Takeaway
Frequent absence from school may reflect unmet health needs. Routinely asking about school attendance can allow clinicians to optimize care for younger patients.
Lifelong learning in clinical excellence | August 10, 2026 | 2 min read
By Catherine James, medical student, Imperial College London
“She’s been to the emergency department three times this semester for breathing problems,” a mother told the school health team. “Her ADHD medicine helps in school, but the nights are hard. We’re also behind on vaccines.”
This child is fictional, but the story is familiar. As a third-year medical student from the United Kingdom, I’ve learned to think about children’s health in hospital, school and home settings. Yet I hadn’t seen care embedded within a school in quite this way, built around the realities of children’s daily lives. It made me wonder how often school absence is the first visible sign that a child and family need more support.
Seeing school absence differently
Healthcare professionals are trained to notice vital signs. Temperature, pulse, breathing, and blood pressure help us see when something deeper may be happening. School attendance can function similarly. When a child is frequently absent, the question isn’t only, “Why aren’t they going?” It’s also, “What’s making school hard to access, tolerate, and/or sustain?”
Behind missed school days, clinicians may find uncontrolled asthma, anxiety, neurodevelopmental needs, trauma, bullying, adverse school experiences, food insecurity, housing instability, transportation barriers, and/or caregiving responsibilities. Absence isn’t usually defiance. More often, it’s data about a child’s health, relationships, and their environment.
Meeting people where they are
In West Baltimore, Maryland, the Rales Health Center, a Johns Hopkins Children’s Center program delivered in partnership with the public charter school, offers a different way to think about care. From a British perspective, where health and education systems are connected in principle but rarely integrated on a school campus, the model feels unfamiliar but deeply intuitive.
Health professionals, educators, behavioral health clinicians, family advocates, and community partners work together where children already spend much of their day. A child can receive preventive care, vaccines, medication management, behavioral health support, and family advocacy without a parent navigating multiple systems alone. What stands out isn’t only convenience for patients and families, but also the philosophy that children shouldn’t have to leave learning behind to receive care.
Here are five things I learned during my time at the Rales Center:
1. Ask about school attendance when symptoms are recurrent, hard to control, and/or affecting daily life.
2. Treat school absence as a clue, not a character flaw. Ask what’s getting in the way of attending.
3. Listen for barriers such as adverse school experiences, unmet health needs, transport, caregiving, housing, food, medication access, and parent work schedules.
4. Partner with schools, school nurses, school social workers, and community organizations when possible.
5. Advocate for care to move closer to patients, and for conditions that make school attendance possible for all children, rather than expecting families to overcome every barrier alone.
With thanks to Drs. Sara Johnson and Kate Connor and all the staff at Johns Hopkins Medicine and The Rales Health Center for this wonderful opportunity.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.