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Being chronically absent from school is associated with a host of poor outcomes, which is why the American Academy of Pediatrics is urging doctors to talk to parents about school attendance. Some of the report's advice is surprising — send your children to school even if they have a cold or head lice.

SALT LAKE CITY — An itchy head or drippy nose used to guarantee a few days off from school.

But the American Academy of Pediatrics wants parents to know that children should be at school every day unless they have a really good reason — and even lice doesn't qualify as one. Neither does a cold, if it's not accompanied by a fever.

In a report issued Monday, the group urged the nation's pediatricians to talk to parents about their children's school attendance, saying that missed days in kindergarten can begin a pattern of poor attendance that follows the child through middle and high school, and ultimately affects the child as an adult.

Students who miss just two days in the first month of school are more likely to be chronically absent throughout the year, and frequent absences as early as sixth grade can predict which children drop out of school, the report said.

"Chronic absenteeism can be a better predictor of school failure than test scores," the authors wrote, warning that it only takes two or three absences each month to propel a child into the ranks of the chronically absent.

About 6.5 million children — about 13 percent of students — meet the criteria of being chronically absent by missing 15 or more days of school each year. It doesn't matter if the absence is excused or not, said Dr. Mandy Allison, a Colorado pediatrician and co-author of the report.

“All absences add up,” Allison said, adding that absenteeism isn't just an education problem, but also affects public health, since low levels of education are associated with risky behaviors in adolescence and poor health later in life.

That's why the group is urging pediatricians to start routinely asking parents and children about how many days the child has missed school in the past month.

“School attendance and how a child is doing in school is a really critical piece of evaluating a child’s development," Allison said.

Absent or truant?

Absenteeism is different from truancy, which is when a child purposefully misses school, sometimes without a parent's knowledge.

But it covers a wide range of absences, from excused absences (such as for a doctor's appointment, where the child gets a note to give to the school) to unexcused (such as a few days missed for a family trip). Days in suspension also count in the tally of absences.

Among young children, absenteeism is highest in kindergarten and first grade, with at least 10 percent of student missing a month or more of the school year. Rates of absences decline in middle school then climb again among teens.

High-school students have the highest rates of absenteeism nationwide, with nearly 20 percent missing school enough to be labeled chronically absent. But rates vary sharply by community.

“There are some schools where chronic absenteeism is close to 33 percent; others, where it’s very low,” Allison said.

" Sometimes people just don’t see that school matters. The family may not have a tradition of caring about school, or they simply may not see the absences adding up. "
Dr. Mandy Allison, a Colorado pediatrician

Some absences are necessary, such as when a child has a severe and contagious illness. The academy has guidelines for when children should stay home from school or day care; they include fever, diarrhea and vomiting.

"Of course, it's appropriate for a child to stay home if they are acutely ill," Allison said.

But many absences are preventable, the report notes. Pediatricians can help by reminding parents that it's OK to send their children to school when they're only mildly sick and aren't contagious, and urging them to return a child to school after a midday appointment.

Harder for pediatricians and educators to address are socioeconomic factors linked with absenteeism, which include unstable housing conditions, transportation difficulties, maltreatment, exposure to domestic violence, and being asked to care for younger family members.

In low-income families in particular, "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."

In cases like that, a pediatrician's influence may help, by making parents and caregivers aware that what seems like a few absences a month is a bigger concern than just the missed schoolwork, the report says.

“Sometimes people just don’t see that school matters. The family may not have a tradition of caring about school, or they simply may not see the absences adding up,” Allison said.

" As a parent, you do walk a line, and I’ve often said that public education gives not only your brain but your immune system a good education. Kids bring stuff home and they bring stuff back. "
Paul Wirkus, a pediatrician in Murray, Utah,

“A lot of people think a day here or there doesn’t matter. And that may be true for one month, but if it keeps happening month to month, that’s when it’s a problem. When you’re missing 10 percent (of school days) or more, you’re really missing out on a lot of instructional time,” she said.

Pediatricians and parents should also be aware of other factors that can contribute to a child's frequent absences, such as the possibility that the child is being bullied and may need interventions to feel safe at school again.

Heidi Matthews, president of the Utah Education Association, said she appreciates the academy’s involvement in absenteeism, which she calls “a serious concern.”

But Matthews added she’d like to see to see policymakers step forward with solutions to other factors that contribute to children staying home from school. For example, she said, “I would also like to see improvement in the type of support provided for working parents whose only option is to forego income in order to stay home with a sick child.”

When to keep a child home

In one study conducted in 2014 and 2015 in Philadelphia, researchers found that simply informing parents of their children’s absences from school reduced absenteeism, suggesting that increased awareness can help, the report said.

And physicians can help curb absences by reassuring parents that it's OK to send a child to school with a sniffle, said Dr. Paul Wirkus, a pediatrician in Murray, Utah, who is president of the Utah chapter of the American Academy of Pediatrics.

Wirkus said the average child contracts 6 to 10 respiratory illnesses each season, and symptoms can last up to two weeks. (By comparison, the average adult gets two to four colds a year.)

“As a parent, you do walk a line, and I’ve often said that public education gives not only your brain but your immune system a good education. Kids bring stuff home and they bring stuff back,” Wirkus said.

“Clearly if a child has a fever, they ought to stay home, but on the other hand, if you stayed home every day you’re congested, you’d never attend school.”

In addition to fever, vomiting or diarrhea, other good reasons to stay home include a rash, hacking cough, earache or toothache, according to the academy.

Additionally, up to 5 percent of children have school anxiety, which can cause symptoms such as headaches, stomachaches, hyperventilation, nausea or dizziness. Children who frequently report symptoms like these should be checked by a doctor to rule out other illness.

Matthews, a high-school media teacher in the Park City School District, said as much as teachers want students in their seats, children belong at home when they’re sick.

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“Teachers are masters of hand sanitizer and anti-bacterial wipes, but when a student attends school in poor health, it is not conducive to learning for the student, for the teacher or for other kids in the class," Matthews said.

And about those head lice, which once kept children home until every last nit was gone — that's no longer the rule.

Both the American Academy of Pediatrics and the National Association of School Nurses have called for an end to the "no-nit" policies of old. Children with head lice should be treated immediately, but they can return to school the next day, the latest guidelines say. Hairbrushes and combs, however, should definitely stay home.