Original Research: Barriers to Return to School Following Pediatric Orthopedic Injury: A Parent Perspective

Introduction School absenteeism is associated with adverse academic and health outcomes in developing children and orthopedic injuries may contribute to prolonged school absences. However, barriers to return to school following pediatric orthopedic injuries remain poorly understood. The purpose of this study is to identify barriers contributing to delayed return to school following orthopedic injury and/or intervention. Materials and Methods Following IRB approval, a cross-sectional survey was administered to parents or guardians of school-age children (6-18 years) who experienced delayed return to school after physician clearance following acute orthopedic injury or intervention between September 2022 and August 2025. Surveys assessed demographics, injury and treatment characteristics, school accommodations, remote learning access, and parent- reported barriers to school reintegration. Descriptive statistics were calculated, and associations between demographic and clinical variables and prolonged school absences were analyzed. Results Forty patients were approached and all completed the survey. Patients missed an average of 32.8 days following injury. The most reported barriers to returning were inadequate school accommodations (63%) and parental concerns for student safety (58%). Schools without elevators were more likely to be seen as not wheelchair accessible (p=0.01). Recommendations to delay return originated from physicians in 53% of cases and school officials in 35%. Although 78% of students received remote learning, implementation was delayed by a mean of 16.5 days. Sixty percent of parents reported a lack of mobility assistance between classes. Approximately 25% of parents reported a negative impact on academic performance during the absence period while nearly 30% of parents saw decreased academic engagement. Despite these challenges, most students did not repeat a grade (95%) or require summer school (93%). Conclusion Delayed return to school after pediatric orthopedic injury is driven largely by school-based accessibility barriers and parental safety concerns rather than ongoing medical restriction. Earlier coordination among orthopedic providers, families, and schools may facilitate a timely return to school and reduce unnecessary absenteeism. Level of Evidence Level IV Case series Level of Evidence III Key Concepts 1. Delayed return to school after pediatric orthopedic injury is influenced by school accessibility barriers and parental safety concerns, in addition to medical factors. 2. Inadequate school accommodations, including limited accessibility and mobility support, are common barriers to timely school reintegration. 3. Remote learning helps maintain academic continuity but is often implemented after substantial delays following injury. 4. Early collaboration between orthopedic providers, families, and schools may facilitate safer and more timely return to school. 5. Improving school reintegration strategies may reduce unnecessary absenteeism and support academic and social recovery after pediatric orthopedic injury.