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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.
Symptoms
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.
Published online: 9/07
Source:
Caring for Your School-Age Child: Ages 5 to 12 (Copyright ©
2003 American Academy of Pediatrics)
To order a copy of this book visit the AAP
Bookstore.
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The information
contained in this publication 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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