School anxiety is common in children, and warning signs may not always be obvious. If anxiety progresses, it may eventually lead to school refusal or avoidance. Vague symptoms may develop initially, and parents may eventually notice frequent complaints of headaches, stomachaches, nausea or lightheadedness. A pattern may appear where children seem fine over the weekend, but illnesses reappear on school days. It is important to remember that the physical symptoms may be very real to the child, but they may be unable to express what is triggering their discomfort.
Some children may not complain of physical symptoms but instead have changes in their demeanor or behavior. Frequently children may become clingy with their parents or caregivers. Other children may be tearful after minor disappointments, act out at home or toward siblings, or have difficulty falling or staying asleep.
Anxiety may also present in different ways to various observers. Some children may try hard to be “good” all day at school and then fall apart or act out after school once they feel safe at home. Other children may misbehave during the school day. Difficulty focusing or listening may sometimes develop if children are unable to concentrate due to excessive worrying.
Anxiety may have many different etiologies. Transitions such as entering school for the first time, changing schools, or starting a new school year may all serve as triggers for anxiety due to fear of the unknown. Once established in school, there may be other causes including fear of failure, bullying or negative social interactions with other children, a challenging relationship between the teacher and student, anxiety about using the bathroom at school, or difficulty keeping up with coursework.
If you are noticing a pattern of physical illness or are concerned about ongoing anxiety, it is important to see your pediatrician to rule out other issues and come up with a plan to address the anxiety. In some cases, therapy or medication may be needed.
As a parent there are several ways you can assist your child:
▪ Make sure your child is getting a good night sleep, eating regular healthy meals, drinking plenty of water and getting adequate exercise. Children who are tired or are not having their physical needs met may have lower reserves to deal with stressors.
▪ Set aside time to talk to your child alone about the reasons he/she does not want to go to school. Be supportive and try to avoid downplaying their concerns. It is often more helpful to assist the child in brainstorming to come up with solutions together rather than telling them what they should do when anxious.
▪ Reach out to the teachers, school nurse or school counselor if your child has ongoing issues with anxiety. The school staff may not always realize that a child is struggling. An anxious but quiet child may not necessarily come to the attention of a teacher who needs to maintain order in a class with several disruptive children. If aware of a concern, the teacher may be able to have an assistant or counselor spend extra time with an anxious child or develop a strategy for dealing with a child’s anxiety. A school nurse may be able to assist with avoiding frequent early dismissals/absences if a plan is in place to help with anxiety-related headaches or stomachaches. Be an advocate for your child, particularly if there is a bully or another situation that requires help from the teachers or administration.
▪ Focus on creating consistent routines, especially in the morning prior to school. Try to avoid asking an anxious child if they feel well or are anxious when they are getting ready for school. If they bring up concerns on their own, remind them of the solutions they helped you come up with previously.
▪ Encourage your child to build their confidence with extracurricular activities that they enjoy. However, avoid overscheduling children as this may lead to further stress. Informal playdates with a friend from school may also help develop relationships, so that they look forward to school and time with their friends.
▪ Don’t forget that even anxious children may have new physical illnesses develop. Have your child evaluated by the pediatrician if they have ongoing or new physical symptoms such as fever, loss of appetite or weight loss, vomiting and diarrhea, frequent bathroom accidents, or are waking up overnight due to abdominal pain or headaches.
Dr. Mason obtained both her M.D. and Ph.D. at the University of Maryland School of Medicine. She then completed a research fellowship at Johns Hopkins University School of Medicine before returning to the University of Maryland Medical Center for her residency in pediatrics. She is a fellow of the American Academy of Pediatrics and is board certified by the American Board of Pediatrics.