Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Overview

When young children begin to attend school, they spend more time away from you. As your child ages, outside pressures grow from school work and peers. School avoidance happens when your child refuses or is afraid to go to school. It is a common problem that affects up to 5 percent of all school-aged children.

Children may give a number of excuses for why they cannot attend school, such as not feeling well although they are not able to describe their symptoms. Your child may have actual physical symptoms caused by anxiety about having to go to school, such as headaches, stomachaches, dizziness, or feeling nauseated. These symptoms are usually active on school days but disappear during the weekend or vacation.

A child may try to avoid going to school because of being afraid of failing or because of social problems with other children. Other common reasons for school avoidance include being afraid to use the public bathroom or thinking their teacher is mean.
Some anxiety symptoms are caused by a medical condition, so we may need to rule out a physical illness before diagnosing school avoidance.

Treatment includes identifying the reason for your child’s school avoidance and focusing on returning your child to school. It is important that you fully understand the pressures your child faces at school. Your child needs to feel supported by you and understand why he or she must return to school. Your child’s teacher, principal, and school counselor should also be informed so they can help your child feel positive about school.

If your child has anxiety symptoms or refuses to go to school for longer than 1 week, call us to schedule an appointment.

Signs of School Avoidance

There are a few common warning signs to alert parents and school staff that children may be avoiding school:

  • Crying regularly about wanting to leave school and go home
  • Worrying about a parent when at school
  • Complaining regularly about having to go to school
  • Feeling their teacher is mean or picks on them
  • Worrying about using a public bathroom
  • Being frequently absent on test days or on days they must give a speech or attend physical education class
  • Having a number of unexcused absences and repeated tardiness
  • Repeatedly asking permission to call a parent or to go home
  • Visiting the nurse’s office regularly complaining of headaches, stomachaches, or other physical ailments

In addition to anxiety, a child who refuses to attend school might also show one or more of the following signs:

  • Depression or not enjoying activities once enjoyed
  • Becoming a victim of teasing, threats, or bullying
  • Having frequent physical complaints, such as headaches and stomachaches

Your child may not have obvious symptoms or be able to describe specific symptoms. Your child might just say he or she doesn’t feel well.

Long-term school avoidance can cause delays in academic progress, failure to make and keep friendships, and interference with other important social relationships. School avoidance also causes stress for parents and can cause problems in family relationships.

A teacher or school nurse may recognize the warning signs of school avoidance first. It is important to identify school avoidance quickly so that we can develop an action plan for successful treatment.

Causes and Risk Factors

Common emotional triggers that cause a child to avoid school include:

Performance anxiety. If your child has extreme anxiety about taking tests, giving speeches or performing in public, or competing in required sports activities, he or she may refuse to attend school. While most children have some nervousness, some children may refuse to attend school to avoid being embarrassed in front of their peers.

Separation anxiety. Your child may be afraid to leave you to attend school because he or she worries that something bad will happen to you when he or she is away. Signs include yelling, crying, kicking, or hiding each morning before school. While occasional morning battles are common for most children, your child may have school avoidance issues if he or she refuses to attend school.

Social anxiety. Your child may have anxiety about talking or interacting with peers and teachers. Some children develop a condition called social anxiety disorder, which causes severe anxiety and emotional distress when in social situations.

School avoidance occurs more frequently when a child is going through a major life change, such as entering kindergarten or moving to a higher grade in a new school. Other significant life events that may trigger school avoidance include moving, changing schools, divorce of parents, school performance problems, and the death of a loved one or a pet.

Some children develop school avoidance problems after being away from school due to a vacation or an illness.

Diagnosis

We diagnose school avoidance by evaluating your child’s physical symptoms and psychological health. We gather information from the parents, child, and school personnel. We may ask each of you to complete a written questionnaire so we can analyze the information.

We might also order medical tests to rule out medical conditions.

We typically review your child’s school attendance and academic records. Depending on the age, we may ask your child to take a test so we can identify possible developmental problems that may make your child feel overwhelmed and trigger school avoidance.

It is important that you do not provide a more pleasing environment for your child when he or she refuses to go to school. For example, is your child watching TV or playing video games, or do you stay home with your child and give him or her a lot of focused attention?

Once we identify the source of your child’s school avoidance, we will work with you and school staff to develop a plan to relieve your child’s anxiety about attending school.

Treatments

If your child’s school avoidance lasts longer than 1 week, call us to schedule an appointment. Your child’s treatment plan depends on his or her age and the reason for school avoidance. It is also important that your child’s teacher(s), school counselor, and principal be involved and follow the recommended treatment plan.

