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Health Matters: Helping Children Overcome School Anxiety

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By Madhurani Khare, MD

Heading back to the classroom after summer break can be distressing for many children and teens.

Where will they sit at lunch?

Whose locker will be next to theirs?

How will they ever understand Advanced Placement (AP) physics?

Some level of school anxiety is normal and expected, but 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.

If your child is struggling with school anxiety, help is available. 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.

Not Uncommon

School avoidance or school refusal is not uncommon and occurs in as many as 5% of children, according to the American Academy of Pediatrics.

There are a variety of reasons that children may refuse to go to school, including social anxiety, fear of failure, being bullied, being afraid of the teacher, and even fear of using the school bathroom.

Major life changes such as moving to a new home, the birth of a sibling, or a family separation can also contribute to school anxiety leading to school refusal.

Additionally, over the past two years children have encountered a lengthy list of additional stressors related to the pandemic including social isolation, missed milestones, difficult learning conditions, trouble focusing and lack of motivation because of disrupted routines.

Triggers that can be linked to school refusal include:

  • Being introverted, socially isolated or behaviorally inhibited.
  • Having low self-esteem.
  • Being immature or dependent on others.
  • Falling on the autism spectrum.
  • Being a high achiever.
  • Difficulty with social relationships.


Symptoms associated with school anxiety and school refusal include:

• Headaches.
• Stomachaches.
• Nausea.
• Diarrhea.
• Tantrums.
• Crying every morning or evening.
• Inability to sleep.
• Ignoring schoolwork, resulting in poor grades.

Generally, these symptoms occur most often on school days and are absent on weekends.

In addition, frequent visits to the school nurse and regularly needing to leave school in the middle of the day are also red flags that your child may be experiencing school anxiety.

Professional Help is Important

While no one wants to see their child suffer, allowing them to skip school or leave school early typically worsens their anxiety making it increasingly difficult for them to return. This creates a cycle that can be hard to overcome.

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 to their pediatrician or a mental health professional 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.
• Distress tolerance skills.
• Mindfulness skills.
• Relaxation training.
• Social skills training.
• Contingency management.
• Reentry planning.

Children and adolescents whose education has been disrupted by school refusal might be eligible for special school services. In some cases, children may qualify for an Individualized Education Plan (IEP). Therapists at Princeton House typically work with schools and parents to develop an IEP, which describes goals for the students and outlines special support provided by the school to help the student achieve those goals.

Tips for Parents

With a new school year right around the corner, keep the following tips in mind for helping your children adjust to the transition and manage school anxiety.

• Return to a consistent sleep schedule. Start your child on a school bedtime schedule several weeks ahead of time. Sleep cycle disruptions during summer can make anxiety even worse. Ideally, young people should have at least eight to nine hours of sleep at night. Consistent bedtimes and wake times are important. If necessary, restrict the use of electronic devices like smart phones at night.

• Avoid the morning rush. To help ease anxiety in the morning when everyone is trying to get out the door, get ready for the school day the night before. Pack backpacks and pick out clothing the night before. Get lunch ready. Make sure homework is complete.

• Keep the lines of communication open. Create an environment in which your child feels comfortable expressing their thoughts and feelings with you. Validate their feelings and remind them they are not alone in experiencing anxiety. Assure them you are there to support them.

• Talk with school officials sooner rather than later. If your child is showing symptoms of school anxiety, talk with their guidance counselor and teachers about the situation and work with them to create a safe space at school. Find out what resources are available.

• Know the signs of bullying. Bullying involves a variety of behaviors from pushing and teasing to leaving someone out of a group to spreading rumors and harassing over social media or text. If you suspect your child is being bullied, talk with school officials.

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, option 2 or visit www.princetonhouse.org.

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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