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Role of paediatricians in supporting children’s school attendance - position statement

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Education is a fundamental right that drives personal, social and economic growth. For many children and young people this is delivered through attending school. Regular school attendance supports a child’s education as well as the holistic development of children and young people, empowering them to reach their full potential. However, an increasing number of children and young people across the UK are missing school with the reasons complex and multifaceted.

This position statement seeks to start the conversation on how paediatricians and governments can support children to achieve their education.
Last modified
4 March 2026
Post date
4 March 2026
Table of contents
Contents

Purpose

  1. Detail how paediatricians can support children and families with school attendance
  2. Outline the importance of education and the impact of persistent school absence

See our quick read report or download at the bottom of this page. 

Introduction

Education is a fundamental right that drives personal, social and economic growth. Education supports the holistic development of children and young people and empowering them to reach their full potential. For many children, this is experienced through attending school from the ages of 5 to 16.

Beyond the numerous educational opportunities, school can provide children and young people with a chance for social and emotional development, nutritious meals, physical activity and extra curriculum opportunities. The school environment also has a pivotal role in identifying vulnerable children, providing the setting for children to access health surveillance, vaccinations, support and advice, as well as individual and group therapeutic programmes where available.

The long-lasting benefits of school attendance on an individual’s physical and emotional wellbeing, as well as employability and future participation in society, have been well documented. Equally, studies have detailed the negative impacts of school absence on both short-term school attainment and long-term educational and labour market outcomes.

UK legislation dictates that children must receive an education between the ages of 5 and 16. The majority of children across the UK will attend maintained/state-funded education, with a smaller number attending specialist settings, private schools or elective home education.

Since the COVID-19 pandemic an increasing number of children and young people have been reported as missing school. This has given rise to persistent (chronic) school absence, defined as children missing more than 10% of sessions a year.

The increase in persistent school absence is driven by a complex interplay of factors drawn from social, economic, and health-related influences. In recent months paediatricians, governments and children alike have approached RCPCH for guidance and support on how to mitigate the health-related influences on persistent school absence and support children in education more widely.

This statement seeks to start that conversation.

What does the data tell us about persistent school absence?

Since the COVID-19 pandemic, persistent school absence has become an increasingly common challenge for all four nations. The reasons behind persistent absence are complex and multi-faceted. Reasons can range from emotional, mental or physical health unmet needs to social factors such as families in crisis and the impact of poverty.

Persistent school absence varies across the nations, as does data quality and transparency. From available data we can determine persistent school absence significantly increased post-COVID and despite progress in the last few years, has not returned to pre-COVID levels.

Persistent school absence also varies by age as seen in all four nations and by school type, with pupils in special schools having the highest levels of persistent absence. For those eligible for Free School Meals (FSM) persistent absence is significantly higher, in some cases almost doubling.

England

Across the academic year 2024/25, 18.7% of children enrolled in state-funded schools in England missed 10% or more sessions.1 This remains higher than pre-pandemic rates, 10.8% in 2016/17.2

By school type, the persistent absence rate across the academic year 2024/25 was:

  • 13.5% in state-funded primary schools
  • 24.3% in state-funded secondary schools
  • 35.8% in state-funded special schools

Wales

The percentage of children persistently absent has nearly doubled between 2018/19 and 2024/25, rising from 14.7% to 26.9%. However, progress has been made to reduce persistent absence, with rates dropping from 30% as recorded in 2023/24.3

The percentage of children persistently absent greatly differs based on age. Year 1 pupils have the highest rates of persistent absence in primary, with 23.2% of pupils persistently absent during 2024/25.4 Whereas Year 11 pupils have the highest rates of persistent absence in secondary school, with 40.2% of pupils persistently absent during 2024/25, 2.6 times its 2018/19 percentage.5

Nearly half (49.7%) of pupils eligible for Free School Meals (FSM) were persistently absent in 2024/25, compared to 21.6% of pupils not eligible for FSM.6

Scotland

The overall persistent absence rate for 2024/25 was 28.5%.7

This is a decrease in persistent absence compared to the previous academic years of 2023/24 (31.4%) and 2022/23 (32.5%). However, the rate of persistent absence remains higher than in the period from 2010/11 to 2020/21 when it ranged between 19.1% and 21.8%.

