School avoidance – sometimes called school refusal or school phobia – is not uncommon and occurs in as many as 5% of children. These children may outright refuse to attend school or create reasons why they should not go.
They may miss a lot of school, complaining of not feeling well, with vague, unexplainable symptoms. Many of these children have anxiety-related symptoms over which they have no conscious control. Perhaps they have headaches, stomachaches, hyperventilation, nausea or dizziness. In general, more clear-cut symptoms like vomiting, diarrhea, fever or weight loss, which are likely to have a physical basis, are uncommon.
School refusal symptoms occur most often on school days, and are usually absent on weekends. When these children are examined by a doctor, no true illnesses are detected or diagnosed. However, since the type of symptoms these children complain of can be caused by a physical illness, a medical examination should usually be part of their evaluation.
Most often, school-avoiding children do not know precisely why they feel ill, and they may have difficulty communicating what is causing their discomfort or upset.
When school-related anxiety is causing school avoidance, the symptoms may be ways to communicate emotional struggle with issues like:
Fear of failure
Problems with other children (for instance, teasing because they are "fat" or "short")
Anxieties over toileting in a public bathroom
A perceived "meanness" of the teacher
Threats of physical harm (as from a school bully)
Actual physical harm
Tips for Concerned Parents:
As a first step, the management of school avoidance involves an examination by a doctor who can rule out physical illness and assist the parents in designing a plan of treatment. Once physical illness has been eliminated as a cause of the child's symptoms, the parents' efforts should be directed not only at understanding the pressures the child is experiencing but also at getting him or her back in school.
Here are some guidelines for helping your child overcome this problem:
Talk with your child about the reasons why he or she does not want to go to school. Consider all the possibilities and state them. Be sympathetic, supportive, and understanding of why he or she is upset. Try to resolve any stressful situations the two of you identify as causing his worries or symptoms.
Acknowledge that you understand your child's concerns, but insist on his or her immediate return to school. The longer your child stays home, the more difficult his or her eventual return will be. Explain that he or she is in good health and his or her physical symptoms are probably due to concerns other things – perhaps about grades, homework, relationships with teachers, anxieties over social pressure or legitimate fears of violence at school. Let your child know that school attendance is required by law. He or she will continue to exert some pressure upon you to stay home, but you must remain determined to get your child back in school.
Discuss your child's school avoidance with the school staff, including his or her teacher, the principal, and the school nurse. Share with them your plans for your child's return to school and enlist their support and assistance.
Make a commitment to be extra firm on school mornings, when children complain most about their symptoms. Keep discussions about physical symptoms or anxieties to a minimum. For example, do not ask your child how he or she feels. If he ior she is well enough to be up and around the house, then he or she is well enough to attend school.
If your child's anxieties are severe, he or she might benefit from a step-wise return to school. For example: On day one, he or she might get up in the morning and get dressed, and then you might drive him or her by the school so he or she can get some feel for it before you finally return home together. On day two, your child might go to school for just half a day, or for only a favorite class or two. On day three, your child can finally return for a full day of school.
Your pediatrician might help ease your child's transition back to school by writing a note verifying that he or she had some symptoms keeping him or her from attending school, but though the symptoms might persist, he or she is now able to return to class. This can keep your child from feeling embarrassed or humiliated.
Request help from the school staff for assistance with your child while he or she is at school. A school nurse or secretary can care for your child should he or she become symptomatic, and encourage his or her return to the classroom.
If a problem like a school bully or an unreasonable teacher is the cause of your child's anxiety, become an advocate for your child and discuss these problems with the school staff. The teacher or principal may need to make some adjustments to relieve the pressure on your child in the classroom or on the playground.
If your child stays home, be sure he or she is safe and comfortable, but do not give him or her any special treatment. Your child's symptoms should be treated with consideration and understanding. If your child's complaints warrant it, he or she should stay in bed. However, your child's day should not be a holiday. There should be no special snacks and no visitors, and he or she should be supervised.
Your child may need to see a doctor when he or she stays home because of a physical illness. Reasons to remain home might include not just complaints of discomfort but recognizable symptoms: a temperature greater than 101 degrees, vomiting, diarrhea, a rash, a hacking cough, an earache or a toothache.
Help your child develop independence by encouraging activities with other children outside the home. These can include clubs, sports activities, and overnights with friends.
When to Seek Help:
While you might try to manage school refusal on your own, if your child's school avoidance lasts more than one week, you and your child may need professional assistance to deal with it.
First, your child should be examined by your pediatrician. If his or her school refusal persists, or if he or she has chronic or intermittent signs of separation difficulties when going to school – in combination with physical symptoms that are interfering with her functioning – your doctor may recommend a consultation with a child psychiatrist or psychologist.
Even if your child denies having negative experiences at school or with other children, his or her unexplainable physical symptoms should motivate you to schedule a medical evaluation.
Additional Information & Resources: