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School Refusal - Kids Who Don't Want to Go to School

School Age Children

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Updated June 02, 2014

Asian mother comforting crying son
Blend Images - Hill Street Studios/Brand X Pictures/Getty images

Many kids look forward to going to school.

They may not always enjoy every single part of the school day. But in general, they like spending time with their friends at school, learning new things and being challenged.

Some other kids just dread going to school though. For these kids, going to school may become so stressful that they have temper tantrums over going to school or complain of symptoms such as headaches, stomachaches, or chest pain.

Why?

For some kids, there is an easily identifiable trigger for school refusal, such as being bullied, death in the family, or move to a new neighborhood. Following one of these events, especially if they are associated with the child staying home with a parent for some time, the child may not want to go to school any more.

Although school refusal has been associated with both separation anxiety disorder and social phobia, the easiest way to think about it is that school refusal is a 'difficulty attending school associated with emotional distress, especially anxiety and depression.'

Symptoms of School Refusal

Not surprising, school refusal is most common in kids who are five to six years old, when they are just starting school and in their first year of kindergarten. It is also common in school-age children who are about 10 to 11 years old, toward the end of the last years of elementary school.

In addition to having temper tantrums and crying when it is time to go to school, symptoms that children may have when they don't want to go to school may include vague complaints such as:

  • stomachaches
  • headaches
  • nausea
  • dizziness
  • chest pain
  • joint pain

Although these symptoms can also be found in children with other medical problems, one good sign that they are being caused by school refusal is that they get better later in the morning once the child understands that he is going to be able to stay home.

Other signs that a child's symptoms might be caused by school refusal include that your child:

  • is gaining weight well.
  • does not have a fever, vomiting, or diarrhea.
  • does not have as many symptoms when he isn't in school, including weekends and holidays.
  • has no obvious physical signs of illness when you visit your pediatrician. For example, he may have joint pain, but no joint swelling or limited movement of the joint.
  • in general has other fears, phobias, or symptoms of anxiety, such as clingy behavior, excessive worrying or nightmares.

Managing School Refusal

Of course, the main goal in managing school refusal is getting kids back in school. Unfortunately, when kids seem sick and are trying to stay home from school, it is not always easy to recognize that they are avoiding school.

That is why a visit to your pediatrician is usually a good first step when your kids don't want to go to school. This can help ensure that your child doesn't have a physical condition causing his symptoms. Unfortunately, while a physical condition can often be ruled out after your pediatrician talks to you and your child and does a physical exam, some children with school refusal end up seeing multiple specialists and having many tests before a diagnosis is finally made.

Once a diagnosis of school refusal is made, it can help to:

  • make sure that your child goes to school each day, since the more he stays home, the harder it will be to get him to go back to school.

  • understand that even though your child likely doesn't have a physical problem causing his symptoms, that doesn't mean that those symptoms aren't real. So your child isn't necessarily making up symptoms, such as stomachaches or headaches. They may just be caused by his anxiety about going to school.

  • talk to your child and school staff to see if you can figure out what is triggering your child's school avoidance behaviors, such as a bully, school performance problems, or trouble making friends.

  • consider getting help from a child psychiatrist and/or a child psychologist, in addition to your pediatrician, especially if you feel like you are having to force your child to go to school each day.

  • have a plan for when your child has symptoms at school, such as spending 10 to 15 minutes in the nurses office and then returning to class.

  • keep a symptom diary and see your pediatrician on the days that your child feels like he really can't go to school.

  • consider family therapy if there are any stressors at home, like a divorce, separation, discipline problems, death in the family, new sibling, or a recent move.

One of the most important things for parents is to be open to the idea that a child's symptoms might be caused by school refusal and not a physical problem. This will help get your child back in school faster and avoid unnecessary medical tests. Even if you are not convinced that your child has school refusal after seeing your pediatrician, you can keep your child in school as you proceed with a second opinion or further evaluation for a physical problem.



Sources:

School refusal in children and adolescents. Fremont WP. Am Fam Physician. 2003 Oct 15;68(8):1555-60.

Separation anxiety disorder and school refusal in children and adolescents. Hanna GL. Pediatr Rev. 2006 Feb;27(2):56-63.

Kliegman: Nelson Textbook of Pediatrics, 18th ed.

School refusal in children and adolescents: a review of the past 10 years. King NJ - J Am Acad Child Adolesc Psychiatry - 01-FEB-2001; 40(2): 197-205.

American Academy of Child and Adolescent Psychiatry Facts for Families. Children Who Won't Go To School (Separation Anxiety).

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