Persistent absence in 2024/25 was highest in secondary at 37.4% and lowest in primary at 21.1%. Among local authorities, the rate of persistent absence varied from 18.3% in East Renfrewshire to 35.8% in Glasgow City.7

Northern Ireland

Terminology note: School attendance in Northern Ireland is described through a tiered approach. What has been called ‘persistent absence’ up to this point in the statement would be chronic absence (Tier 2), missing 10-19.9% of sessions, with an additional field of severe chronic (Tier 3), missing 20% or more. The Department of Education also has a Tier (1b) for at risk children who miss 5-9.9% of school.8

The Northern Ireland Department of Education confirmed that 82,500 children were persistently absent during the 2024/25 academic year. However, this is 16,000 fewer pupils than at the same time in the previous academic year.9

By school type, the persistent absence rate across the academic year 2024/25 was:

  • Primary school: 14.3% chronic, 4.9% severe chronic
  • Non-Grammar: 22.8% chronic, 15.6% severe chronic
  • Grammar: 13.9% chronic, 4.5% severe chronic
  • Post-primary school: 19.1% chronic, 10.9% severe chronic
  • Special: 22.2% chronic, 16.9% severe chronic

Chronic and severe chronic absence was higher for those in the top FSM entitlement band compared to the lowest. This ranged from 10% of children chronic or severe chronic in the lowest FSM band to 38.6% in the highest for primary schools and 15.4% to 30% in post-primary.10

Role of paediatricians

Supporting children to get the best out of life is everyone’s responsibility. As paediatricians, we have a role to play in supporting children’s health and wellbeing, achieving Article 24 of the United Nations Convention on the Rights of the Child (UNCRC), and in doing so ensuring we are not inadvertently competing against any other right, including the right to education (Article 28).

There are many drivers of school absence; some more within our control to address than others. Below, we highlight three areas where paediatricians can support children’s health and contribute positively to their school experience.

  • Smart scheduling: Missing school is sometimes unavoidable, but before scheduling appointments, consider if this will impact a child’s school attendance and if this could be avoided.
  • Use attendance as a wellbeing indicator: Paediatricians should help their patients set their own attendance target, support them to achieve this and use attendance as a wellbeing indicator on consecutive appointments, when appropriate.
  • Advocate for change: There are factors that can be addressed by paediatricians on an individual level, but others require local influencing or whole system change. As a trusted voice paediatricians can play a vital role in informing these discussions and advocating for change.

Smart scheduling

Many children and young people shared they often feel they must make compromises between health and education needs, which meant sacrificing one for the other.11

While paediatricians, the wider child health workforce and service providers do try to schedule appointments to accommodate a child’s education and avoid “Was not Brought” appointments, last year in England alone over 4 million school days were missed due to medical appointments.12 The data further shows that when a child has a medical appointment on a school day, half of them will miss a full day of school.

Where appropriate we should reflect on how our own appointment practices support children’s health while maximising the school day. RCPCH recently published a joint statement with the Royal College of Nursing, Supporting school attendance, posing questions for health practitioners to consider when arranging appointments.

  1. Can appointments or clinics be delivered directly in education settings where we’re supporting multiple children? For example, asthma clinics in schools.
  2. Could a virtual consultation work as effectively, and is this possible to facilitate?
  3. How can we support clustering of appointments to avoid multiple days off for a child to access healthcare?
  4. And while we endeavour to offer appointments at the start or end of the day, where this isn’t possible, can appointment letters include advice to parents (when appropriate) that their child can attend school before and after their visit if they are well enough, and that they can attend the appointment in their school uniform?

Adding to this, while many appointments will unavoidably be during school time due to working hours, asking the child and family if they have a preferred time could benefit both the child and health practitioner. Examples of this are seen in NHS Tayside where they facilitated patient focussed booking for all general paediatric appointments. A letter is sent to families allowing them to choose an appointment that suits them. This ensures they have the opportunity to avoid missing subjects they value most and minimising the psychological impact of missing these subjects as well as minimising the impact on family schedules and routines.

Location and frequency should also be considered. For children needing access to health services, it’s often the case they will need multiple appointments with multiple professionals. A single child may require care from a paediatrician, GP, nurse, physiotherapist and speech and language therapist, to name a few. To minimise the need for children to miss multiple school sessions for multiple appointments, paediatricians and the wider child health workforce should consider if joint or multidisciplinary appointments are possible, where the appointments are held and the frequency of these appointments.

Attendance as a wellbeing indicator

The benefits of school attendance on a child’s physical and emotional development, attainment and life opportunities have been well documented.

Research has highlighted one day of absence for persistently absent pupils was associated with a £650 future earnings loss (2024 prices, present value discounted terms).13 With further research detailing the likelihood of being in receipt of benefits increases by 2.7 times for pupils who are classified as persistently absent.14 This suggests persistent absenteeism is a vital sign that could benefit from closer monitoring and management.

Paediatricians frequently have person-centred conversations with children and their families around what they would like to achieve and support them in setting and achieving these goals. When suitable this could include setting a personal attendance target, one that can be discussed in consecutive appointments and used as an overall wellbeing indicator.
The intertwined nature of health and education means that striving to improve attendance could greatly benefit a child’s overall development and as research suggests, life opportunities. However, this must be a personalised target.

Children, young people and families have shared their frustration in being expected to meet a standardised school attendance target despite their ill-health, long term health conditions (LTHCs) or health requirements.

