I cannot go to school today,” said little Peggy Ann McKay. “I have the measles and the mumps, a gash, a rash and purple bumps.

My mouth is wet. My throat is dry. I’m going blind in my right eye. …” The list of aches, pains and ailments goes on and on. That is until little Peggy – in Shel Silverstein’s classic children’s poem Sick – discovers that it’s Saturday. Peggy’s the personification of lots of kids who “fake sick” to get out of going to school.

According to the American Academy of Child & Adolescent Psychiatry, not wanting to go to school can occur at any time, but is most common in children ages 5-7 and 11-14. These are the times when children are dealing with the new challenges of entering elementary and middle school. Avoiding school affects girls and boys equally.

Reluctance to go to school may follow an extended period at home in which the child has become closer to the parent, such as summer vacation, holiday breaks or an illness.

Other stressful events, such as the death of a pet or relative, moving to a new neighborhood or entering a new school may also prompt children to avoid going to school altogether.

Or, you may notice that you frequently get a call from your child’s school informing you that your child is complaining of an “illness” – just in time to avoid a difficult assignment.

Sterling Heights pediatrician Richard Weiermiller says that he sees “lots of children who want to avoid school in order to remain close to mom, especially during stressful situations at home or school.” Stomach pains are an especially common ploy. The location of the pain will give you a clue as to the seriousness of the complaint, Weiermiller says. “Ask the child to point to where the pain is. If they point directly to their belly button, it’s likely not serious.” Weiermiller says that pain identified around the navel most likely indicates constipation or stomach flu.

If your child points to other areas, parents should investigate further, Weiermiller says.

If possible, take the child’s temperature.

“Abdominal pain with fever can indicate something more serious.” And it’s hard to fake both of these symptoms at the same time.

Activity levels are another good indicator of whether a child is truly ill. “At every age, if the child is not doing the normal fun things they like to do, it’s a good sign that something is up,” Weiermiller says.

The American Academy of Pediatrics recommends that parents “err on the side of sending the child to school,” particularly if you suspect your child is trying to fake an illness. If your child is well enough to be up and around the house, then your child is well enough to attend school. Once the child is at school, the symptoms may disappear.

On the other hand, a child may seem fine in the morning, then suddenly develop an “illness” to avoid a test or a task the child finds unpleasant. Classroom pressures and relationships with other children may become stress-producing situations prompting physical complaints.
Parents should be aware that today, most schools do not have a nurse at school full time. If your child’s school does have a nurse on staff, listen to the nurse’s assessment of your child’s complaint. You may not need to pick up your child immediately. If your school does not have a full-time nurse, enlist the assistance of your child’s teacher and principal to keep your child in school.

If your child is going to remain at home, or leave early from school due to “illness,” the American Academy of Pediatrics recommends that the time away from school should not be a vacation day.

Provide for your child’s safety and comfort, but do not allow special treats. If the child’s complaints warrant it, the child should remain in bed. Television, phone and computer access should be strictly limited, and children should be supervised while at home. As a consequence for missing school, your child should not be allowed to attend afterschool activities.

School avoidance tends to result in poor academic performance, family difficulties and difficulties with the child’s peers. Most children do recover from school avoidance, although some may develop it again after a real illness or a vacation.

WHEN TO SEEK PROFESSIONAL HELP Often, “school refusal” problems will respond to reassurance from parents orTeachers. However, do seek professional help if you or the school observes emotional, learning or behavior problems interfering with school success.

This more serious school avoidance, sometimes called school refusal or school phobia, occurs in as many as 5 percent of children, according to the American Academy of Pediatrics. Physical complaints occur on school days, and are usually absent onWeekends. When these children are examined by a doctor, no true illnesses are detected or diagnosed. However, since the type of symptoms these children complain of can be caused by a physical illness, a medical examination should take place.

While you might try to manage school refusal on your own, if your youngster’s school avoidance lasts more than one week, you and your child may need professional assistance to deal with it. First, your child should be examined by your pediatrician.

If his school refusal persists or if he has chronic or intermittent signs of separation difficulties when going to school – in combination with physical symptoms that areInterfering with school functioning – your doctor may recommend a consultation with a child psychiatrist or psychologist. A visit to a psychologist can help to clarify the situation, determine if further professional assistance is needed, and plan a course of action.

After medical reasons for your child’s complaints have been eliminated, the first step is to “determine whether this is a case of separation anxiety or school refusal,” says Carol J. Schwartz, Ph.D., of Franklinbased Psychological Institutes of Michigan.

Schwartz specializes in child and family psychology and psychological testing.

“Sometimes, parents don’t allow or give children the skills to perform on their own,” she says.

School avoidance issues stem from either a problem at home or problems at school, Schwartz says. “If there’s nothing medical going on, what else is there?” Home problems might include matters like divorce, parents fighting or a recent death.

Schwartz notes that separation anxiety stems more from problems at home rather than problems at school. School problems might include learning difficulties, bullying or a problem the child is having with a teacher.

“Sometimes kids are afraid to tell parents what is going on,” Schwartz says. So, the child develops physical complaints to get out of unpleasant tasks.

Depending on the nature of the child’s problem, services such as parent guidance, individual child therapy or family counseling can be helpful in resolving school avoidance.

Treatment should include communication between parents and school personnel, as well as regular attendance at school. Therapy includes treatment of underlying causes, as well as behavioral techniques to cope with the stresses at school.

Follow-up parental guidance can help work out an appropriate plan for school support.

Psychological testing can identify learning problems. “Definitely, learning difficulties can lead to complaints like stomachaches or headaches,” Schwartz says.

Schwartz cautions that children may even force themselves to throw up in order to stayHome or return home.

“Insist on school attendance,” she says.

“Unless the child is vomiting with a fever, send them to school.” She notes that it would be important to speak to staff and gain their cooperation in having the child remain at school. Some public school policies require that you keep your child at home until they have not had any vomiting for at least 24 hours. “If the child has no fever and is causing themselves to throw up, or simply saying that they are vomiting, send the child to school,” Schwartz says. However, your child should be kept at home or sent home for fever, coupled with active vomiting, or diarrhea.

Parents must insist on school attendance, Schwartz says.

“No matter which of the two (separation anxiety or school refusal) is causing the problem, the kids have to be in school.” The longer a child stays home, the more difficult returning to school will be.