Stakeholder perspectives on primary school pupils and sickness absence - exploring opportunities and challenges.

School absenteeism and its underlying causes can have negative effects on the cognitive, psychosocial and health development of a child. Research in primary education shows high rates of sickness absence. Many stakeholders are involved in addressing school absenteeism, including primary school professionals, child and youth healthcare physicians, school attendance officers and parents. This study explores these stakeholders' perspectives, their approaches and what they envisage to be necessary in order to improve. It also aims to unveil opportunities and challenges in addressing sickness absence among primary school pupils. Qualitative research was performed with six semi-structured focus group interviews and involving 27 participants from the West-Brabant and Amsterdam regions of the Netherlands. Thematic analysis was used. The overarching theme was aiming for the child's wellbeing. Each focus group interview started with low awareness of sickness absence as a threat to this wellbeing, but awareness grew during the interviews. The participating stakeholders regarded problematic sickness absence as complex due to a wide variety of causes, and felt that each other's expertise was necessary to reduce sickness absence. Schools registered absence, but only occasionally used planned steps; they based the identification of problematic sickness on gut feeling rather than any agreed-upon criteria. To be able to systematically address sickness absence and thus improve the wellbeing of children, stakeholders felt the need for a clearly structured approach, including monitoring of sickness absence of all pupils, identifying problematic absence and promoting collaboration with other stakeholders. An approach should allow for tailoring solutions to the individual child.

How to deal with sickness absence among primary school pupils? Adaptation of the "Medical Advice for Sick-reported Students" intervention.

Background: Missing school impacts both education and health. The purpose of this study was to address sickness absence in primary schools by adjusting the 'Medical Advice for Sick-reported Students' intervention for secondary schools. This was necessary because of fundamental differences in relation to the children's age and in the schools' organizational structure. Methods: The intervention mapping approach steps 1 through 4 were used to adapt 'Medical Advice for Sick-reported Students' to primary schools (MASS-PS), including a literature search, stakeholder interviews, establishing a planning group and pre-testing. Results: In step 1, a planning group was formed and a logic model of the problem was created. In step 2, a logic model of change was created. In step 3, a theoretical basis and practical strategies were determined. In step 4, practical support materials were designed, and two pre-tests of the materials were performed. Conclusion: Intervention mapping was successfully used to adapt MASS to primary schools. The main changes were the lowering of the threshold for extensive sickness absence, consultations between teacher and attendance coordinator, and addition of two experts. With MASS-PS, sickness absence can be addressed as a "red flag" for underlying problems.

[An infant with yellow spots in the mouth]. / Een zuigeling met gele plekjes in de mond.

A 3-days-old infant was seen with jaundice and yellow spots in the oral mucosa . The jaundice was treated with phototherapy, after which the lesions became white. The spots appeared on the mucosa of the lower lip; their diameter was approximately 1 mm. The diagnosis Fordyce's spots was made.