Research has shown the emphasis on standardised attendance targets and the use of incentive and rewards systems used in schools often leave children and young people with LTHCs feeling marginalised, misunderstood, not recognised for the difficulties they face, and further excluded from the school community. Some also reported being actively disciplined or cautioned for having low attendance, chastised in class for missing work, or prevented from progressing to the next phase of education.15

Child of the North, the Centre for Young Lives and N8 Research Partnership stipulate that the one-size-fits-all and often punitive approach to tackle absence needs to be consigned to the past. A holistic, place-based approach focused on identifying the reasons why children are missing school, and then devising tailored support and interventions should be adopted.16

By paediatricians supporting and advocating for a child’s individualised attendance target this allows the child and family to destigmatise the generic target, identify barriers and hopefully celebrate successes in raising their attendance levels, whether that be from 30% to 35% or above 90%.

In addition, by using attendance as a wellbeing indicator it not only empowers the child to take control of their own attendance by setting their own target, but it allows systems to identify trends and patterns. For example, if children with a specific LTHC were struggling to improve their attendance this could alert health providers and/or schools that there’s a need to better facilitate the needs of children with that LTHC, leading to increased awareness, training and a more inclusive environment.

Advocate for change

Supporting children to get the best out of life is everyone’s responsibility.

Collaboration, multi-profession and multi-agency working is well recognised for enhancing communication, delivering individual holistic care and often improved outcomes. This is as true for improving school attendance as it is for improving patient outcomes.

Many professions can have a role in advocating with, and on behalf of children, young people and their families, and helping to identify the root causes of absenteeism - whether due to ill-health, family circumstances, or other factors.

Attending school for a child with a LTHC, mental health condition or learning disability can be challenging. It may also not be appropriate in a traditional setting as they could require additional support. However, when a child wants to engage in education, and fulfil all their rights under the UNCRC, any barriers facing them to achieve this should be removed and impact mitigated.

We’re aware that waiting lists for a variety of services, in particular, community and neurodevelopmental assessments, are extensive. RCPCH has been campaigning to improve timely access to services and are asking governments and the Northern Ireland Executive to put measures in place to achieve this. However, the current reality is extensive wait lists means children are being left behind. RCPCH is advocating for change and asking for measures to be put in place to mitigate the impact on children, young people and their families. This includes the importance of ensuring that while a child is waiting for a diagnosis or treatment the impact on their lives is minimised.

With an expert voice, paediatricians can support children, young people and families by identifying barriers to attendance, advocating for specific support or arrangements, and working with schools to ensure a child can reach their full potential. With a child and parent’s consent, and when appropriate, this may take the form of engaging in a conversation with teaching staff to discuss an illnesses manifestation, potential neurodevelopmental needs and how best to mitigate its impact on a child’s school experience.

More generally, paediatricians need to have a voice in advocating for the expansion of existing supportive systems as well as the introduction and implementation of policies, funding and action that support attendance and mitigating the impact of missing education on children’s health and wellbeing. Linking up with existing projects, whether local, regional or national, could greatly benefit children’s ability to receive an education by ensuring the environment is suitable and families aware of existing support. This may include local action to ensure schools have a positive environment or advocating for additional resources for school nurses.

On a national level, paediatricians can support campaigns to address the root causes of persistent school absence such as action to reduce poverty and be involved in discussions around online schooling, hospital education and the resources needed to ensure we are delivering on a child’s right to education.

RCPCH has examples of how to advocate on topics such as health inequalities and climate change. These principles can help guide you in advocating for children in education settings.

Role of policymakers

Education and health are devolved with the direction being set by governments in Scotland, England and Wales and the Northern Ireland Executive. Education provision is predominately delivered by Local Authorities, with practicalities and structures differing between nations. We are calling on the governments, the Northern Ireland Executive and education providers to:

  • Adopt a support first approach to school attendance: Children should be supported to attend school with the knowledge and confidence that the environment is suitable for them and their right to education upheld
  • Support enhanced data collection: Enable coding that allows for a child’s physical or mental health to be recorded as an authorised school absence and establish mechanisms for this to be recorded on a national level to identify patterns and trends
  • Address the wider determinants of persistent school absence: Attending school and receiving an education should be the easiest option. To make this the case for all children wider support is needed to mitigate the impact of poverty and increase additional learning needs provision
  • Improve communication between health and education: Co-develop initiatives, resources, interventions and strategies with schools, health services and local authorities with the child’s long-term health and wellbeing at the centre

Role of RCPCH

When RCPCH was established in 1996, its mission was to lead the way in children’s health. The College remains committed to improving child health in its broadest sense. This includes ensuring children have an environment that enables them to get the best start in life and achieve their full potential. The intertwined nature of health and education requires RCPCH to support discussions on how to improve the current climate to enable children to live happy, healthy and fulfilling lives. 

  • We will advocate for improved communication between health, education and social services.
  • We will continue to call on all UK governments to follow Scotland’s lead and embed the UNCRC in legislation to support children’s right to a happy, healthy and safe life.
  • We will maintain awareness and, in collaboration with children and their families, identify how RCPCH can support the workforce in championing inclusive education.
  • We will continue to campaign for action to reduce waiting lists and advocate for measures to be put in place to mitigate the impact on children, young people and their families. 

Additional resources