Health Reference / Children's Health / School Phobia or Refusal

School Phobia or Refusal

Date Posted: January 3, 2000

DEFINITION

A child with school phobia is a child who misses considerable school because of vague physical symptoms. When she is not in school, she is at home; that is, she is not a truant.
The symptoms are usually the type that people get when they are upset or worried, such as a stomachache, headaches, nausea, vomiting, diarrhea, tiredness, dizziness. These physical symptoms mainly occur in the morning, and they worsen at the time of departure for school.
Your child otherwise seems healthy and vigorous.
School phobia is very common affects at least 5% of elementary school children and 2% of middle school children.
Often the symptoms begin in September or October.
This diagnosis must be confirmed by a physician.

Causes

A school-phobic child is usually afraid of leaving home in general, rather than afraid of anything in particular at school. For example, she may experience homesickness when staying at a friend's house. Often the first test of a child's independence comes when she must attend school daily. Aside from poor attendance, these children usually are good students and well behaved at school. The parents are typically good parents who are conscientious and loving. Such parents are sometimes overly protective and close, and the child finds it difficult to separate from them (separation anxiety). She may lack the self-confidence that comes from handling life's normal stresses without her parents' help.

Sometimes a change of schools, a strict teacher, hard tests, a learning problem, or a bully may be seen as causes of the child's fear of going to school. However, such factors may be only part of the problem, and your child should still go to school while these problems are being resolved.

Expected Course

If daily school attendance is enforced, the problem of school phobia will improve dramatically in 1 or 2 weeks. On the other hand, if you do not require your child to attend school every day, the physical symptoms and the desire to stay home will become more frequent. The longer your child stays home, the harder it will be for her to return. your child's future social life and education may be at stake.

HELPING YOUR CHILD OVERCOME SCHOOL PHOBIA

1. Insist on an immediate return to school. The best therapy for school phobia is to be in school every day. Fears are overcome by facing them as soon as possible. Daily school attendance will cause most of your child's physical symptoms to magically improve. They will become less sever and occur less often, and your child will eventually enjoy school again. At first, however, your child will test your determination to send her every day.. You must make school attendance a non-negotiable, iron-clad rule. Be optimistic with your child and reassure her that she will feel better after the gets to school.

2. Be extra firm on school morning. In the beginning, mornings may be a difficult time. You should never ask your child how he or she is feels because it will encourage her to complain. If she is well enough to be up and around the house, she is well enough to go to school. If your child complains of physical symptoms, but they are her usual ones, she should be sent to school promptly with minimal discussion. If you are uncertain about your child's health. try to err on the side of sending her to school; if later the symptoms worsen, the school nurse can reevaluate your child's health.

3. Have your child see her physician on any morning she stays home. If your child has anew physical symptom or seems quite sick, you will probably want her to stay home. If you are puzzled your physician will usually be able to determine the cause of her sickness. Call the office as soon as it opens, and try to have your child seen that morning. If the symptoms is caused by a disease, appropriate treatment can be started. If the symptom results from anxiety, your child should be back in school before noon. Working closely with your child's physician in this way can solve even the most difficult of school phobia problems. You should probably keep your child at home when she has any of the following symptoms:

Fever (over 100°F[37.8°C] orally)
Vomiting (more than once)
Frequent cough
Widespread rash
Earache
Toothache

On the other hand, children with a sore throat, moderate cough, runny nose, or other cold symptoms but no fever can be sent to class. Children should not be kept home for "looking sick," "poor color," "circles under the eyes," or "tiredness."

4. Ask the school staff for assistance. Schools are usually very understanding about school phobia.

Instructions for Pediatric Patients, 2nd Edition, Š1999 by WB Saunders Company.
Written by Barton D. Schmitt, MD, pediatrician and author of Your Childs Health, Bantam Books, a book for parents.