reasons to exclude a child from school. Additional information about appropriate school inclusion and exclusion criteria can be found in the following publications from the AAP: Managing Infectious Disease in Child Care and Schools: A Quick Reference Guide 137 and the chapter on school health in the Red Book: 2015 Report of the Committee on Infectious Diseases 138 ;

Provide firm guidance on when a child should stay home if sick and how to avoid absences from minor illness or anxiety (links to resource below);

Learn about resources in the community and connect families with resources that can improve the well-being of the entire family (eg, family counseling, food pantries, housing assistance) as described in more detail in the “Poverty and Child Health in the United States” policy statement 139 ; and

Routinely ask about whether your patients have experienced out-of-school suspension or expulsion and assist patients and families affected by suspension and expulsion (more detail in the “Out-of-School Suspension and Expulsion” policy statement). 42  

Population-Based

Pediatricians are encouraged to be advocates and supporters of children’s health. Available opportunities may include the following:

Work with AAP chapter leaders to advocate at the school, school district, state school board, and state legislative levels for policies and interventions known to promote school attendance. These interventions can include policies and approaches that promote a positive school climate and avoid suspension and expulsion. 42 , 121 Advocate for funding to ensure adequate numbers of school support personnel, including school nurses and school counselors, and for school-based medical, oral, and behavioral health services 96 , 140 ;

Encourage and collaborate with community leaders (faith leaders, public officials, businesses) to develop and deliver consistent and coordinated community-specific and culturally salient messages that inform the public about the importance of regular school attendance at all ages, starting in early childhood;

Educate and collaborate with school professionals about appropriate and inappropriate reasons for exclusion (eg, some schools continue to exclude children with head lice from school despite a strong, evidence-based recommendation to avoid exclusion from school for head lice). 141 AAP chapter leaders and the Council on School Health can provide assistance in these efforts;

Support school districts’ efforts to improve children’s and families’ access to health insurance and medical services;

Serve as a school physician or on a school board, school or school district health services advisory committee, or wellness committee to develop policies and practices that promote school attendance 142 ;

Work with your state school board, department of education, or school districts (local educational agencies) to encourage schools to consistently collect and share data with public health and health care providers on chronic absence by grade, school, and neighborhood, because chronic absence is often an indicator that children and families are struggling with health-related issues. Develop and promote strategies that encourage data sharing and are compliant with existing privacy laws;

Work with schools to identify physical and mental health conditions that are significantly contributing to school absenteeism among their students and help identify interventions to address these conditions; and

Encourage public health departments to compare chronic absence data and available health metrics to identify where collaborative action would be helpful.

In addition to the approaches described in tier 1, pediatricians can use the following office-based interventions for patients who are missing 2 or 3 days of school per month (∼10% of total school time):

Prevent, identify, and treat physical and mental health conditions that are contributing to school absences. Collaboration with school and mental health professionals is essential in the treatment of youth with psychosomatic symptoms that result in poor school attendance;

When possible, identify psychosocial risk factors and health factors among a patient’s caregivers that may be contributing to the patient’s school absenteeism and refer the caregiver to appropriate resources in the community;

Avoid writing excuses for school absences when the absence was not appropriate and avoid backdating to justify absences;

Strongly encourage patients who are well enough to attend school to return to school immediately after their medical appointments, so they do not miss the entire day;

Avoid contributing to school absences. In concordance with the medical home concepts of providing accessible, continuous, and family-centered care, consider offering extended office hours and encourage families to make preventive care appointments and follow-up appointments for times outside of regular school hours 143 ;

Communicate and collaborate with school professionals and community partners to manage the health conditions of your patients with chronic absenteeism. The school nurse is usually the best first contact. 96 The AAP publication Managing Chronic Health Needs in Child Care and Schools 136 is a reference that may be particularly useful in the child care or preschool settings, where a school nurse or child care health consultant may not be readily available; and

Encourage parents of students with excessive absences to seek a formal school team meeting (often termed a school study team) to discuss how the school and family can cooperate to address the issue. Specifically, parents can request that their student be considered for participation in their school’s behavioral intervention system. 144  

