Why do children avoid school using stress-based physical complaints?

Children often are exposed to typical stressors in school as part of their normal growing up process. It is not uncommon to have frequent headaches or bellyaches as typical responses to stressors.

Could school avoidance be linked to pediatric depression?

Yes, in some cases, school avoidance is often an issue when children are not very happy with their performance in school. It's probably very important at this point to sort out physical and emotional factors in order to sort out this mood depression.

Since children HAVE to go to school, what can parents do to overcome school avoidance and the physical complaints associated with it?

One needs to explore if there are any physical or organic causes to the illness. However, when we respond to stress-based complaints at home, this often determines whether or not they will continue to be used by children when stresses appear.

Are the child's symptoms usually treated with medication or psychologically?

If we use medication, it has to be related to some kind of medical problem. Most of the time, children's stresses do not require major use of medication. The idea is to provide them with an understanding of what the emotional issues represent, and then deal with those issues in a constructive way.

Are the physical symptoms usually related to children not wanting to go to school, or do they not want to go because they are actually sick?

In this regard, one needs to explore common reasons for physical illness as you would with your child in any instance. You rule out major physical problems by contacting and discussing this with your family doctor. Once you have a reasonable idea that these are probably not organic or physical problems, it's important to respond to the emotional needs of the child and what they're trying to tell us. It's important that we do not disregard the pain, but that we explore other reasons for these stresses and provide a home environment that does not make avoidance more enjoyable than going to school. If a child is kept home from school, it's probably not a good idea to spend all day in front of the television--we need to make staying at home less enjoyable than going to school! In this regard, we're responding to the child's emotional needs, but we're also responding to the child's "sick behavior."

How do you usually treat this problem and how long does it take to be resolved?

We usually treat the problem with some form of parent counseling and see how the child is responding to any of the stressors that we can uncover. Usually, these are fairly short-term treatments.

Do you find a lot of recurrences once the problem has been addressed?

Generally, we do not, especially in younger children if we address the problem early on. Local family doctors and pediatricians are often very good at providing this anticipatory guidance. The key is how we respond to physical complaints and then promote a wellness attitude.

Are there any preventive measures I can take to keep this from being a problem for my child?

One of the best preventive measures is how parents respond to illnesses and stressors. Illness and stress need to be viewed as a normal part of life that we experience, get over it and move on. It is important not to use physical complaints to avoid daily activities, if at all possible. Visits to family doctors are often complicated by additional stress factors that make it difficult to sort out the physical from the psychological. Please consider that we're dealing with stress-based complaints that lead children to miss a great amount of school.

My problem in addressing ALL the physical complaints in my child is that I do not want my child to run to a physician every time they do not feel right, as they grow up. How does one find the fine line between appropriate physical complaints to address and ones to ignore?

If we have a good suspicion that the physical complaint is short-lived, that the child has no fever, that there is no clear pain focus, that the pain seems to be just a general response, these are often used as indicators to suggest that we're dealing with more stress-based difficulties than only an organic illness. Again, these are guidelines. The child's medical history and the current illnesses going around the school are often additional guidelines to help us sort through this dilemma. It's also very useful to ask your physician directly what they think about bringing the child in when you're not sure. Granted, it's better to err in a certain way when your child's health is in question, but ask your physician for their opinion as well.

My son, on the days he has to ride the bus, complains of aches and pains, and when I tell him he will be fine and send him to school, he says that I don't care that he feels bad, what should I be telling him when he makes these complaints to make him not feel like I don't care?

It's important that you emphasize that you do care, that these will likely go away. It may be helpful to get him to focus on other activities while he's on the bus like counting cars, looking for license plates, doing some homework. The idea is to distract him so he might be able to move on. You might also give your son the options of what he wants to do if he stays home. Here is when it becomes important; how we structure his day when he is at home. He needs to have quiet time, he should not watch TV all day, and after school, his activities need to be restricted because he stayed home ill. We need to make sure that home isn't used to avoid school activities. We accept his stress, but we can't let that always become a determining factor in avoiding all other activities. We need to explore these reasons for avoidance at home as well as in school.

How important a role should teachers play in the whole scheme. Should they be involved?

Teachers often have more information on the child's stressors than we suspect. We need to be in dialogue with them, we need to ask specific questions about school performance, and we need to respect their role as teacher and not always as just emotional problem solver for our children. Teachers do solve children's emotional problems, but we also need to be respectful of their limitations because they have to deal with so many children. Teachers often have a very good view of the child's emotional health, but it's only one view. It's very important for parents to attend school conferences regularly and ask specific questions about their child's performance.

Are there clinics that specialize in this sort of issue?

At the University of Iowa, we do have a clinic that focuses on stress-related problems with children. However, school psychologists, child psychologists, if they work with children on a regular basis, are often able to deal with these stress-based complaints. Often, we use relaxation methods, distraction techniques, biofeedback and, explore other common reasons for school problems--that is, things such as learning difficulties, family stressors. The goal is to look for ways to help the child cope whether it's a stress or a physical illness. Behavioral methods, which are what I just mentioned, are often very helpful in reducing headache or belly pain, especially when these have more of a psychological or stress-based origin. It's probably most helpful to your child to be sensitive to their physical complaints, explore the need for good medical consultation, but try to teach them good coping methods in dealing with stressors. Our role as parents and how we respond to illnesses and how we teach our children to deal with them is probably the key to developing a healthy and wellness-oriented approach generally, for our kids.