Case Study

Promoting Texas Health Steps Checkups

“Chronic school absenteeism, starting as early as preschool and kindergarten, puts students at risk for poor school performance and school dropout, which in turn, put them at risk for unhealthy behaviors as adolescents and young adults as well as poor long-term health outcomes.”

American Academy of Pediatrics (AAP), 2019

Kegan’s mother called your office to cancel the boy’s 5-year Texas Health Steps preventive medical checkup because he is still sick with a respiratory infection a week after receiving treatment. Kegan will start kindergarten in the fall but does not attend preschool regularly because of repeated respiratory infections. Kegan and his mother live with extended family to help make ends meet and share child-care responsibilities. The checkup is pushed back for one week to give Kegan time to get well.

Kegan’s checkup will be an opportunity to provide screening, intervention, and guidance that promote school attendance and help avoid the pitfalls associated with absenteeism. You can address many common causes of absenteeism by completing all components of the Texas Health Steps medical checkup according to the Periodicity Schedule.

portrait of young boy
5 years

NOTE: Consult the Related Courses listed below to learn more about conducting Texas Health Steps medical checkups and the Periodicity Schedule.

The AAP’s 2019 policy statement, “The Link Between School Attendance and Good Health,” highlights the important connection between pediatric care and school attendance: “Pediatricians may play a role in addressing absenteeism attributable to a wide range of factors.”

  • Among elementary school students, absenteeism is highest in kindergarten and first grade, then decreases until middle school.
  • At least 10 percent of kindergarten and first-grade students miss a month or more of the school year.
  • Absenteeism usually increases again in middle school and high school, with an estimated 19 percent of high school students chronically absent.

Common health conditions that have been associated with school absenteeism include:

  • Influenza infection.
  • Group A streptococcal pharyngitis.
  • Gastroenteritis.
  • Fractures.
  • Poorly controlled asthma.
  • Type 1 diabetes mellitus.
  • Chronic fatigue.
  • Chronic pain (including headaches and abdominal pain).
  • Seizures.
  • Poor oral health and dental pain.
  • Obesity.

Although occasional health-related absences are expected, absences can quickly add up and lead to chronic absenteeism if a child experiences multiple health conditions, unrecognized or undertreated conditions, or lack of access to health care.

Pediatricians and other primary care providers caring for children in a medical setting have opportunities at the individual, family, clinical practice, and population levels to promote school attendance and reduce chronic absenteeism and resulting health disparities.

Source: AAP, 2019.

Texas Health Steps providers are encouraged to promote school attendance for all youth. The AAP recommends office-based interventions like the following:

Ask about attendance.

Make a plan with parents.

Educate and advocate.

Why It Matters

“The literature reveals that poor school performance is associated with poor adult health outcomes” (AAP, 2019). Texas Health Steps medical checkups include components that identify and address common risk factors for absenteeism, including family history, physical and mental health conditions, and traumatic experiences such as bullying.

Check out our related courses to learn more about the Texas Health Steps Periodicity Schedule and how to conduct and document all required components of Texas Health Steps medical checkups.

Related Courses


Allison, M. A.; Attisha, E., & the AAP Council on School Health. The Link Between School Attendance and Good Health. Pediatrics,143(2):e20183648.

About Texas Health Steps

Texas Health Steps’ award-winning online program offers FREE CE courses for primary care providers and other health professionals. These courses offer updated clinical, regulatory, and best practice guidelines for a range of preventive health, oral health, mental health, and case management topics.