In addition to the approaches described in tiers 1 and 2, pediatricians can use the following office-based interventions for patients who have severe chronic absenteeism and are missing 4 or more days of school per month (∼15% of total school time):

Encourage the school or school district to provide services such as intensive case management and mentorship, communicate and collaborate with professionals providing support services in school, and serve as your patient’s advocate and medical expert; and

Children are eligible for home or hospital educational services from the public schools if they have a legitimate medical reason for absences. The use of these services should be clearly justified on the basis of the patient’s medical presentation. The goal should be for these services to be time limited. Communicate and collaborate with school professionals to decide whether out-of-school instruction is appropriate, develop a time line for out-of-school instruction, develop a reentry plan, and identify whether an alternative to out-of-school instruction is appropriate.

America’s Promise Alliance, Grad Nation ( http://www.americaspromise.org/program/gradnation );

Attendance Works ( http://www.attendanceworks.org/ );

Everyone Graduates Center ( http://www.every1graduates.org/ );

Healthy Schools Campaign ( https://healthyschoolscampaign.org/ );

National Center for Education Statistics, Every School Day Counts ( https://nces.ed.gov/ ); and

National Center for School Engagement ( http://schoolengagement.org/ ).

Handouts to give to parents ( http://www.attendanceworks.org/resources/handouts-for-families/ );

Video to show in waiting room ( http://www.attendanceworks.org/tools/for-parents/bringing-attendance-home-video/ ); and

Mobile-friendly Web site geared to preteenagers, teenagers, and their parents ( https://getschooled.com/dashboard ).

FUNDING: No external funding.

This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. However, policy statements from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent.

The guidance in this statement does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

American Academy of Pediatrics

adverse childhood experience

Centers for Disease Control and Prevention

school-based health center

Mandy Allison, MD, MSPH, FAAP

Elliott Attisha, DO, FAAP

Marc Lerner, MD, FAAP, Chairperson

Cheryl Duncan De Pinto, MD, MPH, FAAP, Chairperson Elect

Nathaniel Savio Beers, MD, MPA, FAAP

Erica J. Gibson, MD, FAAP

Peter Gorski, MD, MPA, FAAP

Chris Kjolhede, MD, MPH, FAAP

Sonja C. O’Leary, MD, FAAP

Heidi Schumacher, MD, FAAP

Adrienne Weiss-Harrison, MD, FAAP

Richard Ancona, MD, FAAP

Breena Welch Holmes, MD, FAAP, Immediate Past Chairperson

Jeffrey Okamoto, MD, FAAP, FAAP, Past Chairperson

Thomas Young, MD, FAAP

Hedy Chang – Attendance Works

Ken Seeley – National Center for School Engagement

Susan Hocevar Adkins, MD, FAAP

Laurie Combe, MN, RN, NCSN

Veda Charmaine Johnson, MD, FAAP

Shashank Joshi, MD

Nina Fekaris, MS, BSN, RN, NCSN

Linda Grant, MD, MPH

Sheryl Kataoka, MD, MSHS

Sandra Leonard, DNP, RN, FNP

Madra Guinn-Jones, MPH

Stephanie Domain, MS

Competing Interests

Re:the link between school attendance and good health.

As a Paediatrician who fully ascribes to the dictum that school non attendance is linked to long term life failure I acknowledge how crucial school attendance is. Furthermore I have my own aphorism which is that 'sick children go to school' - as evidenced by our patients with cancer, cystic fibrosis, JIA etc who are keen to go to school and whose parents are desperate to send them. School non attendance is more usually linked to factors such as separation anxiety, somatisation and at extremes embellishment and fabrication. there are often child and parental factors involved. School non attendance is therefore a manifestation of other underlying issues. School attendance per se seems to be crucial as even children who are successful academically function less well in society if they have not been to school. There is an unanswered question as to whether school absence is merely a symptom of wider dysfunction or an additional cause and exacerbating factor. The implication, and an orthodoxy which we believe, is that attending school is an important intervention by removing children from a somewhat negative home environment and exposing them to a more normal one in school including providing the skills required for social living. if school non attendance is predominantly a symptom of multiple other issues it is unlikely that increasing attendance alone will improve outcomes until the other cause are addressed

Ref; Understanding School Refusal A Handbook for Professionals in Education, Health and Social Care M. S. Thambirajah, Karen J. Grandison and Louise De-Hayes Jessica Kinsley publishers 2007

RE: The Link Between School Attendance and Good Health

Pediatricians and Pediatric Dentist should routinely tell the parents of their young patients that they are to return to school the same day before/after routine office visits. My experience in the school health office is that students may have an early morning or an afternoon appointment for annual/semi-annual check ups but keep the student out of school for the entire day.

