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School Avoidance

My child seems afraid to go to school. Should I be concerned?

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.

School avoidance

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

What you can do

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 youngster is experiencing but also at getting him back in school.

Here are some guidelines for helping your child overcome this problem:

  • Talk with your child about the reasons why de does not want to go to school. Consider all the possibilities and state them. Be sympathetic, supportive, and understanding of why he 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 immediate return to school. The longer he stays home, the more difficult his eventual return will be. Explain that he is in good health and his physical symptoms are probably due to concerns he has expressed to you  perhaps about grades, homework, relationships with teachers, anxieties over social pressure or legitimate fears of violence at school. Let him know that school attendance is required by law. He will continue to exert some pressure upon you to let him stay home, but you must remain determined to get him back in school.
  • Discuss your child's school avoidance with the school staff, including his teacher, the principal and the school nurse. Share with them your plans for his 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 youngster how he feels. If he is well enough to be up and around the house, then he is well enough to attend school. Err on the side of sending your child to school. Once your youngster begins to attend school regularly, his physical symptoms will probably disappear.
  • If your child's anxieties are severe, he might benefit from a step-wise return to school. For example: On day one, he might get up in the morning and get dressed, and then you might drive him by the school so he can get some feel for it before you finally return home with him. On day two, he might go to school for just half a day, or for only a favorite class or two. On day three, he can finally return for a full day of school.
  • Your pediatrician might help ease your child's transition back to school by writing him a note verifying that he had some symptoms that kept him from attending school, but though the symptoms might persist, he is now able to return to class. This can keep your youngster from feeling embarrassed or humiliated.
  • Request help from the school staff for assistance with your child while he is at school. A school nurse or secretary can care for him if he becomes symptomatic, and encourage his 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 youngster 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 is safe and comfortable, but he should not receive any special treatment. His symptoms should be treated with consideration and understanding. If his complaints warrant it, he should stay in bed. However, his day should not be a holiday. There should be no special snacks and no visitors, and he should be supervised.
  • Your child may need to see a physician when he has to stay 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 youngster'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 school refusal persists, or if he 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, her unexplainable physical symptoms should motivate you to schedule a medical evaluation.

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.
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