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School Avoidance in Children

School avoidance is relatively common in children and adolescents.  It occurs in about 1 in every 20 children at some point.  It is sometimes called school phobia, school anxiety, or school refusal as well.  These children may miss lots of school, often related to generalized, vague, or unexplainable symptoms including headache, stomachache, nausea, or dizziness.  They will rarely have symptoms that are visible or measurable, such as fevers, vomiting, or diarrhea.  

It is important for parents to realize that these are often true physical symptoms the child is experiencing as a result of anxiety.  The symptoms occur almost exclusively on school days and not on breaks or weekends.  The child may have difficulty explaining the symptoms as well.  Some common causes of school avoidance include fear of failing, being incorrect or making mistakes, stress over public restroom use, avoidance of teasing from other children, poor relationship with or perceived “mean” teacher, or threats of physical harm or actual physical harm/bullying.  


What can parents do? 

Firstly, see your pediatrician who can rule out other physical causes of the symptoms and help plan a return to school timeline.  They can also assist with follow-up appointments, notes for school, and referral or treatment for underlying anxiety.  

After this, the focus can turn to understanding the specific stresses or pressures affecting the child and getting them back in school.  

Talk to your child about why they do not want to go to school 

  • Consider and ask about all possibilities, be supportive and understanding. 
  • Start a plan to resolve any concerns that arise from this discussion. 

Set a return to school expectation immediately: Be understanding but firm in this regard. 

  • The longer the child stays home, the more difficult the return will be.  
  • Explain that they are healthy and the symptoms they are experiencing are from other causes, that will continue to be addressed.  
  • Make sure they understand that school is mandatory (including by law).  

Communicate with the school: Discuss the plan for return to school and enlist their support.  

  • This may include the child’s teacher(s), school nurse, and principal.  

Encourage activities with other children outside of school to help build relationships, independence, and confidence. 

Advocate for the child at school if symptoms are a result of bullying or a poor student teacher relationship.  Speak with the teachers, the principal, school counselors and come up with a plan to resolve any conflict.  


When to get more help? 

Ongoing symptoms and refusal lasting more than 1 week or physical symptoms that are severe or disrupting daily activities such as eating or sleeping may require further assistance and follow up with your pediatrician. Further evaluation or referral to a behavioral specialist may be warranted and helpful.  


References and Parent Resources: 

School Avoidance: Tips for Parents 

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