Children who refuse to go to school are at heightened risk of developing serious health problems because they are also missing medical checkups.

Some of these undetected ailments can become permanent disabilities later in life.

Although schools are required under law to conduct the health checks, there are no unified standards on what to do about children who rarely or never show up for them.

Some people are trying to change the system so that all children can get the care they need.

Mari Saikusa, 29, a graduate student in Kita-Kyushu who studies health problems of truant children, said she sometimes wakes up in the middle of the night with back pain.

Saikusa has moderate scoliosis, a curvature of the spine.

She has not undergone surgery because of the risks involved. Instead, she visits an orthopedic rehabilitation center several times a week. But she said this is only a stopgap measure.

Her doctor asked her several times: “Didn’t they tell you about it when you got your health checkups at school? Why didn’t you correct it then?”

Saikusa attended school only intermittently from third grade of elementary school through her third year of junior high school.

During that time, she received almost no medical checkups, and she was unaware that her spine was crooked. A school checkup would have detected the problem.

She now regrets her constant truancy.

“If I had noticed it when I was growing up and treated it with a corset, it wouldn’t be as crooked as it is now,” she said.

As a junior high school student, Saikusa went to a dentist because of a sudden toothache. All of her molars were full of cavities and had deteriorated to the point that the nerves of several teeth had to be removed.

“I saw on the internet that pulling the nerves would shorten the life of the teeth,” she said. “I also should have had a dental checkup.”

When she entered university, she conducted a survey on children to explore the extent of the problem of students missing school health checkups.

Of the 225 students who had a history of skipping class during their elementary and junior high school years, 84 said they “almost never” received a school medical checkup, and 61 said they “sometimes received it and sometimes did not.”

Twenty-six of the respondents said they “almost always” had the checkups.

Some students who did not receive checkups were unaware of that their vision was impaired.

“It’s hard to notice that when you live at home all the time,” Saikusa said.

The survey results were included in her graduation thesis and post-graduate papers.

In the reports, she said: “Children should not lose the opportunity to receive medical checkups just because they don’t attend school. Children’s medical checkups need to be flexible and not limited to the school setting.”

Saikusa noted that people on social media said parents, not schools, are at fault if their children miss school health checkups. She said the issue is not that black and white.

When she refused to go to school, she was essentially trying to survive on her own. Her parents were also too busy dealing with the school, taking care of other siblings, and working in the community to worry about school health checkups, she said.

“I want all children, including those who are truant, to be guaranteed the right to live a healthy life and to have access to medical care,” Saikusa said.

REQUIRED BY LAW

According to the education ministry, the number of elementary and junior high school students who refused to attend school in fiscal 2022 hit a record high of about 299,000, up by more than 20 percent from the previous year and the 10th straight year of increase.

School health checkups are required under the law regarding school health and safety. They are conducted by the end of June for each school year.

Health problems checked for in the examinations include: malnutrition; diseases of the spine and thorax; vision and hearing impairments; dental and oral diseases; tuberculosis; and heart diseases.

Under the law, if a student has not received a medical checkup due to illness or other reasons, the school will promptly conduct a checkup after the reason ceases to exist.

However, there are no unified school guidelines on following up on the health of such students. Some schools inform the students of the dates of checkups at neighboring schools. Others let them attend examinations for children in different grades.

In 2021, the municipal government of Suita in Osaka Prefecture established a uniform system to solve the problem in the city.

Under the system, children at municipal kindergartens and elementary and junior high schools can receive checkups at any of the 184 internal medicine clinics and 150 dental clinics in the city from July through the end of September.

According to Suita’s board of education, 782 elementary and junior high school students did not receive medical checkups during the last school year, and 1,093 missed the dental checkups.

Of them, 133 were examined individually by internal medicine specialists and 139 by dentists at off-campus institutions, the board said.

The annual budget allocated by the city for this project is about 500,000 yen ($3,430), the board said.

OUTSIDE HEALTH CHECKS

A Yokohama-based nonprofit organization called Tanpopo, which offers support to truant children, has been petitioning the city government to establish a system that allows truant children to freely receive checkups at medical institutions.

According to the Yokohama government, an estimated 8,000 elementary and junior high school students did not receive medical checkups and about 9,900 did not undergo dental checkups in fiscal 2023.

But with the exception of some schools, there is no system in place that allows these students to receive free health checkups outside of the school.

“This is clearly a major problem, and this is administrative inaction,” Momoki Ichinose, 70, director of Tanpopo, said in a report on the group’s activities in Osaka in July.

The Yokohama city’s board of education has begun discussions with a local medical association about the issue.

“The biggest bottleneck is that there are approximately 500 elementary and junior high schools in the city,” an education board official said.

The official said medical institutions in the city should develop a system to accept such truant children.

The education ministry’s health education and nutrition education division said it is aware that students have not received school health checkups, but it does not know how many.

“We believe that each school will take measures based on individual circumstances,” an official of the division said.