School Phobia

What is school phobia?

A child with school phobia stays home from school and is missing a lot of school days because of vague physical symptoms. The symptoms are usually the type that people get when they are upset or worried, such as stomachaches, headaches, nausea, vomiting, diarrhea, tiredness, or dizziness. These symptoms mainly occur in the morning, and they worsen when it is time to leave for school. Your child my also have trouble falling asleep the night before a test or other stressful event. Your child otherwise seems healthy and vigorous.

What is the cause?

A school-phobic child is usually afraid of leaving home in general, rather than afraid of anything in particular at school. For example, he may experience homesickness when staying at a friend's house. 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, and the child finds it difficult to separate from them (separation anxiety).

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

How long will it last?

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 him to return.

How can I help my child?

• Insist on regular school attendance.

  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 improve. They will become less severe and happen 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 nonnegotiable rule. Be optimistic with your child and reassure him that he will feel better after he gets to school.

• Be extra firm on school mornings.

  In the beginning, mornings may be a difficult time (especially on Mondays). You should never ask your child how he feels because it will encourage him to complain. If he is well enough to be up and around the house, he is well enough to go to school. If your child complains of physical symptoms, but they are his usual ones, he 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 him to school. If later the symptoms get worse, the school nurse will let you know if there is a problem.

  If your child is late, he should go to school anyway. When he misses the school bus, you should have a prearranged alternative plan of transportation. If your child comes home on his own during lunch or recess, he should be sent back promptly. Sometimes a child may cry and scream, absolutely refusing to go to school. In that case, after talking with him about his worries, he has to be taken there. One parent may be better at enforcing this than the other. Sometimes a relative can take charge of the matter for a few days.

• Have your child see her healthcare provider on any morning she stays home.

  If your child has a new symptom or seems quite sick, you will probably want her to stay home. If you are puzzled, your healthcare provider will usually be able to find the cause of the sickness. Call the office as soon as it opens, and try to have your child seen that morning. If the symptom is caused by a disease, appropriate treatment can be started. If the symptom is from worry and anxiety, your child should go back to school before noon. Working closely with your child's provider 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, or 37.8°C, taken by mouth)
  • vomiting (more than once)
  • frequent diarrhea
  • 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."

• Ask the school staff for assistance.
• Schools are usually very understanding about school phobia because it is a common problem. If your child has special fears, like talking in front of the class, his teacher will usually make special allowances. If his symptoms act up in school, ask the school nurse to let your child lie down for 5 to 15 minutes in her office and regroup, rather than send him home. If the school staff is uncertain whether your child is too ill to remain in school, try to get an appointment with your child’s doctor that same day. Return your child to school if no significant illness is found.
• Talk with your child about school fears.

  At a time other than a school morning, talk with your child about her problems. Encourage her to tell you exactly what upsets her. Ask her what is the worse possible thing that could happen to her at school or on the way to school. If there's a situation you can change, tell her you will work on it. If she's worried about the physical symptoms becoming worse at school, reassure her that she can lie down for a few minutes in the nurse's office as needed. After listening carefully, tell her you can appreciate how she feels, but it's still necessary to attend school while she's getting better.

• Help your child spend more time with his agemates.

  Outside of school, school-phobic children tend to prefer to be with their parents, play indoors, be alone in their rooms, or watch a lot of TV. Many of them cannot stay overnight at a friend's home without developing overwhelming homesickness. They need encouragement to play more with their friends. This can be difficult for a parent who enjoys the child's company, but it is the best for the child in the long run. Encourage your child to join clubs and athletic teams (noncontact sports are usually preferred). Send her outside more or to other children's homes. Her friends can be asked to join the family for outings or for overnight stays. Help your child learn to stay overnight with relatives and friends. A summer camp experience can be a turning point.

When should I call my child's healthcare provider?

Call during office hours if:

• The school phobia is not resolved in 2 weeks using this approach.
• The school phobia recurs.
• You think the cause of the symptoms may be physical rather than emotional.
• Your child continues to have other fears or separation problems.
• Your child is withdrawn in general or seems depressed.
• Your have other questions or concerns.