Dealing With Kids Who Refuse to Attend School

Asian mother comforting crying son
Blend Images - Hill Street Studios/Brand X Pictures/Getty images

Many kids look forward to going to school. They may not always enjoy every single part of the school day. But in general, they like spending time with their friends at school, learning new things, and being challenged.

Some other kids just dread going to school. For these kids, going to school may become so stressful that they throw temper tantrums over going to school or complain of symptoms such as headaches, stomach aches, or chest pain.

Why Kids Refuse School

For some kids, there is an easily identifiable trigger for school refusal, such as being bullied, experiencing a death in the family, or moving to a new neighborhood. Following one of these events, especially if they are associated with the child staying home with you for some time, your child may not want to go to school anymore.

Although school refusal has been associated with both separation anxiety disorder and social phobia, the easiest way to think about it is that school refusal is your child's association of school with thoughts or experiences that trigger uncertainty or nervousness.

Symptoms of School Refusal

School refusal is most common in kids who are 5 or 6 years old—when they begin kindergarten. It is also common in school-age children who are about 10 to 11 years old, toward the end of the last years of elementary school.

In addition to having temper tantrums and crying when it is time to go to school, symptoms that children may reference when they don't want to go to school may include vague complaints such as:

  • Chest pain
  • Dizziness
  • Headaches
  • Joint pain
  • Nausea
  • Stomach aches

Although these symptoms can also be found in children with other medical problems, one good sign that they are being caused by school refusal is that they get better later in the morning after your child understands that he can stay home.

Other signs that a child's symptoms might be caused by school refusal, instead of some other medical condition, include:

  • Appropriate weight gain
  • Demonstration of other fears, phobias, or symptoms of anxiety, such as clingy behavior, excessive worrying, or nightmares
  • Lack of fever, vomiting, or diarrhea
  • No apparent symptoms when he isn't in school, including weekends and holidays
  • No obvious physical signs of illness when you visit your pediatrician—for example, she may complain of joint pain, but the doctor finds no joint swelling or limited movement of the joint

Managing School Refusal

The main goal of managing school refusal is getting kids back in school. When kids seem sick and are trying to stay home for the day, it is not always easy to recognize that they are avoiding school.

A visit to your pediatrician is usually a good first step when your kids don't want to go to school. This check-up verifies that your child doesn't have a physical condition causing his symptoms.

Unfortunately, while a physical condition can often be ruled out after your pediatrician talks to you and your child and does a physical exam, some children with school refusal end up seeing multiple specialists and having many tests before a diagnosis is finally made.

After a diagnosis of school refusal is made, it can help to:

  • Consider family therapy if there are any stressors at home, like a divorce, separation, discipline problems, death in the family, new sibling, or a recent move.
  • Develop a plan for when your child has symptoms at school, such as spending 10 to 15 minutes in the nurse's office and then returning to class.
  • Maintain a symptom diary and see your pediatrician on the days that your child feels like he really can't go to school.
  • Make sure that your child goes to school each day, since the more she stays home, the harder it will be to get her to go back to school.
  • Obtain a referral for a child psychiatrist or a child psychologist, in addition to your pediatrician, especially if you think that you're forcing your child to go to school each day.
  • Talk to your child and school staff to see if you can figure out what is triggering your child's school avoidance behaviors, such as a bully, school performance problems, or trouble making friends.
  • Understand that even though your child likely doesn't have a physical problem causing his symptoms, that doesn't mean that those symptoms aren't real. So your child isn't necessarily making up symptoms, such as stomach aches or headaches—they may just be caused by his anxiety about going to school.

One of the most important things for parents is to be open to the idea that a child's symptoms might be caused by school refusal and not a physical problem. This knowledge will help get your child back in school faster and avoid unnecessary medical tests.

Even if you are not convinced that your child has school refusal after seeing your pediatrician, you can keep your child in school as you proceed with a second opinion or further evaluation for a physical problem.

5 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Gonzálvez C, Díaz-herrero Á, Sanmartín R, Vicent M, Pérez-sánchez AM, García-fernández JM. Identifying Risk Profiles of School Refusal Behavior: Differences in Social Anxiety and Family Functioning Among Spanish Adolescents. Int J Environ Res Public Health. 2019;16(19) doi:10.3390/ijerph16193731

  2. Knollmann M, Knoll S, Reissner V, Metzelaars J, Hebebrand J. School avoidance from the point of view of child and adolescent psychiatry: symptomatology, development, course, and treatment. Dtsch Arztebl Int. 2010;107(4):43-9. doi:10.3238/arztebl.2010.0043

  3. Sibeoni J, Orri M, Podlipski MA, et al. The Experience of Psychiatric Care of Adolescents with Anxiety-based School Refusal and of their Parents: A Qualitative Study. J Can Acad Child Adolesc Psychiatry. 2018;27(1):39-49.

  4. Thastum M, Johnsen DB, Silverman WK, Jeppesen P, Heyne DA, Lomholt JJ. The Back2School modular cognitive behavioral intervention for youths with problematic school absenteeism: study protocol for a randomized controlled trial. Trials. 2019;20(1):29. doi:10.1186/s13063-018-3124-3

  5. Stephens MM, Cook-fasano HT, Sibbaluca K. Childhood Bullying: Implications for Physicians. Am Fam Physician. 2018;97(3):187-192.

Additional Reading
  • American Academy of Child and Adolescent Psychiatry Facts for Families. Children Who Won't Go To School (Separation Anxiety).
  • Kliegman: Nelson Textbook of Pediatrics, 18th ed.
  • School refusal in children and adolescents: a review of the past 10 years. King NJ - J Am Acad Child Adolesc Psychiatry - 01-FEB-2001; 40(2): 197-205.
  • School refusal in children and adolescents. Fremont WP. Am Fam Physician. 2003 Oct 15;68(8):1555-60.
  • Separation anxiety disorder and school refusal in children and adolescents. Hanna GL. Pediatr Rev. 2006 Feb;27(2):56-63.

By Vincent Iannelli, MD
Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.