The sentence "She's missed a lot of school time," is familiar enough. A parent will say it in a worried way, not sure what the answer is. A teacher, though, is likely to use it to point out why a child is not doing very well in class. What is needed is a meeting of minds - an understanding by schools and local authorities of the burdens that some children carry, and a realisation by parents that what seems obvious to them might not be clear to an institution which runs on the assumption of regular attendance.
The National Association for the Education of Sick Children (NAESC) exists to promote this co-operation. The first essential, says the association, is to realise just how many children are involved. For example, one child in seven has asthma, one child in 650 under 15-years-old gets cancer, 20,000 have diabetes.
Add those recovering from physical injury, and with mental health problems, and at any time there are 100,000 children having hospital or home tuition. Eight to 12 pupils in any secondary school are likely to have significant gaps in basic skills caused by illness earlier in childhood.
Carolyn Skilling, executive director of NAESC, points out that many of these children will have lost time in small amounts over a long period:
"Mainstream schools sometimes take them for granted, but a child with asthma or cystic fibrosis can regularly lose half an hour each morning, and it adds up." These children need awareness, understanding and flexibility.
Awareness may mean a school simply realising who has a problem and when. Dr Skilling says: "If it could monitor the pattern of absence, the school might see if the child is missing the same lessons each week, and be able to give a bit of extra support." She believes this is something for each school's special needs co-ordinator to take notice of and has produced a training pack for them. She strongly believes that children missing school through persistent sickness should come within the co-ordinator's remit. Such pupils "should be at level two of the Code of Practice - the point at which governors have to be kept informed. This rarely happens".
Heather Frost, who does outreach work for NAESC, points out that imaginative and early intervention can make things easier in the longer term. Simple solutions can help: the teacher could make a separate folder and keep photocopies of class worksheets, and keep some kind of record to help maintain continuity.
Children who are away from school usually long to be kept in touch with their friends. David Quince, a 14-year-old secondary school pupil in Bedfordshire, has strong opinions about this. Since 1998 David has had a harrowing series of operations and treatments, coupled with periods in a wheelchair, all handled with immense courage. He loves school, and makes a plea to all teachers whose pupils are away for a long time.
"You must see to the social side of their lives," he says. "I missed the atmosphere of being with mates. Perhaps they could do a letter once a week or there could be written messages on the homework."
Some authorities take the line that a child too ill to be at school is too ill for home tuition. Others take literally the guidance from the Department of Education and Employment which states that home tuition should start after four weeks, so that a child who is intermittently away for two or three weeks at a time never has home tuition.
Schools, authorities and parents have to talk to each other and come up with solutions, which may involve mixtures of part-time schooling, home tuition and school-supported homework.
Information and communications technology has a role. Monkseaton High School in Whitley Bay has computers available for long-term absentees - last year, sixth-form student Jenny Hall had a computer as she convalesced from a long illness. It helped her to stay organised when several pieces of work were in progress and essays were going to and from school with her home tutor.
"It's a lot easier," she says. "You don't lose anything, and you can produce as many copies as you need."
National Association for the Education of Sick Children18 Victoria Park Square, Bethnal Green, London E29PF. Tel: 01509 416160.
The NAESC's SENCO training pack 'Present' describes some illnesses and how they affect schooling. pound;25 plus pound;3 postage from the association.
Advisory Centre for Education 1b Aberdeen Studios, 22 Highbury Grove, London N5 2DQ. Tel: 0171 354 8318 (publications) 8321 (advice).
ACE publishes a fact sheet on the education of sick children and assisting with their recovery Department for Education and Employment Circulars 1294 the Education of Sick Children; 1496 Supporting Pupils with Medical Needs in School; 1199 Social Inclusion: Pupil Support.
Sick Children's Educational Network for Teachers (SCENT) e-mail forum run by British Educational Communications and Technology Agency (BECTA): terry_becta.org.uk