It’s Monday morning. After a busy, action-packed weekend, it’s time to get everyone up and awake to eat a balanced breakfast, brush teeth, go to the bathroom, stuff a lunch into the backpack, and make it to the bus stop or drop-off line on time. Doing that for 5 days in a row, most weeks of the year is challenging enough. And then you hear these three words from you tearful child:

“My tummy hurts.”

What does that mean, exactly? You think back on the weekend when everyone was feeling fine. Maybe it was the combination of pizza, soda, cake and ice cream at a friend’s birthday party yesterday. Or maybe it’s the start of that stomach virus you’ve heard is going around school. Or, it might just be that your child is using the wrong words to express what is really on his mind: “I don’t want to go to school today.”

It is probably impossible to make the translation the first time it happens. But a physical complaint of not feeling well, described in vague terms (“My tummy hurts,” “I have a headache,” “I’m tired,” “I don’t feel good”) and not accompanied by specific symptoms (vomiting, diarrhea, constipation, fever) should be viewed suspiciously by attentive parents, especially when the complaints are repeated on consecutive days or over consecutive weeks.

The most common reason for school avoidance or school refusal (also known as school phobia) is school-related anxiety. Estimated to affect about 5% of schoolchildren, school phobia often leads to many missed school days. And, according to the American Academy of Pediatrics, it is only on those days these vague complaints are heard:

School refusal symptoms occur most often on school days, and are usually absent on weekends. When these children are examined by a doctor, no true illnesses are detected or diagnosed. However, since the type of symptoms these children complain of can be caused by a physical illness, a medical examination should usually be part of their evaluation.


Triggers of school-related anxiety include:

> Fear of leaving you, the parent (separation anxiety).

> Fear of failure. This is especially true in children who find learning in school difficult, like those with chronic medical conditions, behavioral problems, social concerns, attentional issues, or specific learning differences. Remember that whenever parents hear the phrase “I don’t like school,” a red flag should go up.

> Teasing coming from other children.

> Perceived “meanness” or negative attention from a teacher.

> Anxiety around using a public toilet.

> Threats of physical harm, or actual physical harm from a bully.


Getting your child to go back to school — and stay there — might be easier said than done. A visit to the pediatrician would be a good first step to hash out the problem, rule out a medical, psychological, or learning-based reason for wanting to avoid school, and generating a plan to manage the anxiety:

While you might try to manage school refusal on your own, if your child’s school avoidance lasts more than one week, you and your child may need professional assistance to deal with it.

First, your child should be examined by your pediatrician. If his or her school refusal persists, or if he or she has chronic or intermittent signs of separation difficulties when going to school – in combination with physical symptoms that are interfering with her functioning – your doctor may recommend a consultation with a child psychiatrist or psychologist.

Even if your child denies having negative experiences at school or with other children, his or her unexplainable physical symptoms should motivate you to schedule a medical evaluation.​



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