Kids With Chronic Health, Social Needs More Likely to Frequently Miss School

U.S. kids with chronic health needs and health-related social needs (HRSNs) were more likely to experience extended school absenteeism, a cross-sectional study indicated.

In a weighted sample representing more than 49 million kids ages 6 to 17, the estimated probability of elevated health-related school absenteeism — missing 11 or more days in the past year due to illness or injury — was 4.4% (adjusted odds ratio [aOR] 2.60, 95% CI 1.90-3.58) for kids with chronic health needs and 3.7% (aOR 2.14, 95% CI 1.57-2.92) for those with HRSNs compared to just 1.8% for those without either, reported Michelle Shankar, MD, of Children’s Hospital at Montefiore Einstein in New York City, and colleagues.

The estimated probability of chronic absenteeism was even higher at 9.4% (aOR 5.79, 95% CI 4.48-7.47) for kids with both chronic health needs and HRSNs, they reported in JAMA Pediatrics. The findings were also presented at the Pediatric Academic Societies annual meeting in Boston.

“Communities across the United States have seen unprecedented levels of chronic absenteeism in the aftermath of the COVID-19 pandemic, and this has not yet recovered to prepandemic levels,” Shankar told MedPage Today in an email. “Researchers and policymakers in health and education sectors are working to understand what is driving this in order to develop universal and targeted interventions to support school attendance.”

In an accompanying editorial, Genevieve Guyol, MD, of Boston Medical Center, and colleagues said the study “highlights important connections between health and school attendance, which is an important driver of child well-being.”

“Pediatricians can discuss barriers to school attendance with families and develop ways to screen formally for chronic absenteeism at pediatric visits,” they wrote. Pediatricians build close relationships with kids and families, so they may be well-suited for this kind of work, as well as behavioral health clinicians, the editorialists noted. “Community health workers may have an important role in liaising between the medical and school systems to help improve school attendance,” they added.

Shankar and colleagues used data from the 2022-2023 National Survey of Children’s Health. Their study sample consisted of 66,752 survey responses from kids representing 49.3 million U.S. children; mean age was 11.6 years, and 48.9% were female. Survey weights were used to generate national estimates.

Overall, the prevalence of elevated health-related school absenteeism in the study sample was 6.8%, representing an estimated 3.4 million kids.

Notably, 52.5% of the sample — representing an estimated 25.9 million kids — reported having both chronic health needs and HRSNs.

“While we expected to see associations between health needs, social needs, and missed days of school, what was striking to us was that over 50% of children in the nationally representative sample had both health and social needs,” Shankar said.

A child was considered to have chronic health needs either if they met criteria for children with special healthcare needs (CSHCN) or were reported to have at least one chronic health condition from a list of more than 20, Shankar and colleagues noted. CSHCN criteria focused on use of prescription medication; need for medical, mental health, or educational services; functional limitations; use of specialized therapies; and treatment or counseling for emotional or developmental problems.

The estimated probability of elevated health-related school absenteeism for the subset of kids meeting CSHCN criteria was 12.2% (aOR 2.89, 95% CI 2.57-3.25) compared to 4.6% for those who did not meet these criteria. There were especially strong associations for chronic pain (18.2% vs 5.7%), headaches (17.8% vs 6%), anxiety (14.8% vs 5.1%), and depression (18.7% vs 5.7%).

HRSNs included housing instability; food insecurity; and measures of family context, such as parent health needs; and exposure to adverse childhood experiences (ACEs). The estimated probability of chronic absenteeism was higher for the following compared with kids who were not experiencing these HRSNs:

• Housing instability: 10.3% (aOR 1.92, 1.66-2.23)
• Food insecurity: 10.2% (aOR 1.68, 1.30-2.18)
• Parent health needs: 8.2% (aOR 1.82, 1.59-2.08)
• No parent in the home: 8% (aOR 1.77, 1.31-2.39)

Estimated probabilities also increased by the number of ACE exposures kids had, reaching as high as 17% for kids who had four or more exposures.

Limitations of the study included that its cross-sectional design did not allow for causal inference, that caregiver-reported data may have been affected by recall bias, that data used to complete the study did not capture a standard 18-day chronic absenteeism threshold nor other reasons for absences that may be relevant to a child’s health, and that chronic health needs and HRSNs examined were not comprehensive.