Federico Marchetti, Giorgio Cozzi, Egidio Barbi
The recent rise in school absenteeism reflects something more than an educational concern. Indeed, it is an early indicator of child and adolescent vulnerability. Rather than being interpreted as misconduct, school absence should be understood as a possible sign of bio-psycho-social distress. Increasing mental health difficulties, neurodevelopmental disorders, socioeconomic disadvantage, bullying and family stress all contribute to what is more accurately described as “school distress” rather than simple refusal. School attendance may be considered a social determinant of health: regular attendance is associated with better physical, mental and social outcomes, whereas chronic absence predicts long-term educational and health inequalities. For the paediatric practice, monitoring school attendance may function as a practical ‘vital sign’ encouraging early, integrated and non-punitive interventions that involve healthcare professionals, families and schools.