TOPLINE:

Children with chronic health needs or health-related social needs had a higher likelihood of missing 11 or more school days in a year due to health issues than their peers without these challenges.

METHODOLOGY:

• Researchers conducted a cross-sectional analysis of data from the 2022-2023 National Survey of Children’s Health, examining associations between chronic health conditions, health-related social needs, and health-related school absenteeism among children aged 6-17 years.
• More than 66,000 children (mean age, 11.6 years; 48.9% girls; 47.4% White individuals) were included, representing about 49 million US children.
• Children were classified as having chronic health needs if they had conditions lasting 12 months or longer that required prescription medication, above-average use or need of medical services, specialized therapies, or emotional or developmental care.
• The health-related social needs assessed were housing instability, food insecurity, parent health needs, and exposure to adverse childhood experiences.
• The primary outcome was health-related school absenteeism, defined as missing 11 or more days due to illness or injury in the past year, assessed through caregiver-reported survey data.

TAKEAWAY:

• The prevalence of elevated health-related school absenteeism was 6.8%. Those with chronic health needs had a probability of 4.4% elevated risk for missing school (95% CI, 3.6%-5.3%), while those with social needs had 3.7% and those with neither had 1.8% risk.
• Associations were strong for chronic pain, headaches, anxiety, and depression.
• Children with behavioral or conduct problems, those with attention-deficit or attention-deficit/hyperactivity disorders, and those with developmental and neurocognitive needs showed elevated probabilities of school absenteeism than children without these conditions.
• Children experiencing housing instability (10.3%), food insecurity (10.2%), and parent health needs (8.2%) had a higher likelihood of elevated health-related school absenteeism than those not experiencing these needs. The probabilities of absenteeism increased with greater exposure to adverse childhood experiences — from 4.2% (95% CI, 3.9%-4.6%) with no exposure to 17.0% (95% CI, 14.8%-19.3%) with four or more exposures.

IN PRACTICE:

“Integrating attendance monitoring into clinical care, strengthening cross-sector referral networks, and advancing collaborative models between health and education systems represent critical opportunities to reduce absenteeism and improve outcomes for children,” the authors wrote.

“We agree with the authors that this finding is highly relevant in the setting of the pediatric behavioral health crisis and that behavioral health supports should be integrated into programs and policies to reduce chronic absenteeism,” authors wrote in an accompanying editorial.

SOURCE:

The study was led by Michelle Shankar, MD, MHS, of the Children’s Hospital at Montefiore Einstein at Albert Einstein College of Medicine in New York City. It was published online on April 27, 2026, in JAMA Pediatrics.

LIMITATIONS:

The survey measure of school absenteeism did not align with the standard 18-day chronic absenteeism threshold and failed to account for other health-related reasons for absences. The survey did not account for other caregiver demands such as work schedules or child care needs that may influence school attendance.

DISCLOSURES:

One author disclosed receiving grants from Monaghan Medical Corporation, the Stony Wold-Herbert Fund, and the US National Institutes of Health/National Heart, Lung, and Blood Institute outside the submitted work, and another reported serving as a board member of The Los Angeles Trust for Children’s Health.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.