School just started and our second-grader has already missed four days. She was a wonderful student last year, but this year she is reluctant to go to school; and recently she has been sent home from school twice with a stomachache. She seems fine after she's been home a while. What should we do?
You are not alone. We hear about this problem every year. Fortunately, your daughter's school refusal should be easy to solve, since she is young and it hasn't been going on very long.
The first thing to know is that your daughter's stomachache is quite real to her. It is bodily symptom of some kind of fear or stress. We suspect something is worrying her about school -- making her want to avoid it -- or home -- making her want to be there.
You can start by having three discussions.
* Call your daughter's teacher. Tell the teacher how your daughter seems to be at home. Find out how she seems to be at school. See if the teacher has knowledge of any problems or stresses at school. Experienced teachers have dealt with school refusal many times and can be quite helpful. You may find the school situation is giving your daughter realistic reasons for concern and will need to be modified.
* Call your daughter's doctor to discuss the problem. A visit may be suggested to talk and to examine your daughter for undetected health problems. The chance you are missing a health problem severe enough to keep your daughter out of school is slim, so be certain to schedule any doctor's visit after school hours. It is best to avoid contributing to your daughter's absences, but having her doctor's reassurance can be helpful.
* Explore the situation with your daughter. Try to get her to talk about her feelings about school, herself and home. Do this in a gentle way, showing that you are willing to listen.
Give her a number of quiet opportunities to be with you. She will probably give you clues to what is bothering her. This may take time, because it is unlikely that she knows herself exactly what is wrong. Talking with you may by itself help your daughter get over her fears. If you already know your home life is putting severe stress on your daughter, get into family counseling now!
You must deal with your daughter's school refusal, while acknowledging her abdominal pain -- it is very real to her. Your approach can be to say, "I'm sorry your tummy hurts. Your doctor, your teacher and I have all agreed that it will be all right for you to be in school, even though your tummy is hurting. We want you to be there, so you can go on learning." Then, with her teacher as an ally, firmly insist that your daughter go to and stay in school.
Naturally enough, school attendance is the cure for school refusal. As your daughter succeeds, her fears will gradually fade away. And so will her abdominal pain.
Dr. Wilson is director of general pediatrics at Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.