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Health Issues

With the start of school, youngsters begin to regularly spend a consid­erable amount of time away from the family. This time brings new experi­ences and many personal challenges. Much of their time is spent at school—a place where pressures in the classroom and rela­tionships with other children can be quite stressful. While some youngsters naturally greet new situations with enthusiasm, oth­ers tend to retreat to the familiarity of their home. For some children, merely the specter of being at school away from home and apart from their parents causes great anxiety. Such children, especially when faced with situations they fear or with which they believe they cannot cope, may try to keep from returning to school.

This school avoidance—sometimes called school refusal or school phobia—is not uncommon and occurs in as many as 5 percent of children. These youngsters 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 youngsters do not know precisely why they feel ill, and they may have difficulty communicating what is causing their discomfort or upset. But 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

For some youngsters the school environ­ment can increase preexisting tension. For example, if children tend to be overly conscientious and expect excellent perfor­mances from themselves, their fear of fail­ure can gradually create overwhelming and paralyzing anxiety.

In some cases children have experienced the loss of a loved one through death, di­vorce, or moving to another locale. Espe­cially when they are young, they may fear that in their absence from home another loss will occur.

In addition to the school environment it­self, school avoidance may be related to a child's difficulty in separating from her par­ents and feeling safe while assuming more independence. These youngsters tend to be unsure of themselves and less indepen­dent than most of their peers. They may be less socially involved. They may be reluc­tant to go on overnight stays at friends' houses, preferring to be home with their own parents. Some children who have dis­abilities or chronic illnesses may struggle more with entry to school and being away from the shelter and care of home.

While the parents of these children are very loving and conscientious, they also may be somewhat overprotective. In some cases parents are depressed or physically ill and may unconsciously desire the com­pany of their children. The youngsters are often the only child in the family or are spe­cial in some other way—for example, they may be the first or the last child of a larger family.

As children approach adolescence, the incidence of school phobia decreases sig­nificantly; however, when it does develop in a preadolescent, it is of much greater concern. Phobic young adolescents often fear growing up. They also may be overwhelmed by stresses at home that shake their sense of security or personal confi­dence, leaving them even less able to face academic and social challenges.


Last Updated
Caring for Your School-Age Child: Ages 5 to 12 (Copyright © 2004 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.