Introduction Children with complex needs have greater rates of school absenteeism.

Our earlier audit, at a special needs school,in Camden,London, conducted between Sept 2013 and March 2014, identified 34 children with attendance of <85%. Medical reasons for absenteeism and ways of improvement were sought.

Unknown illness (16/34 47%), sleep difficulties (5/34 15%) and seizures (3/34 9%) were the main medical reasons for absenteeism. Unclear coding made further analysis difficult. Recommendations included: regular review of attendance record, improved coding of reasons for absenteeism and notification to school of pupils’ A+E attendances.

Aim To review whether the recommendations, resulted in improved attendance the following year, in the same cohort of children.

Method Retrospective case note analysis and school attendance register review from Sept 2014 to March 2015.

Results 3 pupils left the school and were excluded. 13/31 (42%) had attendance improved to >85%. 9/31 (29%) had attendance between 70%–85% and the rest <70%. The main diagnoses were learning difficulties (10/31 32%), epilepsy (9/31 29%), autism (7/31 23%) and cerebral palsy (5/31 15%). Illness again was the major reason for absenteeism (16/31 52%). Increased seizure frequency resulting in admission to PICU (6/16 39%), severe LRTIs (3/16 17%), viral illness (3/16 17%), low mood (2/ 16 11%) and liver transplant (1/16 6%) were the main identifiable illnesses. Sleep disturbance (7/31 23%), transport issues (2/ 31 6%) and others (6/31 19%), (unauthorised family holidays and parental anxiety to send their child to school with minor illness) were also noted.

Conclusion School attendance for the same cohort of children was better than previous year. It was easier to identify the exact reasons for absenteeism due to improved coding. The notification of A and E attendances in the notes was still poor although there was better access to clinic letters and electronic patient record system.

Increased seizure frequency and LRTI were the most frequent causes of illness.

Recommendations 1) Joint epilepsy clinics (multi-disciplinary team review) commenced to improve management of those with complex epilepsy.

2) Clinics with respiratory physician prior to the winter term, to review those with recurrent chest symptoms were commenced.

Routine influenza vaccination was introduced at the school in September 2015.