School success for kids with chronic illness

Children with a chronic health condition perform below the basic academic requirements in literacy and numeracy compared to their peers, a study from UNSW Sydney and University of Sydney has found.

Reporting the findings in Archives of Disease in Childhood, the researchers note that one in every 10 kids under the age of 14 live with a chronic health condition. These conditions – which can include heart disease, diabetes and asthma – affect many areas of a child’s life and, in some cases, can lead to hospitalisations that last days, weeks or even months.

Research shows that over the last two decades, the number of children living with chronic conditions has increased two-fold, mostly due to improved treatments enabling severely ill children to live longer.

The big data study of more than 397 000 children in New South Wales used data from Australia’s standardised school assessment NAPLAN (National Assessment Program – Literacy and Numeracy) to find out just how much children hospitalised with chronic illness are falling behind.

‘We analysed data from a population-based cohort including all children born between 2000 and 2006 in New South Wales, Australia, using records routinely collected at birth, hospital inpatient admissions and [NAPLAN] in NSW,’ the authors write in the report.

‘We examined how frequency and duration of hospitalisations—proxy markers for condition severity—were associated with children’s literacy and numeracy outcomes at three school grades, compared with children who were not hospitalised. We also compared children hospitalised with a chronic condition to those hospitalised without any chronic conditions to explore whether educational outcomes are associated with chronic conditions among children who have ever been hospitalised.’

Among the children hospitalised with a chronic condition in this study, the most common diagnoses were asthma (33 per cent), chronic ear conditions (20 per cent) and other respiratory conditions such as sleep disorders (20 per cent).

The findings

The study found that children with a chronic condition have a 30–80 per cent increased risk of missing school due to recurrent hospitalisations for treatment of their health condition.

‘This can lead to chronic school absenteeism, which impacts children’s engagement in school learning and affects their motivation to succeed academically. Children with a chronic condition may also experience difficult peer relationships interfering with their normal development of socioemotional and cognitive competence that are vital for academic outcomes,’ the authors note in the report.

‘We found that children hospitalised only once or for one to two days had a 30-50 per cent increased risk of academic underperformance.’

‘We all knew this was happening, but the weight of the numbers is huge from a policy and practice perspective,’ co-senior author of the study Raghu Lingam said on the release of the findings. Lingham, a Professor in Paediatric Population Health at UNSW Medicine & Health and paediatrician at Sydney Children's Hospitals Network, added the data show there’s a need for additional support for students with chronic illnesses.

In this study, academic underperformance was identified as ‘below the national minimum standard’ in five literacy or numeracy domains using NAPLAN data at each grade – Grades 3, 5 and 7. The research team found that children hospitalised with a chronic condition were more likely to miss school on the day of testing, and, if they completed the tests, they underperformed in various literacy and numeracy domains compared to their peers who had not been hospitalised.

Children hospitalised with mental health or behavioural conditions also had a higher risk of poor academic performance compared with those hospitalised with other chronic conditions. These children accounted for 7-10 per cent of all admissions related to chronic conditions, but they had the highest odds of performing below national minimum standard across all domains at each grade.

Children hospitalised with cardiovascular or neurological conditions had the second highest odds of performing below standard across domains at each grade.

The need for early interventions

In their report, the authors cite evidence that shows appropriate medical action plans can improve the child’s quality of life and potentially minimise the impact of their illness on their academic outcomes, particularly those experiencing mental illnesses.

They say there is an urgent need for ‘integrated, potentially hospital-based, psychological and educational interventions for children requiring hospitalisation for mental health conditions’, given the risk for children with mental health or behaviourial conditions.

Commenting on the overall study findings, they add: ‘We showed children hospitalised with a chronic condition, especially those hospitalised more frequently or for longer, had an increased risk of poor academic performance across literacy and numeracy domains in both primary and secondary grades. These children need to be supported with novel, integrated health and educational interventions.’


Hu, N., Fardell, J., Wakefield, C. E., Marshall, G. M., Bell, J. C., Nassar, N., & Lingam, R. (2021). School academic performance of children hospitalised with a chronic condition. Archives of Disease in Childhood.