Clinical Reference Systems: Pediatric Advisor 10.0
Spanish version
School Phobia
DESCRIPTION
A child with school phobia is a child who misses
considerable school because of vague physical symptoms.
When he is not in school, he is at home; that is, he is not
a truant. 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 physical symptoms mainly occur in the
morning, and they worsen when it is time to leave for
school. Your child otherwise seems healthy and vigorous.
School phobia is very common and affects at least 5 percent
of elementary school children and 2 percent of middle school
children. Often the symptoms begin in September or October.
CAUSES
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. Often the first test of a
child's independence comes when he 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). He may lack the self-confidence that
comes from handling life's normal stresses without his
parents' help.
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 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 him to return. Your
child's future social life and education may be at stake.
HELPING YOUR CHILD OVERCOME SCHOOL PHOBIA
- 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 severe 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 nonnegotiable, ironclad 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. 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 worsen, the
school nurse can reevaluate your child's health.
If your child is late, he should go to school anyway.
When he misses the schoolbus, 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 physician on any morning she
stays home.
If your child has a new 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 symptom 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
doctor 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 degrees F, or 37.8 degrees C, orally)
- 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, once they are informed of the diagnosis, because
this problem is such a common one. 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 his
symptoms act up in school. It is often helpful if you
talk to your child's teacher about the situation.
If your child has special fears, like reciting in class,
the teacher will usually make special allowances.
- 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, watch a lot of TV, etc. Many of them
cannot stay overnight at a friend's home without
developing overwhelming homesickness. They need
encouragement to play more with their peers. This can
be difficult for a parent who enjoys the child's
company, but it is the best course of action 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.
CALL YOUR CHILD'S PHYSICIAN 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.
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