Many more children and young people with inflammatory bowel disease (IBD) miss school or college classes compared with their IBD-free peers, an English study shows. The study found patients' main concerns are a limited access to toilets, a lack of understanding of IBD from teachers, and a generalized feeling of being unwell. Titled “Children and young people with inflammatory bowel disease attend less school than their healthy peers,” the study was published in the Archives of Disease in Childhood. Inflammatory bowel disease and its treatment demands can affect patients’ quality of life, including work, social activities, and schooling. Indeed, research indicates that children and adolescents with IBD miss class time more often than their healthy peers. "Some data suggest that health-related quality of life and education attainment are not always impaired in children with IBD if coping and support strategies are effective," the investigators said. Therefore, determining IBD’s impact on school or college attendance is essential to provide targeted support to young patients, their families, and schools. Now, researchers at the Southampton Children’s Hospital in the United Kingdom examined the extent to which IBD affects academic attendance and sought to determine the contributing factors for absences. In the U.K., all children's school attendance is noted as a percentage on a yearly academic report, enabling accurate and reliable collection of such data for analysis purposes. Investigators created a survey for children with these diseases to determine the school or college attendance rates in the last year, the reasons for absence related to IBD, facilitators or barriers to academic attendance, and current treatments. “All eligible patients [ages 5-17] and their families were invited to complete the questionnaire while attending hospital for clinic, day case or inpatient management,” the team said. Around 74% of the 231 distributed questionnaires — 151 in the hospital and 80 by mail — were completed. The final study sample included 169 participants, as two patients were excluded: one for being home-schooled, and the other for dropping out of school. Among the 169 students, 59 were girls and 110 were boys, with a mean age at diagnosis of 11.5 years. The median school or college attendance rate for those with IBD was found to be significantly lower than average attendance in England (92.5% versus 95.2%). Almost 40% of the surveyed students with IBD (39.6% versus 11.2% for all children in U.K.) missed 10% or more of class time, which the English Department for Education defines as persistent absenteeism. Importantly, only five children (3%) had an absence-free attendance record, and 45.6% (77 patients) missed more than three weeks of school. "Almost half (44%, 74 patients) of respondents reported that all their absences were due to IBD, 18% (30) reported ¾ or more absences due to IBD, 13% (22) reported 50%–74% absences due to IBD and the remainder (43) less than 50%," the researchers said. More than 81% of the students with IBD were receiving treatment as an intravenous (into-the-vein) infusion — mostly with Infliximab — and this was found to be a predictor of absenteeism, just like increasing age. When crossing data attendance from the Southampton Children’s Hospital with that from the subjects’ schools, the researchers found that the greater the number of days spent in the hospital, the poorer school attendance was. “Commonly reported factors impacting on school/college attendance included hospital appointments, feeling unwell and access to a toilet. Improved access to after school appointments, better teacher/school education [regarding IBD] and sending work home were all reported as facilitators to improve school attendance,” the researchers reported. Free text comments were included on 38% of questionnaires. In this section of the survey, and regarding strategic measures to improve school attendance, the patients and their families highlighted virtual learning, sending school work home, and having treatment appointments available after school as factors that would decrease absenteeism. Education on IBD from a nurse specialized in gastroenterology should be made available not only to young patients and their families but also to other professionals — like teachers, tutors or coaches — who have contact with these children on a daily basis, the researchers said. Improved awareness about the disease also would help teachers to better understand their students’ needs while they’re at school, the team said. That would aid teachers in finding ways to help their students overcome any challenges they might face during the school day. "Using strategies to minimise healthcare burden and provide more integrated care can directly impact service provision and facilitate school/college attendance for CYP [children and young people] with IBD," the researchers concluded.