Fort Worth, Texas,
14:31 PM

Roll call: a pediatrician's thoughts on perfect attendance policies

Justin Smith, M.D.It’s coming up on that time of year again. Spring break is here, next comes school assemblies leading up to the end of the school year.

It’s that inevitable time of year where I see news story after news story where children are rewarded Oprah-style for their awesome record of perfect attendance:

“You get a bike and you get a bike and you get a bike.”

Yeah!!  It’s pretty heart-warming and exciting, right?

There are kids (and families) that blew their perfect attendance the first week of school and didn’t think twice about it, but there are some that are holding out hope that maybe this year will be their year to win the drawing for $100 or an iPad or a trip to Hawaii (I haven’t actually seen this one, but I want my kids to go to that school) or whatever their school dreams up.

I do have a question though. Is perfect attendance really the point?

You need to be at school to learn. I get that. Missing school for frivolous reasons is harmful to the student and the school. So incentives to get kids to school make sense from that standpoint. But, at what cost?

There is a tension going on right now in the minds of parents throughout our community. It might go something like this:

“He’s only coughing a little bit.  He did get a few hours sleep last night. His fever is only 101 and if I give him Tylenol® maybe he won’t have fever at school.”

Does this sound right?

Has this line of thought ever happened in your house?

Do you think it really happens at other houses?

I can assure you it does. Parents say something like this all the time, “Well, he was having fever last night, but I gave him some Motrin® this morning so he hopefully wouldn’t have one at school. But sure enough, he did and the nurse called me to pick him up.”

This clearly misunderstands the whole point of not wanting your child at school if he has fever. Not having fever is not the goal. Keeping your child away from others when they are sick is the goal. Whether your child’s fever is masked by medicine or not doesn’t make them less contagious.

What can we do about it?

What if we changed the goal from perfect attendance to responsible attendance?

Perfect attendance implies that you go to school no matter what.

Responsible attendance implies that you go to school when it is appropriate and don’t when it isn’t.

Perfect attendance puts your child’s classmates health at risk.

Responsible attendance puts your child’s and their classmate’s health above another goal.

I am an optimist, but not unrealistic. I’m pretty sure that we can’t change the school’s policies regarding perfect attendance awards.  Besides, how would you reward responsible attendance anyway?  But, we can make a decision to practice responsible attendance with our kids and teach them to do the same.

Get to know Justin Smith, M.D.

Justin Smith, M.D., is a pediatrician in Trophy Club  and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. Dr. Smith is an experienced keynote speaker for a variety of topics including pediatric/parenting topics, healthcare social media and physician leadership. If you are interested in having Dr. Smith present to your conference or meeting, please contact him at

He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” open now. Click to learn more. To make an appointment, call 817-347-8100.


Comments 1 - 3 (3)
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I think the problem starts well before school - this problem starts in the daycare setting. I've had quite a few of those days when your torn between keeping the sick child home and sending them to school or day care and hope for the best. Working families often have to deal with alternate care or taking an unscheduled day off. Too many unscheduled days off in a quarter or month can get you reprimanded at work and possibly fired. Not to mention the fact that you might have to take the day off without pay. It's a terrible conundrum.
I think this is more of a problem than people realize. My son has asthma and any cold or virus can make his asthma worse. Last year my son missed 13 days of school and had strep four times. Then I watched another boy whose mother told me her son had strep five times, get awarded a perfect attendance award. I could not but feel that at least some of my sons illness, medical expenses, and my time off from work was directly caused by parents like these who send ill and contagious kids to school.
I applaud your take on "responsible" attendance, both as a mother of a child with reactive airway disease and as a biologist. Keeping a sick child at home not only helps protect others' health, but also allows time for the ill child to recover. While this sounds like a win/win scenario, I recognize that a sick child may place a hardship on some working parents. Perhaps (affordable) sick-care options could alleviate this burden somewhat? But that's a topic for another day. Thank you for the timely reminder!