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Why are schools so serious about attendance?

by: The GreatSchools Editorial Team | Updated: March 28, 2023

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Between terrible weather and life’s ups and downs, getting a child to school every day isn’t easy. In generations past, parents felt like it was their prerogative to take their children out of school — whether to tend to the farm or travel to see family. But that’s no longer the norm. American public schools have gotten serious about making sure students don’t skip school unless they’re sick.

Many parents feel that attendance in kindergarten or early elementary school is less important than in later grades, but the habits and values learned early are just as important as academic learning. Making the effort to get your child to school every day, on time , conveys the message that education is important to your family much more strongly than simply telling them “education is important!”

Avoiding negative labels like “truant” and “at risk”

If your child misses more than 15 days of school each year (including both excused and unexcused absences), they may be considered “chronically absent.” What does this mean for your child? It may alert your school that your child is “at risk” — for getting into trouble, getting poor grades, or even dropping out of school.

Even missing a few unexcused days, which means any absence that’s not health-related, such as car trouble, a parent’s work schedule, or a family trip, may compel the school to label your child “truant.” This may go on your child’s permanent record. If your child is identified as truant — even in elementary school — you and your child may be required to attend a hearing at the district to explain your child’s absence. In extreme cases of chronic truancy, parents can lose custody of their children or even go to jail!

The value of attendance for the school and the student

Why is attendance so important from the school’s perspective? School budgets may suffer when students don’t attend. In many states, school funding is based on the average daily attendance at a school. If many students enrolled at a school fail to consistently attend, the school has less money to pay for essential classroom needs.

But the focus on attendance is about a lot more than school budgets. Experts have found that school attendance — even in kindergarten — is a big predictor for a students’ school success. A 2019 report by physicians at Council on School Health published in Pediatrics states: “Chronic school absenteeism, starting as early as preschool and kindergarten, puts students at risk for poor school performance and school dropout.” An earlier 2008 study conducted by the Rodel Community Scholars at Arizona State University that tracked students from kindergarten through high school found that dropout patterns were linked with poor attendance, beginning in kindergarten. Gregory Hickman, director of the Rodel Community Scholars program and former director of the Arizona Dropout Initiative, notes they discovered that as early as kindergarten, attendance rates are different between those who go on to graduate and those who drop out. Dropouts missed an average of 124 days by eighth grade.

All of this research is just common sense. It’s difficult for the teacher and the class to build their skills and make progress together if even a few students are frequently absent. In addition to falling behind academically, students who are not in school on a regular basis are more likely to get into trouble with the law and cause problems in their communities. Even in the early grades, missing a lot of school can make students feel out-of-the-loop and like they don’t know what’s going on in class, which makes them even more reluctant to go to school. This is a vicious cycle: it’s much easier never to begin it than to fix the problem once it’s started.

Does this mean that you should force your child to go to school when they are sick or if they feel unsafe at school because of bullying or some other extreme scenario? Of course not. You know your child best. On the other hand, it’s important that your child go to school even when it’s inconvenient. Making sure your child gets to school — on time and ready to learn — will not only help their grades this year, it will help them succeed in years to come.

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Addressing Chronic Absenteeism: 4 Takeaways From Educators

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Helping students rebuild consistent attendance habits has become an urgent priority for schools as absences surge, and the problem is threatening academic recovery efforts.

Rates of chronic absenteeism , in which a student misses 10 percent or more of school days, have as much as doubled since the start of the COVID-19 pandemic, according to an analysis by Attendance Works, a research and advocacy organization.

Education Week asked educators on Facebook and Twitter to share the biggest hurdles to addressing chronic absenteeism in their schools. Here’s what they said:

1. There is no ‘“one size fits all’” solution

It’s difficult for schools to move the needle on absenteeism because it’s affected by a range of out-of-school issues, including family circumstances, educators said.