Common strategies in a treatment plan for school avoidance include:

Reinforce positive behavior. When a child participates in school, the teacher and parents need to praise the child to reinforce the behavior. It is also important to ignore crying, complaining, and other negative behaviors.

Support the child when at school. It is important that the teacher make your child feel welcome and provide emotional support to your child when he or she experiences separation anxiety. Teachers can also include your child in simple daily tasks to help him or her socialize without feeling peer pressure. For example, a teacher might ask your child to hand out books or to collect assignments.

Modify requirements at school. The school may need to modify its requirements of your child until your child has less performance or social anxiety. For example, if your child has severe anxiety about public speaking, your child may be excused from reading aloud in class. A child who has test anxiety might be allowed to take a practice test before the real test to help him or her feel comfortable.

Assign a peer buddy. If a young child has social anxiety, it might help to have a peer buddy to talk with at recess or lunch time.

Reduce assignments. If your child has academic problems, a teacher can adjust assignments to your child’s level. You might also think about hiring a tutor to help your child complete homework assignments.

Provide a safe room at school. The school can provide a quiet, safe area where your child can go to reduce his or her stress level when needed.

Provide a safe environment at school. If children feel threatened by a bully, they may avoid school. The school needs to be aware of any bullying problems. It might help if your child is not alone while at school. We can also teach your child ways to handle verbal and physical threats from peers and, sometimes, from adults.

Develop a school reentry plan. If your child or teenager has missed a significant amount of time from school, we must develop a school reentry plan to ease him or her back into school and reduce his or her anxiety. It is important that your child’s teachers be part of the team that supports him or her in returning.

Other Treatment

We might recommend that your child participate in relaxation therapy, learn to set goals, improve social skills, and learn better ways to process negative thoughts, such as fear and worry.

If your child develops school avoidance problems after experiencing a significant life change, such as a divorce or death, be sure to call us to schedule an urgent appointment.

Medication. In severe cases, we may recommend medications to reduce anxiety and depression in your child. The medications are combined with talk therapy to reduce or eliminate your child’s anxiety about attending school. We monitor your child closely when he or she is prescribed these medications as they have potentially serious side effects.

Parent education. We recommend that parents learn how to avoid morning battles about attending school. It is also important to have consistent evening routines on school nights. During sessions, we teach you how to reinforce your child’s positive behavior and how to ignore the negative behavior surrounding school avoidance.

It is important that you do not unintentionally reinforce school avoidance by providing an environment at home that is more desirable for your child than attending school. For example, if your child wants to stay home, he or she cannot be allowed to watch TV, play video games, or attend fun activities.

Supporting Your Child

It is important to understand the pressure your child feels about attending school even while insisting that your child return to school. School avoidance can be frustrating and stressful for parents.

General guidelines for helping your child return to school include:

Calmly talk with your child about the reasons for school avoidance. Listen to his or her concerns without judging them. If you can talk through a particular problem together, your child may feel better about returning to school.

Address significant issues that trigger school avoidance. For example, if your child is the victim of bullying or has a difficult teacher, we will involve the school principal, nurse, and counselor in solving the problem. Together, we identify a solution to protect your child and reduce anxiety about attending school.

Let children know you understand their fears and worries but be firm that they must return to school right now. The longer a child remains out of school, the more difficult it will be to return.

Be prepared for regular morning battles about going to school. Walk away from an arguing child and do not ask how they feel or engage in a discussion about staying home from school. Send your child to school even if he or she has general physical complaints as long as he or she does not have a fever. Physical symptoms often disappear once your child is at school.

Involve the school, including teachers, as well as the school nurse, counselor, and principal in your child’s treatment plan. Your child may need to visit a safe place, such as the nurse’s office, if he or she becomes overly anxious at school. However, it is important that the nurse also encourage your child to return to class after a brief visit. It helps if you are all on the same page about enforcing desired behaviors.

Get your child involved in after-school programs, such as sports, clubs, and other activities where he or she can make friends. Once your child feels more independent, he or she may no longer have separation anxiety or other anxieties that trigger school avoidance.

