Q: He’s already missed the first hour of school for this check-up. Won’t you just sign the form saying he can go back to school tomorrow instead of today?
A: No, in general, I won’t. I like to make my patients and their parents happy. But there are some exceptions, where I hope to prevent them from asking me to make bad decisions for them. An example: “No, you won’t need an antibiotic for that cold.” And another, in this case: “No, I think your child is so healthy, she should be in her class.”
Unfortunately, appointments for school-aged children must often be made during school time, since we have only a few after the final bell of the afternoon. But that doesn’t mean that the rest of the day must be lost, nor that brothers and sisters of the child with an appointment need to miss school to come along. School is too important.
I asked an educator friend, Professor Ruth Luckasson of the UNM School of Education, what she felt the importance was of avoiding school absence. Here is her reply: “There are so many aspects to consider: keeping up with the academic content; maintaining the learning relationship between teacher and student; sustaining friendships; catching learning problems early; learning the discipline required to stick to a schedule; learning to keep one’s responsibilities; demonstrating one’s commitment so that others, for example, the teacher, are also motivated to fulfill their commitment; developing the ‘habits of mind’; keeping a schedule; learning to effectively deal with disruptions to routine; learning to organize oneself even when one’s schedule is disrupted by illness. All [of these are] important life skills and dispositions for effective human functioning.”
Luckasson referred me to a number of scientific studies that show the importance of avoiding absence, even in the earliest grades. For example, the National Center for Children in Poverty has published a fine monograph on the subject, “Present, Engaged, and Accounted For,” at nccp.org/publications/pub_837.html. The study shows that high school dropouts had 60 percent more absences in first grade than high school graduates. Every day of absence in first grade is associated with a 5 percent increase in risk of dropping out of school. Reading is also affected; children who miss more school than average have much lower reading scores than those who miss less than average. And that applies both to children in poverty and children who are well off.
The NCCP divides factors leading to school absenteeism into three categories: school-, community- and family-related, and suggests remedies for each. Schools may not pay as much attention to absences as they might, for example; having a means of identifying children missing many days of school early in the year means that a staff member can address the reasons with families, resulting in plans on getting children to school.
Communities can provide adequate preschool experiences that help children “make a positive transition to school.” Families can recognize the “adverse impact of chronic early absence and … develop routines that promote consistent school attendance.”
I believe that there are three categories of good reasons for missing days of school: being too sick to learn, being contagious, and having a disease that will be made worse by being in school. In the clinic where I work, the five physicians and two nurse practitioners altogether see one or two school-aged patients a month who are too sick to be able to learn anything in school. It just isn’t that common.
Of course not every class minute is golden — there’s some wasted time there, just as there is in our clinic — but it’s just not possible to determine when those less than golden minutes will be, when a child will be inspired to do something wonderful, and when a continuing theme will reach a critical linking moment. If you miss the Emancipation Proclamation, will you understand Lincoln’s role in ending the Civil War?
Young children with eye infections and with diarrhea can’t be relied upon to keep their hands out of their eyes or other places, so they should stay home, but that probably does not apply to older children. Children with ear or sinus infections are not contagious, and their pain will probably be worse at home when there’s nothing else to think about. Common colds are so very common that most educators believe it’s better to go to school with them. And there are very few diseases that are made worse by attendance at school, except possibly inadequate immune systems.
Physicians should convince parents that their children benefit by going to school whenever they don’t meet one of those criteria — contagiousness, being too wiped out to learn, or having that rare disease that will get worse there. We must realize that each day of absence contributes to worse educational outcomes, and that, as has been shown in numerous studies, you must be educated to be optimally healthy.
Lance Chilton, M.D., is a pediatrician at the Young Children’s Health Center in Albuquerque, associated with the University of New Mexico. Send questions to email@example.com.
— This article appeared on page C01 of the Albuquerque Journal