When your child refuses to go to school, here’s how to respond

The start of the school year is full of firsts, including the first dreaded back to school virus — or is it? Often a child’s complaints of illness can be attributed to a physical cause, but sometimes when a child is complaining of a headache or a stomach-ache, that pain could be the physical manifestation of his or her stress and or anxiety. This is the case for up to 5% of children each year who refuse school. So how do parents determine if that stomach-ache is the result of a bug or the result of anxiety or other emotional concern?

The connection between mental and physical health is well documented. The cause of an ailment such as a headache or stomach ache can sometimes be purely physical or purely mental, but it's more often a little of both. Research has shown that stress in children and adults can contribute to physical symptoms as well as the exacerbation of current ailments. It is estimated about 10% of children will complain of pain or illness during the school day, and stress-induced ailments in adults have continued to increase.

In psychology, the term somatization describes how emotional causes contribute to physical symptoms in both adults and children. It’s fairly common; Think about the last time you had a bad day at work and came home with a headache, or were really nervous before a flight and felt stomach pain. Additionally, when experiencing minor discomfort, some individuals may hyper-focus on the discomfort, which can exacerbate those symptoms. For example, a child may be experiencing the usual “butterflies” in the stomach associated with the first day of school, but he or she may become so focused on that sensation that the severity of the symptoms increases.

So, how can you tell whether your child refuses school because of a purely physical ailment, or if there is an emotional component contributing to that ailment?

First, always rule out a medical concern. Remember that a child’s description of their physical pain is real and should not be discounted, but try to further explore its cause. Ask your child questions about school, their friends, teachers, their upcoming math test, who they sit with at lunch, and who they play with at recess. Additionally, write down the times and events when your child is complaining of pain and illness — is it in the morning before school? Are there complaints on the weekends? If your child is refusing school, it may also be helpful to speak with the school psychologist to further explore an underlying emotional issue.

Also, try to determine if your child is contributing to his or her ailment by ruminating over it —often, the stories we tell ourselves can contribute to our anxiety about an illness. If you’ve ever consulted “Dr. Google” for a physical ailment and started to think about all of the potential causes, you’ll understand that children have similar thought patterns. It’s important to determine with your child if that is the case, and clear up any of these fears with developmentally appropriate information. If you think your child may be experiencing pain due to nervousness, be sure to normalize that pain and explore with them potential causes.

Lastly, there is a delicate balance between reassuring your children that they are safe and well, and providing so much reassurance that it begins to feed the anxiety. Children who constantly ask to go to the doctor for minor ailments, or insist they have some sort of disease (when you have ruled out that they don’t) may be engaging in reassurance seeking to decrease the anxiety. This practice may initially decrease anxiety for the short term, but ultimately results in feeding a vicious cycle of increasing his or her anxiety. Acknowledge your child’s physical sensation, help them identify the emotions around them, assure them they are safe, and then engage in other activities in an attempt to distract. They will take your lead. If you are anxious they will be anxious.

The origin of pain and illness is complex and can often have emotional components at their roots. By helping your child identify what is truly a physical ailment, and what is a physical response to stress is or anxiety, can help them cope with their stressors in healthy and productive ways.

Jessica Glass Kendorski is an associate professor and chair of the department of school psychology at the Philadelphia College of Osteopathic Medicine (PCOM).