This Oakland teacher said there is no single solution.

That we don’t control that. Parents and caregivers do. And the reasons for chronic absence are as diverse as our families. There is no one size fits all solution. — Ayoka (@ayokayejide) June 6, 2023

Attendance researchers agree: The job of improving attendance can’t be restricted to one single school department because everyone from the bus driver to the principal affects students’ engagement in school, they say.

Recognizing that dynamic, some schools have adopted comprehensive attendance strategies that include data monitoring and working with families and communities.

At West Seaford Elementary School in Seaford, Del., educators developed a communications plan that includes discussing the importance of attendance with parents as soon as they register their children for kindergarten. Parents are also given “myth busters” fact sheets that dispel myths about attendance, like the persistent belief that absences don’t matter if students get good grades.

2. Overly punitive approaches don’t work

Teacher Alice C. said that schools need more resources to support the individual student needs that contribute to poor attendance.

The biggest challenges are “lack of supports/resources to provide trauma and other mental health responses and individualized, relevant curriculum...and a culture that blames parents and punishes children,” she commented on our Facebook post .

Researchers have backed up those concerns about parental blame. Authors of a report released in March by Policy Analysis for California Education analyzed language about attendance in handbooks and websites from 40 randomly selected middle schools and high schools throughout the state. They found that racially segregated and high-poverty schoolswere more likely to use punitive language, like threats of court appearances or detention for students who miss too much school.

Meanwhile, more diverse schools and schools with fewer students in poverty “tended to adopt communication styles treating parents as partners in promoting attendance and even as valued clients,” the report found. One school’s attendance page even listed contact information for attendance clerks alongside a photo of a smiling hotel concierge.

3. Students need personalized attention

Students need more ongoing support, teacher Carrie W. said.

Accountability and follow up. Whatever happened to truant officers? Maybe we bring them back in a more counselor-type role to help kids get to school, less LEO-like. Teachers do not have the time to track kids down & we need someone to report it to. — Carrie Weese (@washedupOBX) June 6, 2023

Facebook commenter Genevra V. agreed.

Schools “don’t have the capacity to sufficiently follow up and engage in family partnerships to reinforce attendance expectations and accountability,” she said. “Many of our families did not complete their own schooling past middle school and many of our secondary students have economic and family pressures to work, which sometimes conflict with school attendance.”

Unlike truancy, chronic absenteeism campaigns aim to help students avoid absences, including those that are excused for reasons like illness, rather than punishing them after they’ve crossed a legal threshold of poor attendance.

Schools can monitor absenteeism patterns early, paying special attention to students who’ve come close to missing 10 percent of school days at any point in the school year, Attendance Works has said.

And some schools have used that data to drive the individualized accountability Carrie W. suggested. Connecticut officials, for example, used $10 million in federal COVID-19 relief funds to create a home visiting program for students with poor attendance patterns . Rather than offering tough talk, trained educators assessed students’ needs, offering solutions like referrals to mental health care or helping families create routines that can calm students’ anxieties about returning to school.

4. Students need to feel welcomed and engaged

So what does work? We asked readers in an unscientific poll on Education Week’s Linkedin page .

Most readers, 37 percent, said their school had offered attendance awards. That beat out the three other options in our poll: making parent outreach plans, creating attendance teams, and fixing transportation issues.

“You can do all of the above, but not see a sustained improvement in attendance,” said Melody O., a teacher education officer at the University of North Dakota. “What you have to do: Build community right away in the early grades. Continue throughout middle and high school. Connect the work that students are doing in the class to their own lives, hopes, and dreams. Make sure each child knows his/her strengths and how they can use them to achieve their goals. No small task but it’s the only way to make a sustainable improvement in attendance because students will WANT to be in class.”

Other readers stressed building a sense of belonging and healthy school culture. And a few criticized those popular school attendance awards.

While some schools have found success with incentives for students to improve attendance habits, awards for perfect attendance have fallen out of favor in many areas.

Researchers say such awards send the wrong message. Even one excused absence removes students from the pool of eligible recipients and takes away the incentive to show up, Hedy Chang, executive director Attendance Works, told Education Week in December.

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