Please note: This information was current at the time of publication but now may be out of date. This handout provides a general overview and may not apply to everyone. 

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Am Fam Physician. 2003;68(8):1563-1564

What is school refusal?

Children with school refusal are scared to go to school. They may be so scared that they won't leave the house. School refusal is most common in 5- and 6-year-olds and in 10- and 11-year-olds, but it can start at any age.

The problem might start after a child has been home for awhile, such as after a holiday, summer vacation, or brief illness. It also might happen after a stressful event, such as moving to a new house or the death of a pet or relative.

Children who won't go to school often say they feel sick. They might wake up and say they have a headache, stomachache, or sore throat. If they stay home from school, the “illness” might go away, but it comes back the next morning before school. Some children may have crying spells or temper tantrums.

What other problems are children with school refusal likely to have?

Children with school refusal may worry about the safety of their parents or themselves. They may not want to be in a room by themselves, and they may be scared of the dark. They also may have trouble falling asleep by themselves and might have nightmares.

What is the difference between school refusal and “playing hooky”?

Children who are truant (or “playing hooky”) are not scared to go to school the way children with school refusal are. The table below compares some of the characteristics of school refusal and truancy.

School refusal

The child is unreasonably scared of going to school.

The child might pretend to be sick or say he or she doesn't want to go to school.

The child usually wants to stay home because he or she feels safe there.


The child chooses not to go to school.

The child skips school and doesn't tell his or her parents.

The child may have antisocial behaviors such as delinquency, lying, and stealing.

What should I do if my child refuses to go to school?

Take your child to the doctor. Anxiety or a physical illness might be causing the problem. You also should talk to your child's teacher or school counselor.

How will I know if my child is really sick?

Your child's doctor will be able to rule out any illness that may be causing the problem.

How is school refusal treated?

Unreasonable fears about leaving home can be treated. Parents must keep trying to get their child to go back to school. Your child's doctor may want your child to talk to a psychologist, social worker, or child psychiatrist. The doctor also might prescribe medicine to help with your child's anxiety.

The longer your child stays out of school, the harder it will be to return. The goal of treatment is to help your child learn ways to reduce anxiety and return to school.

Can other problems develop if my child does not get help?

Children who do not go to school for long periods may develop serious learning setbacks or social problems. Children who do not get professional help might have emotional problems such as anxiety when they get older. Early treatment of this problem is important for your child's well-being.

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