Children who refuse to go to school

Children with problems at school is a very important topic to discuss in pediatric psychiatry as this is very common condition in the society. A very important part of a child's life is spent in the school. Therefore it is to be expected that when a child has some psychological problem it will show up in school attendance or school performance. Children who refuse to go to school, the majority of such children (below 12 years or so) , are good performers at school, but refuse to go to school because of emotional problems. They have fears of leaving home and going to school; often they develop some tummy ache, headache, leg pains or aches and pains elsewhere, when it is time to go to school. Younger children are not so resourceful so they simply cry and refuse to go. If taken they will try to run away from the class. Often the child keeps away from school persistently. In that instance, the parents are aware of the child's whereabouts as the child is at home, unlike in truancy where the child conceals the absence from school. The problem can occur at different ages. It usually occurs at times when schools are changed. There is also a  during adolescence.

It may manifest after a minor illness when the child is kept away from school for a few days, when there are problems at home (‘e.g.-depressed mother, physical illness of a parent) or when there are problems at school (e.g. being bullied in school). In these instances the child may express unwillingness to go to school openly or may present with physical symptoms such as those described above. On further questioning one finds that most of these complaints are confined to the mornings and that the symptoms are absent during weekends and school holidays. After the happy weekend, these children wake up on Monday morning with a fear of having to go back to school - "Monday morning sickness" Once the time to go to school passes the child starts to play and indulges in the usual activities. In the treatment of this condition the absence of a physical ailment has to be excluded fairly rapidly. Usually with a good history it is rather obvious. The presence of problems at home or in school has to be explored and, if present, remedial measures have to be taken. The main aim is to get the child back to school as soon as possible. In practice this has to be planned out between the parents, the teachers and the doctor. To overcome the initial difficulties of returning to school, the child may have to be accompanied by one of the parents in the mornings. The guiding principle in managing these children is that the parents must be told firmly that they should show firmness in sending the child to school. The parent would often have to take the child and speak to the teacher about the problem. The teachers in primary schools are often skilled in handling these situations.