Short answer: school refusal is a child’s repeated distress about going to school, often with stomach aches or tears in the morning. It is usually driven by anxiety, not defiance. The sooner the child returns to school with support, the easier recovery tends to be.
Signs to watch for
- Headaches or stomach aches on school mornings that improve on weekends
- Frequent visits to the school nurse or calls to come home
- Tantrums, crying or freezing at drop-off
- Worry about tests, friends, teachers or being away from a parent
- Growing absences, especially after holidays or illness
Common causes
Separation anxiety, social anxiety, generalized worry, bullying, learning difficulties, ADHD, depression or a stressful change at home can all contribute. Medical causes of physical symptoms should be checked by the pediatrician.
What helps
- A team plan: parents, school counselor and clinicians working together.
- Gradual return: partial days or specific classes first, building up step by step.
- CBT for anxiety: teaches children to face fears in manageable steps.
- Consistent mornings: calm, predictable routines, with limited screen time and rewards for days at home.
- Medication: considered when anxiety or depression is severe or not improving with therapy.
Massachusetts school supports
A 504 plan or IEP may provide accommodations such as a check-in person, breaks or a modified schedule while the child recovers. Documentation from a clinician can support these requests.
Talking with your child
Ask open questions at calm times, not on stressful mornings: “What is the hardest part of the school day?” Children may struggle to name the fear, but they often point to specific moments such as lunch, the bus, a class or a classmate. Validate the feeling (“that sounds really hard”) while expressing confidence that they can handle it with help.
Teens and school avoidance
In teenagers, school refusal is more likely to be linked to depression, social anxiety, bullying or online conflict, and it can look like oversleeping, staying in their room or constant illness. Teens benefit from having a say in the return plan and from privacy in their own appointments.
The cost of waiting
The longer a child stays out of school, the bigger the hurdle of returning: missed work piles up and anxiety about being behind grows. Acting within the first few weeks, with school staff and clinicians working together, gives the best chance of a smooth return.
Frequently asked questions
Should I let my child stay home on bad days?
Occasional sick days are fine, but repeated avoidance usually makes anxiety stronger. Work with your clinician on a gradual plan.
When should we see a psychiatrist?
If absences are growing, your child seems depressed, or there are any safety concerns.
Psych Boston’s child and adolescent psychiatry team supports families across Greater Boston. Read our parent guide to child psychiatry or request an appointment.
Related reading: 504 Plans and IEPs for ADHD in Massachusetts Schools · Specific Phobias: Flying, Needles, Driving and More
This article is general information, not medical advice. If you are in crisis, call or text 988 or call 911. Psych Boston is an outpatient psychiatry practice at 35 Bedford St #17, Lexington, MA781-218-9550).