It’s time to leave for school, but your 8-year-old is complaining that their stomach hurts. They’re clutching their tummy, crying, and begging you to let them stay home from school. When you agree, they settle down on the couch to watch TV. You notice that their symptoms seem to vanish, and they don’t mention an upset stomach for the rest of the day.

Later that week, the same thing happens. This time, you take them to school. But you get a phone call from the school nurse — your child has left their classroom with a terrible stomachache. You pick them up early, and they spend the rest of the day at home playing normally.

If this type of scenario happens in your home regularly, your child may be displaying what’s known as school refusal.

According to the Anxiety and Depression Association of America (ADAA), school refusal is a term for a disorder where a child regularly refuses to go to school or has trouble staying in school for an entire day.

This can happen with kids aged 5 to 17 who display the following behavior:

  • They’re absent from school entirely.
  • They go to school in the morning, but leave before the end of the school day.
  • They go to school unwillingly after crying, tantrums, clinging to a parent or caregiver, or other intense behaviors.
  • They are visibly distressed on school days and bargain or plea to stay home.

Other symptoms of school refusal include complaints of physical ailments like headaches, nausea, or stomachaches that come on suddenly. A child may ask to go to the school nurse repeatedly.

Other common symptoms include:

  • defiance
  • inflexibility
  • separation anxiety
  • avoidance
  • tantrums

Anxiety-based school refusal affects between 2 and 5 percent of school-aged children.

It’s common during periods of transition like the start of kindergarten, moving from elementary to middle school, or middle to high school. It also tends to be more common for children with average or above-average intelligence.

School refusal in a child is often triggered by stressful life events. These might include moving, starting school, or divorcing parents.

In other cases, it’s a method of avoiding school-related situations that can cause anxiety or depression. This could include tests, oral presentations, or interactions with particular students or teachers.

Another reason for school refusal is to enjoy attention from someone outside of school — to spend time with a parent, for example. Or, a child has more fun at home than in school.

It’s important to make sure that your child’s refusal to attend school isn’t related to a legitimate medical condition, or an issue like bullying. If you suspect these could be reasons for your child’s school refusal, consult your family physician and speak to your child’s teacher, principal, or counselor right away.

Sometimes, it’s easy for families or parents to figure out exactly what’s prompting a child’s school refusal. For others, the source can be difficult to pinpoint. A child may give vague, varied, or even confusing reasons. But no matter why your child is refusing school, it can have a very negative impact. Continued absence from school can result in serious problems, both academically and socially.

Parents should have their child evaluated by a mental health professional. You can ask for a referral from your child’s doctor or their school counselor. An evaluation can help determine the root of the school refusal problem, which makes it easier to figure out next steps.

You can also try these coping strategies.

  • If possible, try to expose your child to school gradually.
  • Communicate with your child, and make it clear that you’re ready to listen to their concerns and fears. Talking about fears can be very helpful.
  • Ask your child what they like about school. Maybe your child loves recess or story time, spending time with friends, or computers.
  • Schedule a meeting with your child’s teacher. If possible, arrange it on neutral territory.
  • Meet with the school counselor and principal for guidance and support.
  • Consider finding a self-help book with useful relaxation techniques. Keep an open mind to show your child that it’s helpful to try different things.
  • Help your child build hobbies or find things that interest him. They can help build self-confidence.
  • Build a support system for your child, including siblings (especially those in the same school), friends, teachers, the principal, and school counselor.

It’s important to keep your child in school. It may seem counterintuitive, but by keeping your child out of school, you’ll reinforce his or her anxiety instead of helping it go away. It’s important to find out what’s going on with your child. If necessary, ask your pediatrician or school counselor for a referral to a child mental health specialist.