Child Is Missing School Due to Illness

When a child complains of physical symptoms in the morning before school it can be a tricky situation and difficult to know what to do. Are they sick? Are they nervous/scared? Are they faking it to get out of something?

Any of these thoughts are possibilities, and as a teacher or a parent, it can be difficult to differentiate. Let’s face it, germs and illness are constantly being traded at daycares and schools.

Anyone experiencing changes in their mood can have corresponding physical symptoms, and kids have less and less time to study for tests.

When it comes to differentiating which it could be, keep in mind that you know your child best. As a psychologist, I can ask questions and make hypotheses based on patterns and previous experiences working with children with physiological complaints, but nothing compares to the relationship between a child and their caregiver.

Look for Patterns with Your Sick Child

Does your child always complain of stomachaches or headaches? Do these complaints correspond with Sunday evenings or the end of the summer? Do you notice more physical complaints around tests, large projects, or public speaking? Do the stomach aches occur before social situations?

Looking for patterns such as these can be extremely helpful when determining correlations. However, they can at times be difficult to spot, especially over long periods of time.

Children might also have poor insight into these correlations or even their own mood because labeling emotions can be difficult at a young age. Note any of these patterns to your pediatrician or mental health provider.

Is Your Sick Child Faking Their Illness?

Chances are, no. Stress can often lead to physical symptoms. When we become anxious or nervous this can trigger our fight or flight response.

Our body has difficulty differentiating between the stress of a car heading towards us as we cross the street or the stress of an exam. This fight or flight response often leads to increased heart rate, muscle tension, quick/shallow breaths, sweaty palms, and butterflies in the stomach.

Frequent physical reactions to this survival response can cause pain or make typical aches and pains worse. For example, frequent muscle tension or teeth grinding related to stress can cause headaches or worsen them.

School Avoidance and School Stressors

If physical symptoms correspond to school in general (e.g., get worse Sunday night and during the school year) school itself could be the stressor. In this situation, it can be helpful to look at school as a phobia.

By staying home and avoiding the stressor anxiety immediately decreases. However, this anxiety will increase the next day and become more severe.

As is the treatment with phobias, exposing your child gradually to the stressor can help them get back to school. This might mean taking the drive to school one day, walking to the next, staying for one class, then a half day, etc.

Missing school for children with anxiety can also increase school related worries. “What did I miss? Are other students going to ask where I was? I didn’t turn in my assignment!”

Your Child Does What You Do

While physical symptoms can be purely biological, how we deal with them is often learned socially.

Take for example the child that falls and scrapes their knee and responds only after seeing the horrified look on their parent’s faces.

Children whose parents go to work with a headache or cold symptoms are likely able to cope better with these symptoms themselves. Whitehead et al. (1994) even found that children who are modeled sick behaviors will also miss more work days as adults.

This doesn’t mean we all don’t need a day in bed to recover from an illness, but coping with frequent physical symptoms (e.g., allergies) in a positive manner is a great model for your children.

Taking care of yourself (e.g., taking medicine to feel better, going to bed earlier, using a heating pad) and then continuing to function (e.g., go to work, run needed errands) sets the precedent that life does not stop when difficulties arise.

What If It’s a Chronic Illness?

Chronic pain is when pain persists, in the medical world this tends to be longer than three months. If your child struggles with a diagnosed medical illness or even a long-term unexplained medical illness a 504 plan may be appropriate.

A 504 plan is the medical equivalent of an Individualized Education Plan or IEP. It can legally require schools to provide appropriate accommodations for children suffering from a medical condition.

Functioning is key for improving chronic pain and for coping with a chronic medical condition. Zeltzer and Schlank (2005) note that improvement in chronic pain is first measured by improvements in daily functioning.

Dr. Zeltzer is a leader in the field of pediatric chronic pain. I highly recommend you check out Dr. Zeltzer’s book “Conquering Your Child’s Chronic Pain” (affiliate link).

Staying at home for long periods of time away from friends and activities could also lead to poor mood or even depression. School accommodations provide students suffering from physical concerns ways to participate in school and return to day-to-day functioning as much as possible.

Reward Your Child

This doesn’t mean that your child should never miss school. Setting yourself and your child up for unrealistic expectations can be damaging.

If your child needs to miss school due to an illness, especially if they have a fever or are contagious, this should be a recovery day, not a fun day.

When missing school due to an illness the day should include coping strategies that can help your child feel better. Avoid pairing sick days with activities they enjoy (e.g., going to the movies, playing video games, etc). This can reinforce any school avoidance.

Also, save missed school days for things that are important to you and your family (e.g., a total eclipse, the cubs winning the world series, grandma coming to town).

If your child can function through a school day when they are experiencing some pain, they can save missed days for something they enjoy.

These planned family events can also improve their mood. Keep in mind that it is always important to attend school and that these days should be for special occasions and used in moderation.

What to Do If Your Child Frequently Complains of Physical Symptoms:

  • Talk with your pediatrician. Underlying medical concerns should always be ruled out first.

  • If physical complaints are chronic, work with your doctors and school to develop a 504 plan. Some medical offices and schools will have a social worker, psychologist, or counselor to help with this process. Utilize accommodations for your child to attend school as much as possible.

  • Focus on functioning. Make healthy lifestyle changes if needed. Look at diet, exercise, and sleep for possible areas of improvement.

  • Cognitive behavioral therapy provided by a mental health provider with experience working with chronic medical conditions can also be effective.

References and Recommended Readings:

Palermo, T. M. (2012). Cognitive-Behavioral Therapy for Chronic Pain in Children and Adolescents. New York: Oxford University Press.

Whitehead, W. E., Crowell, M. D., Heller, B. R., Robinson, J. C., Schuster, M. M., & Horn, S. (1994). Modeling and reinforcement of the sick role during childhood predicts adult illness and behavior. Psychosomatic Medicine, 56, 541-550.

Zeltzer, L.K., & Schlank, C.B. (2005). Conquering Your Child’s Chronic Pain. New York: William Morrow – Harper Collins Publishers.

Click here to read more articles by Danielle Mizell, Psy.D.!

Danielle Mizell, Psy.D.
Dr. Mizell enjoys working with children, adolescents, and young adults, providing therapy and assessments.Danielle has experience working with families in children’s hospitals, addressing the stressors that coincide with medical diagnoses. Specialty treatment areas include anxiety, sleep disturbance, chronic illness, pain management, and medical treatment adherence.

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