Childhood Problems
School Refusal

Going to school usually is an enjoyable and even exciting event for most children. However, it brings intense fear or panic, in some children. You as a parent should be concerned if your child regularly complains about feeling sick or wants to skip school with minor physical complaints. This phenomenon is most common in children at ages 5-7 and 11-14, ages when children are dealing with the new challenges of elementary and middle school. These children may suffer from a paralyzing fear while leaving the safety of their parents and home. This is very difficult for both parents and the child to cope with, but with professional help, these fears and behavior can be treated successfully.

Refusal to go to school normally starts after a period at home in which the child has become close to the parent, like summer vacations, holidays, or an illness. It may also follow some stressful event like the death of a pet or relative, a change of schools, or a move to a new neighborhood.

Sometimes children complain of a headache, sore throat, or stomachache shortly before it is time to leave for school. The symptoms subside after the child is permitted to stay back, but reappears the next morning. Occasionally, the child may simply refuse to leave the house. But normally the child is calm once in school, as the panic originates from the action of leaving home rather than being at school. These children may also feel unsafe being alone in a room, cling to adults, worry about parents or harm themselves, have sleeping difficulties, nightmares, unrealistic fears, and throw tantrums. Such symptoms and behaviors are common among children with separation anxiety disorder. The possible long-term effects (anxiety or panic disorder when he grows up) are serious and professional assistance should be sought in such cases. The child may also develop serious educational or social problems if these fears keep them away from school. When fears persist the parents and child should consult with a qualified mental health professional, who will work with them to develop a plan to immediately return the child to school and other activities. This is more serious in older children/ adolescents and calls for more intensive treatment. It is important to identify problems early and provide appropriate help. Assessment and management of school refusal require a collaborative approach that includes physician, school staff, parents, and a mental health professional. Medical problems should always be ruled out before you embark on treatment which may include educational-support therapy, cognitive behavior therapy, parent-teacher interventions and pharmacotherapy.

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