Rising awareness of school refusal reveals hidden anxiety triggers in children

Experts highlight that children experiencing frequent headaches, stomach aches, or nausea before school may be suffering from school refusal linked to underlying anxiety, prompting calls for better intervention and understanding.

Children who suddenly develop headaches, stomach aches or nausea before school may not be faking illness or simply being difficult. According to Dr Nguyễn Mai Hương, head of the Centre for Developmental Medicine and Mental Health at the National Children’s Hospital in Việt Nam, repeated distress before the school day can point to a pattern known as school refusal, in which a child becomes so anxious about attending that they try to avoid it. The American Academy of Child and Adolescent Psychiatry says the behaviour is not a formal diagnosis but a sign that something deeper may be going on, most often anxiety.

The warning signs can be hard for families to miss. Children may cry, throw tantrums, plead to stay home, hide in their room or become physically ill only when school is mentioned. Cleveland Clinic and HealthyChildren.org say these symptoms often include stomach pain, headaches, vomiting, worry, sleep problems and low mood, with the discomfort easing once the child is allowed to remain at home.

Experts say the causes can range from separation anxiety and fear of leaving parents to academic pressure, friendship problems, depression, attention difficulties or an undiagnosed learning disorder. Nationwide Children’s Hospital notes that school refusal is especially common when younger children first start school, or when older pupils face a specific stressor that makes the classroom feel unsafe. The AACAP says studies estimate that between 1% and 5% of school-age children experience the problem at some point, often around ages five to seven and again in early adolescence.

Specialists advise parents not to answer distress with threats, criticism or punishment. Instead, they recommend restoring a predictable morning routine, preparing clothes and school items the night before, and working with teachers to make the return to class feel manageable. If avoidance persists, or if a child shows signs of depression or severe anxiety, Cleveland Clinic and child mental health experts say a professional assessment is important so the root cause can be treated rather than the symptoms alone.