Early Matters: Site Level Practices

Offer Supports to Reduce-Health Related Absences

Research conducted in Chicago found that preschool families report that over 60 percent of their children’s absences are health-related. During the transition to kindergarten, preschools and schools are in a unique position to provide students and their families with information and access to services that help children stay healthy throughout the year. These guidelines, Health Services to Promote Attendance, by the Office for Head Start shares strategies that programs, teachers and schools can use to avoid health-related absences.

These efforts are even stronger when schools and early education programs partner with health providers in the community as well as what is already available in school or districts. The Attendance Works Making the Case statement for health providers as well as the publication of the position statement on school attendance by the American Academy of Pediatrics, The Link Between School Attendance and Good Health, published in February 2019, are excellent resources for enlisting health providers in preventing health related absences.

Ideas and Resources

These ideas and resources can be used by schools, preschools, and communities to educate families during the transition to kindergarten about how they prevent health-related absences.


Integrate comprehensive health information into the school enrollment process. This includes mandatory health forms, locations and contact information for nearby health providers, information on how to access free or low-cost insurance and finding a medical home as well as tips for parents and caregivers to keep their students healthy as they transition into school. Ensure school clerks and secretaries are aware of health requirements for school enrollment, such as immunizations, and how families can access the services they need for their students to meet them.

Collaborate with health providers to offer onsite screening and services, such as dental and eye exams or immunizations, to prevent and address health conditions early in the school year before they affect students’ attendance and school performance. The Healthy Schools Campaign Toolkit for Action, Addressing the Health-Related Causes of Chronic Absenteeism, includes a section on key partners in the health and public health sectors.

Prevent unnecessary absences through encouragement of basic hygiene practices that prevent acute illness. Especially when young children first enter group settings, they may not be aware of what they should be doing to prevent the spread of illness, such as handwashing or sneezing into your elbow, etc. During transition, educators can both model these practices and remind students to use them during daily classroom interactions, orientation and/or back-to-school assemblies, or loudspeaker announcements.

Improve attendance through the promotion of asthma-free classroom environments. In the United States, 1 out of 12 children has asthma — and it’s a leading cause of school absenteeism, causing more than 13 million missed days of school every year. The transition into a new school is a perfect time to ensure that the classroom and the home environments are free of asthma triggers. The American Lung Association has produced Back to School Asthma Toolkit and the Center for Disease Control has compiled these resources. The Healthy Homes Initiatives sponsored by the U.S. Department of Housing and Urban Development offers supports for addressing problematic environmental conditions in homes.

Address attendance as part of transition plans for incoming kindergartners with known chronic health condition. According to this brief from the National Association for School Nurses, federal law, especially related to students with disabilities, requires coordinated transition planning for students with chronic health conditions to ensure they have equal access to a school experience. Transition planning can include school tours for families before school starts to introduce them to health staff and teachers. Plans should ensure school health staff and teachers are aware of students’ health needs. Don’t forget to explicitly include strategies for ensuring excellent attendance as part of the transition plan.

Provide local health providers with flyers, videos, or other materials on the importance of avoiding health-related absences for use in waiting rooms of doctor’s office and school clinics. Consider using the How Sick is Too Sick flyer from Attendance Works, which offers guidance on when to send children to school or keep them home due to illness.

Use data on chronic absence from preschool and kindergarten to identify where to target health and trauma related supports. High levels of chronic absence can be associated with chronic illness such as asthma or diabetes, or a lack of access to health services. See the Healthy Schools Campaign’s Toolkit for Action, Addressing the Health-Related Causes of Chronic Absenteeism for more information. In addition, research shows that chronic absence is associated with greater exposure to trauma, which can elevate the incidence of other health concerns. The National Association for the Education of Young Children has published an article about creating trauma-sensitive classrooms.

Ensure children experiencing attendance challenges in preschool or kindergarten have received health screening. Chronic absence could be a sign that a child has undiagnosed health issues or developmental delays. Early identification of developmental delays and health concerns can help to ensure a child gets the supports and services they need. As described in this guidance from the U.S. Department of Health and Human Services, screening is a key part of children’s overall health care.

Inspiring Examples

Click here to read how schools, preschools, and communities have taken action to prevent health-related absences during the transition to kindergarten.

Explore Early Matters: Integrating Attendance Into Kindergarten Transition Toolkit