Health Matters 8/13: Helping Children Transition Back to In-Person Classrooms


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By Madhurani Khare, MD

With the new academic year and return to in-person classrooms right around the corner, children — and their parents — may be experiencing a mix of emotions, from excitement and relief to panic and fear.

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Those feelings are natural considering the COVID-19 pandemic turned life upside down, and after a year of virtual learning and unprecedented social isolation, the transition back to school will likely be difficult for many.

For children who may have already had some school-related anxiety prior to the pandemic, the challenges of returning to the classroom may be even harder.

The Child and Adolescent programs at Penn Medicine Princeton House Behavioral Health offer comprehensive treatment plans to help children overcome school-related anxiety so they can transition back to the classroom.

Pandemic Takes Toll

Prior to the pandemic, school avoidance or school refusal occurred in as many as 5 percent of children, according to the American Academy of Pediatrics.

While it is too early to tell if that number will rise, surveys on children’s mental health have found that the pandemic has taken a toll.

A report published this spring by the Kaiser Family Foundation indicated that 31 percent of parents said their child’s mental or emotional health was worse than before the pandemic.

Being out of in-person school with limited social interaction may make children suffering with school-related anxiety even more vulnerable this school year. They may be more likely to want to avoid school or refuse to go altogether.

However, when children outright refuse to go to school or have difficulty staying in school, it can impact their quality of life and participation in normal activities.

Numerous studies have established links between excessive absenteeism and educational underachievement, psychiatric problems, delinquency, and substance abuse.

Symptoms associated with school-related anxiety and school refusal include:

• Headaches
• Stomachaches
• Nausea
• Diarrhea
• Tantrums
• Crying every morning or evening
• Inability to sleep
• Ignoring school work, resulting in poor grades
• Additional visits to the school nurse, and coming home from school early

What Can Parents Do?

Parents can keep the following tips in mind when it comes to helping their children, regardless of their age, adjust to the new school year.

• Plan ahead. Find out what the school’s safety precautions will be and take time to thoughtfully go over them with your child until they feel comfortable. Develop contingency plans for changes in policies or slip-ups on the part of your child. Familiarizing your child with what will be expected of them can ease anxiety. In addition, if you are concerned about your child, contact the school guidance counselor to put a plan in place for helping them cope with anxiety, such as giving them a pass to see the counselor once a day for the first week or having the counselor meet with them on the first day of school.

• Get into a routine. After months of not even having to get out of their pajamas or having to be in homeroom by the time the bell rings, your children may no longer know what a regular routine is like. A few weeks before school starts, begin practicing a back-to-school routine. Start waking your child up earlier and get them to bed on time. Encourage them to eat breakfast, brush their teeth, and get dressed for the day even if they don’t have anything else planned.

• Encourage socialization. It could be stressful for your child to encounter friends and classmates who they haven’t seen in more than a year. Who do they walk into the building with? Who do they sit with at lunch? Encourage your child to reach out to at least one or two friends before school starts to so they know they’ll have a friendly face to look out for when they return.

• Talk openly. Create a safe environment for your child to express their excitement, fears, and concerns. Sometimes just being able to let their feelings out may be enough to ease your child’s mind. Take their feelings seriously and help them work through their emotions before school begins and as the term continues.

• Be consistent. Stability during times of change is important, so try to remain consistent in how you address your child’s concerns and provide support.

• Stay flexible. Anxiety and stress, as well as excitement and joy, can come and go as the school year approaches and progresses. Sometimes those feelings change on a daily basis. By staying flexible and keeping lines of communication open, many challenges can be anticipated and addressed in advance. Others will require support and understanding when they arise.

• Practice patience. Readjusting will take time, whether it involves reintegrating into a classroom setting, reestablishing social relationships, or meeting academic expectations. Focus on providing steady support and encouragement.

Professional Help is Available

If your child refuses to go to school or shows symptoms of school-related anxiety, seeking professional help is important.

Parents should not hesitate to reach out for help if their children have trouble adjusting.

At Penn Medicine Princeton House Behavioral Health, treating school-related anxiety and school refusal starts with a comprehensive assessment that rules out any medical issues.

Therapists work with children and families to reintegrate the student back into the school environment using a variety of different treatment tools including:

• Cognitive behavioral therapy
• Mindfulness skills
• Relaxation training
• Social skills training
• Contingency management
• Reentry planning

Children and adolescents whose education has been disrupted by school refusal might also be eligible for special school services. School counselors are on alert and ready to help kids manage the transition back to in-person learning. In some cases, children may now qualify for an Individualized Education Plan (IEP). Therapists at Princeton House typically work with schools and parents to develop an IEP, which describes a student’s goals and outlines the special support that will be provided by the school to help the student achieve those goals.

For more information about the Child and Adolescent programs at Penn Medicine Princeton House Behavioral Health or to schedule an appointment call 888-437-1610 or visit

Madhurani Khare, MD, is board certified in child and adolescent psychiatry as well as general psychiatry. She is the medical director of the Hamilton site of Penn Medicine Princeton House Behavioral Health.

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