What is school refusal?

School refusal is a term used to describe the signs of anxiety a school-aged child has and their refusal to go to school. It is also called school avoidance or school phobia. It can be seen in different types of situations, including:

• Young children going to school for the first time. This is a normal type of school refusal. This develops with a child's normal separation anxiety, or uneasiness about leaving a parent figure. This type of fear often goes away a few days after the child starts school.

• Fear. Older children may have school phobia based on a real fear of something that may happen to them at school. This could be a bully, or a teacher being mean. In this situation, it's important to talk with your child to find out what is causing their fears.

• Distress. The final type of school phobia is seen in children who are truly distressed about leaving their parent and going to school. Often these children enjoy school. But they are too anxious about leaving their parents to attend.

What are the signs of school refusal?

Every child is different. But these are some of the behaviors your child may have:

• Your child may complain of other symptoms, such as a stomachache or headache, that get better as soon as they are allowed to stay home.

• Your child may tell you that they are anxious or afraid of a certain situation that happens at school.

• Your child may not want to leave you because of a change in their life, such as:

  • New school

  • Just moved

  • New brother or sister

  • Sick brother, sister, or parent

  • Divorce

  • Death in the family

How is school refusal diagnosed?

School refusal is often diagnosed with a team approach. The team is made up of your child's healthcare provider, you, your child, and teachers and counselors. Your child's healthcare provider will rule out any real health problems that may be happening. A complete health history and physical exam will be done. School officials may be contacted for more information.

Managing school refusal

Every child is unique. So each situation will be handled on an individual basis. These are some of the interventions that may be used to help your child:

• Talk with your child about the reasons why they do not want to go to school.

• Acknowledge that you understand your child's concerns but insist on their immediate return to school.

• Share your child's school avoidance with school staff. Enlist their support and assistance. Make sure the school officials understand the situation and don't send the child home for the wrong reasons.

• If your child's anxieties are severe, they might benefit from a gradual return to school.

• If your child does stay home from school, make sure they are safe and comfortable, but do not give them any special treatment.

• Think about family counseling if other problems exist.

• Let the child talk about their concerns and fears.

• Slowly separating the parent from the child in school may also be used. One approach is to have the parent sit with the child in the classroom at first. Then the parent may attend school but sit in another room. Next, the parent may continue to get farther away.

• If a problem like a school bully or an unreasonable teacher is the cause of your child's anxiety, become an advocate for your child and discuss these problems with the school staff.

• A referral to a child psychologist or psychiatrist may be needed. Speak with your child's pediatrician if you are unable to manage your child's school refusal for more than 1 week.