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Clinical Reference Systems: Pediatric Advisor 10.0
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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

  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 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.

  2. 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.

  3. 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."

  4. 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.

  5. 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.

  6. 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.

Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
Copyright 1999 Clinical Reference Systems