As summer ends, some kids get excited about the impending school year--new clothes, new teachers, new friends. Other kids may fear it.

While many children like school, the feeling is by no means universal. Some 2 to 5 percent of school-age American children are thought to suffer from "school refusal"--a disorder in which a child regularly balks at going to school.

Not wanting to go to school may occur at any age, but it's most common in children ages 5 to 7 and 11 to 14. Learning more can help you understand the causes, consequences, and recommended remedies.

Q. What causes school avoidance?

A: The behavior can have a range of causes. Depending on the age of the child, it may be triggered by stressful events at home or at school. Other children may refuse to return to school after a family vacation or after being kept home due to illness.

Some children fear that while they're at school, something could happen to a parent. Others fear that they'll be bullied by other students.

Studies have suggested middle school students who develop the condition are often anxious about social pressures or school performance. Some teens who balk at school may be using drugs or want to get a job.

Still other children who refuse to go to school may be suffering from anxiety, depression, separation anxiety, or post-traumatic stress disorder.

Q. What are the symptoms of school refusal?

A: Children who dread going to school will often say they're sick with a headache, stomachache, or sore throat when it's time to go. If they're allowed to stay home, the illness often goes away but returns the next morning. Other children have temper tantrums when it's time to leave for school.

Q. What are the consequences of school refusal?

A: Short-term consequences include poor academic performance and strained or nonexistent relationships with friends. Long-term consequences may include a risk of not completing high school, employment problems, and even increased risk for psychiatric illness.

Q. What can I do to help my child?

A: The American Academy of Pediatrics suggests parents begin by having a doctor examine the child to rule out physical illness. The academy also recommends these steps:

• Ask your child directly why he or she doesn't want to attend school. Be sympathetic, supportive, and understanding no matter how trivial your child's reasons seem. Take time to allay his or her fears as best you can. Try to come up with solutions.
• Insist that he or she return to school. The longer children are allowed to stay home, the more difficult it is for them to go back. Explain that the law requires school attendance.
• Discuss your child's refusal to go to school with your child's teachers, principal, and school nurse. Ask for their support, assistance, and suggestions.
• If your child's anxieties are caused by a bully, bring these concerns up directly with school staff.
• If you let your child stay home, don't provide special treatment. The day shouldn't be a holiday.

If your child's refusal to attend school continues despite your efforts, seek help from a mental health professional who treats children or teens.

By Barbara Floria, senior writer for Vitality. For more information, senior writer for Vitality.For more information, visit the American Academy of Pediatrics at www.healthychildren.org.

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