Problems in the classroom: Why lagging grades may warrant a visit with the pediatrician

  • If your child is struggling academically, your pediatrician may be able to help.

    If your child is struggling academically, your pediatrician may be able to help. Getty Images

By Laura Alessio
American Academy of Pediatrics
Posted9/29/2019 7:00 AM

When a child gets sick, a pediatrician diagnoses the illness and recommends treatment.

When a child is struggling academically, parents may not immediately think to turn to their pediatrician, but they can -- and they should.


Often, the problems behind a student's failure to succeed are complicated. Your child's doctor can help rule out possible causes behind lagging grades, which could include learning disabilities, emotional difficulties and disorders, adversity or trauma, stress, attention deficits, or physical illness.

"I've seen how miserable and hopeless kids feel when they're falling behind or failing at school," said Dr. Arthur Lavin, a pediatrician who worked on behalf of the American Academy of Pediatrics to research tools to help.

"Our goal is to use our resources as pediatricians to help identify why the child is struggling and provide realistic options to help them succeed in moving forward in their education."

Pediatricians already work with families to help children reach their full academic potential in many ways as they monitor a child's health and development. They may also screen for exposures to environmental toxins such as lead and counsel families about safety measures such as wearing bicycle helmets to prevent traumatic head injury.

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When academic problems arise, sometimes they can be addressed with a thorough medical history and interventions during a clinical visit. For example, undiagnosed or poorly controlled chronic illnesses such as asthma and diabetes are associated with worse academic performance. They can also affect sleep quality, creating further problems.

A pediatrician can work with families to create an action plan to help a child manage symptoms and function better at school. The doctor will consider the child's age, the time period over when the problems started and events in the child's life that might provide clues to the cause. For instance, low math grades may indicate a learning disorder, an altered mood or lack of focus.

Often, academic struggles are a symptom of more complex issues such as various types and combinations of behavioral, psychological, and learning difficulties. Chronic medical problems may also play a role.

Some students will need to be evaluated for conditions that require help from specialists, such as child psychologists, neuropsychologists, speech and language pathologists, occupational therapists, physical therapists, developmental-behavioral pediatricians, child neurologists, and child psychiatrists.


Pediatricians can also help families request and advocate for the best Individualized Education Program or 504 for the child, ensuring access to resources they need.

"It may seem like an easy option to hold the child back and have them repeat a grade to help them 'catch up' academically, but this can leave children feeling disconnected from school and do more harm than good in the long run," said Dr. Laura McGuinn, also an AAP expert.

In 2016, about 1.9 percent of U.S. elementary through high school students stayed in the same grade they were enrolled in the prior school year, but this percentage has been declining.

"Evidence shows that children are most successful when they are supported to advance grade levels with their peers while we sort out and address possible causes for their academic struggles," McGuinn said. Repeating a grade, also known as grade retention, has not been shown to help children learn.

In fact, it may contribute to a poor self-esteem, emotional or social difficulties.

"By working together with the family, the school, and other providers in the child's medical home, we can build a plan to help children with complex academic struggles reach their full potential," she said.

For more information on child health, visit

• Children's health is an ongoing series. This article is courtesy of the American Academy of Pediatrics in Itasca.

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