Extremely anxious behavior

If your child suffers from extreme anxiety about going to school, we might recommend that your child take slower steps to return to school (exposure therapy). For example:

  • Day 1, your child gets dressed for school but remains home.
  • Day 2, your child gets dressed in the morning and then you travel past the school.
  • Day 3, your child gets dressed, you travel to school, and your child stays at school for one-half day.
  • Day 4, your child attends school for a full day.
We might write a note to the school excusing your child from being absent for a few days due to “physical symptoms.” This often helps a child return to school who may be embarrassed about having school avoidance. 
Group therapy might also help an older child increase self-esteem and feel supported by peers.
Additional References:

Your Child's Care with Me

The Child and Adolescent Services in the Department of Psychiatry offer a variety of mental health services. We hope you will not hesitate to call us, for advice or to arrange for services, if your child appears to be troubled or suffering in some way.

Your child’s treatment plan, based on an assessment of his or her needs, may include health education; individual, family, or group interventions; and, sometimes, medication, as appropriate. If your child should need chemical dependency services, these are available within our department as well.  Your child’s emotional health is related to the quality of his or her physical health, family life, and social and academic experiences. The mental health professionals in the Child and Adolescent Psychiatry Clinic encourage the promotion of health in all these realms.

If you are concerned about your child’s symptoms, please call our clinic to speak with a therapist, during the hours of 8:30 am to 5:30 pm, Monday through Friday. After hours and on weekends, for urgent matters, you may call our clinic number, and you’ll be connected to our Regional Psychiatry Call Center, where you will be assisted by a mental health professional. If you believe you have a medical or psychiatric emergency, please call 911 or go to your nearest emergency room.

Whether by phone or in person, we will discuss your child’s symptoms and address your concerns. Together we will create a treatment plan to help your child and your family.

After our first visit, you can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

For nonurgent questions or concerns, you can e-mail me using this site, once you have set up access to manage your child’s health. Use the Manage Your Family’s Health links to get started. If you are a teen, you may e-mail me directly as well.

Coordinating Your Child's Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting care for your child easier.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your child’s care to stay current on your child’s health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your child’s condition, care is safer and more effective.

If you come to an office visit
  • At the end of your child’s visit, you may receive a document called the “After Visit Summary” that will summarize the issues we talked about during the visit. You can refer to it if you forget what we discussed, or if you just want to recheck your child’s height, weight, or vital signs. (If your child is under age 12, you can also view these summaries online, under Past Visits.)
  • To help you prepare for your visit, please see additional details under Office Visit.
If medications are prescribed

Your child’s therapist and psychiatrist will work together to monitor and assess how your child’s medications are working and the psychiatrist will make adjustments as needed.

Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let us know which pharmacy works best for you, and we will send the prescription electronically, in advance.

If refills are needed in the future, you can:
  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your child’s medications at the pharmacy.
  • If no refills remain when you place your order, the pharmacy will contact us regarding your prescription.
If lab testing or imaging is needed

For lab tests, we use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, such as X-rays, we will schedule an appointment with the Radiology Department.

When the results are ready, we will contact you with the results by letter, secure e-mail message, or phone. In addition, you can view most of your child’s laboratory results online, along with any comments that may be attached to explain them.

If we refer your child to a specialist

My specialty colleagues are readily available to assist if we need additional advice about your child’s condition. In some cases, they may be contacted during your visit, so we can discuss your child’s care together. If we decide your child needs a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

Convenient Resources for You

As your child’s mental health professional, I have a goal to provide high-quality care and to offer you choices that make your child’s health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available to help you manage your family’s care at any time that is most convenient for you. You can also learn how to coordinate care for the ones you love from my home page.

Manage your family’s health

Take a few minutes to set up access to act on your child’s behalf. Then you can use my home page to:

  • View and compose secure e-mail messages.
  • Manage your child’s prescriptions and refills.
  • Schedule well visit and nonurgent primary care appointments.
  • View your child’s preventive services to see whether your child is due for any immunizations or well visits.
  • If your child is under 12, you can also view most lab test results and review information about past visits.

If you need help doing the things listed above, check the "Learn how" page. From there, you can learn tips and tricks on how to manage your child’s health conveniently.

Learn more about your child’s condition
  • Read about causes, symptoms, treatments, and procedures.
  • Find interactive health tools, videos, and podcasts to help you manage your child’s condition.
  • View programs to help you decide on or prepare for a surgery or procedure.
Help your child stay healthy
  • Sign up for our online newsletters for parents, customized to your child’s age.
  • Locate health education classes and support groups offered at our medical center.
  • Explore interactive programs, videos, and podcasts that focus on helping you keep your child healthy.
  • View your child’s Preventive Services to see whether he or she is due for any immunizations or a well visit (checkup).

Related Health Tools:

Podcasts

See more Health Tools »

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder. This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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