By David Rzeszutko, M.D. | Vice president of medical and clinical operations at Priority Health with Board Certification in Internal Medicine and Pediatrics
As back to school time approaches pediatricians see an uptick in visits from parents with children feeling more anxious than usual about returning to school. While most children have occasional worries about school performance, friendships, teachers or routines, separation anxiety disorder is different.
The central fear is not simply school itself, but instead a persistent worry that something bad will happen to the child or to a loved one while the child is away at school. It can begin after a long summer break, moving, family transitions or illness. When this fear becomes excessive and interferes with school attendance it may be time to seek help.
The second grader with morning stomachaches
A 7-year-old came to my office with his mother after three weeks of difficult school mornings that were only getting worse. This little boy had changed from being a confident, friendly child who enjoyed recess and reading groups, to one who clung to his mother and repeatedly asked, “What if something happens to you while I’m gone?”
While his mother initially thought he was worried about a new teacher and harder classroom, through questioning it was determined that he liked his teacher and had many friends at school. Also, his pattern of anxiety peaked during the separation and improved when he was allowed to stay home with his mother.
Treatment began with education for both parent and child: anxiety can cause real physical symptoms, but avoidance teaches the anxious brain that school is unsafe.
We created a brief, predictable goodbye routine; limited prolonged reassurance; and coordinated with the school so he could check in with a trusted adult for a few minutes after arrival. The family used a simple bravery chart that rewarded attendance and staying at school, not the absence of anxiety. Over several weeks, his morning symptoms decreased, and he began walking into school with less distress. The goal was not to convince him he would never feel anxious; it was to help him learn that he could feel anxious and still separate safely.
How Parents Can Help
Parents play a critical role in helping children overcome and manage separation anxiety. Children feel secure and prepared when there is predictability.
- As the summer draws to a close begin to gradually move bedtime and wake-up times and daily schedules closer to the school-year routine.
- If your child is expressing anxiety about going back to school stay positive and communicate confidence about school and the exciting opportunities ahead.
- Don’t dismiss your child’s concerns. Really listen, validate and find positive solutions together.
- Practice short periods apart to help rebuild your child’s confidence that you will always be reunited after the separation.
- Create goodbye rituals that are brief and consistent to make parting transitions smoother. Prolonged farewells often increase anxiety rather than reduce it.
How the school can help
Greeting students warmly, establishing predictable routines and helping children connect with peers can significantly reduce anxiety.
School counselors may provide additional support for students struggling with the transition.
Don’t wait to talk with your doctor
Pediatricians see separation concerns frequently and are well positioned to identify the pattern, rule out medical causes, name the anxiety, and help families intervene early.
For children struggling with separation anxiety remember that the goal is not to eliminate anxiety completely, but to teach them that they can successfully navigate new situations even when they feel nervous. Those lessons in resilience often become as valuable as anything they learn in the classroom.
How separation anxiety differs from “school refusal”
School refusal is another matter entirely. School refusal results when a child does not want to go to school because there is a situation, person or activity that the child wants to avoid. Reasons could include:
- Bullying from a student or group of students that could include, teasing, belittling or even physical harm.
- Feeling academically inferior as if everyone else is smarter and understands the lessons and knows the answers.
- Feeling alone, with difficulty making friends, especially at lunchtime and recess when kids congregate and socialize.
- Feeling different than everyone else and feeling out of place.
Many students experience some of these feelings at some point in their school years and are able to work through them, but for some children the pain and fear associated with facing a trouble situation at school can reach a breaking point after summer respite and being away from the situation.
As in separation anxiety, do not dismiss your child’s concerns. Sit down face to face and listen and ask questions. Validate and show your concern and discuss solutions so they know they are not alone.
If bullying is the reason your child is refusing to go to school ask your child the details of who, what, where and when. Contact the teacher and principal to inform them of the situation and learn what steps they can take to keep your child safe. Additionally, help your child reframe the situation. Bullies often bully because they are experiencing their own difficulties at home or at school. Help your child to see this person or persons in a different light. Extend kindness and friendship to the bully.
Regarding academic concerns, determine whether the issue is related to skill gaps, learning differences, anxiety, perfectionism or an overwhelming workload. Meet with the teacher to review performance and what supports are available.
If your child has difficulty making friends, provide tools to initiate friendships. Role play greeting new people in the cafeteria and initiating conversation. Encourage your child to seek out other children who may be alone and need a friend. Identify a club or interest-based group that your child would enjoy and meet like-minded friends.
If your child feels different than everyone else, remind them to be proud of who they are. Explore why they feel different. Is it interests, personality, identity, family circumstances or school culture? Encourage confidence in themselves which will draw people to them.
For parents, school refusal can be challenging.
While being compassionate, try not to let school avoidance become a long-term pattern. Work collaboratively on a plan, celebrate small successes such as attending part of the day and involve school professionals like a school counselor, social worker, teacher or administrator.
For a resource to help with kids’ big emotions, click here to access Priority Health’s Frida’s Fireworks, a children’s book that teaches children mental resilience.