Advances in perinatal and paediatric medicine have led to an increase in children requiring ongoing medical care while living within their local communities. This study aimed to identify challenges in enabling children with medical needs to enrol in local schools and participate fully in school activities. A literature review was conducted, analysing 20 peer-reviewed academic papers published in Japan between 2015 and 2025. The results revealed that challenges concerning the enrolment and participation in school activities of children with medical needs can be categorised into the following five domains: diverse circumstances of children with medical needs, systems concerning enrolment and support, teachers’ expertise, parental burden, and coordination within and outside the school and shortage of nursing staff. These challenges are interrelated and suggest they may constrain school attendance and participation in local schools.