“My tummy hurts again”: Decoding children’s school avoidance


Every once in a while, parents may wake up to the sounds of perfectly healthy children complaining of tummy aches and feeling sick. While occasionally pretending to be sick to avoid school is a normal part of growing up, more frequent or regular requests to play hooky may signal a larger problem. School avoidance and refusal may occur for a variety of reasons, and – in the long run – addressing the underlying concern(s) will help parents and children return to regular school attendance.

The many faces of school avoidance

Often children avoiding school may complain of illness, express anxiety and worries, or tantrum in anticipation of going to school. Tummy aches, headaches, and general aches and pains are the frequently reported. However, some children become angry, defiant, or may lash out physically or emotionally in the time leading up to the school day.

Signs to look for include:

  • difficulty falling asleep

  • clinginess to parents or caregivers

  • asking to go to work or stay home with parents

Even if your child successfully makes it to school, that may not be the end of the story. Once at school, children may often request to go to the nurse or school office to be sent home.

Parents should rule out any medical reasons for children avoiding school. This can be done by a visit to your pediatrician and ensuring that all well-child visits are up-to-date. From there, parents will need to do some detective work to uncover the underlying cause.

Start by working with your child’s teacher, school staff, and other caregivers to understand the role of each of the following areas of concern for kids that can contribute to school avoidance:

Academic Stress

  • Is your child underperforming, feeling overwhelmed, or experiencing test anxiety?

  • Does your child have a negative relationship with teachers or school staff?

  • Is there a suspected, undiagnosed, or underserved learning disability?

  • Can your child adequately see and hear in the classroom?

  • Is your child in the same classroom all day? Or does he/she need to navigate the campus? If so, does he/she have any trouble finding his/her way from class to class on time?

Social Stress

  • Is your child the victim of bullying?

  • Is your child particularly shy or experiencing nervousness with social interactions?

  • Do your child’s friends also miss school frequently?

Family and Home Stress

  • Is your family undergoing stressful transitions at home, such as: a move, parent separation, parent travel, changes in parent’s employment, addition of a new sibling?

If you suspect that anxiety or stress due to any of the above factors is contributing to your child’s school avoidance, what can you do about it?

  1. Form a team. Partner with your child’s teacher, the school staff, her pediatrician, and/or other mental health professional. In some cases, evaluation for a learning disability or anxiety may be needed.

  2. Show your child that teachers, school staff, and peers can be helpful. Arrange for playdates, positive interactions with peers outside of school, such as at your home, a park, or a friend’s home.

  3. Address any problems at school – particularly if your child is the victim of bullying. This one will require problem solving and interventions with the school staff and teachers. Even if the bullying is outside of school (e.g., cyber bullying), get your school involved.

  4. Work with your team to form a united front. Once you understand the underlying concern(s), addressing your child’s anxiety is essential. This should be guided by a team that includes a mental health professional (e.g., psychologist, psychiatrist, school psychologist, school counselor, therapist).

  5. Develop a consistent plan. Routine and clear expectations are essential for success. This includes setting a schedule (a picture schedule can be helpful for younger children) with regular reminders and cues to help children prepare for the day. Work with the school and your health care providers to establish clear guidelines for when school can be missed. It is helpful to rely on guidelines from the Centers for Disease Control and Prevention (CDC) or school guidelines for measurable signs that it is okay for kids to miss school (e.g., fever, diarrhea, vomiting).

  6. Avoid pitfalls. No one wants to do something hard if they are tired or hungry. The same is true for children struggling with school avoidance. Make sure your child gets a good night’s rest, eats breakfast and feels ready to learn.

  7. Establish a reward system. You are asking your child to do something hard and rewards can go a long way. Work with your team to establish a reward system and get your child’s input so that the prizes are meaningful.

  8. Lastly – take care of yourself as a person and as a parent! If you become overwhelmed in the mornings, take a break, walk away, and try again. Reward yourself for small improvements along the way. If your child has not been going to school and makes it there before the end of the day, you’ve made progress!

Additional Resources for Parents

Proper citation link for this blog post:

Kiff, C. J. (2019). “My tummy hurts again”: Decoding Children’s School Avoidance.
from https://infoaboutkids.org/blog/my-tummy-hurts-again-decoding-childrens-school-avoidance.

Cara Kiff Ph.D.