In this commentary, Paget and Emond note that school exclusion is not just an education issue, but is increasingly recognised as pertinent to child health, with implications for how education, health, social care, and voluntary sector services should interact to support children at risk in a holistic, integrated manner. Children who are excluded from school due to behavioural difficulties may have an underlying mental health or developmental condition which is unrecognised or inadequately supported, and the consequences of exclusion go further than a few days missed from school. This commentary aims to outline the risk factors for school exclusion, to explore the role of community child health services in supporting schools to avoid exclusions that have a basis in health and suggests a potential care pathway by which this may occur. Although exclusion is clearly a cross-disciplinary issue, Paget and Emond desire to clarify the role of the Paediatrician for those in other sectors who may have less experience of what medical services can offer in such situations.