It starts with a stomachache, perhaps a headache, maybe a little sore throat thrown in for good measure.  Any parent with school-age children knows the symptoms of “schoolitis,” and with the start of school just around the corner, most parents expect the occasional episode. For some children, though, “schoolitis” is more than just a passing phase. Instead, it develops into full-fledged school refusal, and unfortunately, adults often make it worse by accident.

It usually takes awhile before parents start doubting their child’s “sickness,” so they let the child stay home a few times before they put two and two together.  Other children don’t fake sick — opting instead for tears and tantrums — but parents still let them stay home. After all, it’s hard for a parent to drive away while their kindergartener drops crocodile tears on the school sidewalk.

Usually, even the most tearful children get over it soon after the parent leaves. Teachers know how to redirect children, so the morning routine is enough to settle most children. After a few days, maybe a few weeks, even the most reluctant children adjust. For those who don’t, however, the problem usually gets worse.  Again, well-meaning adults are often to blame.

For example, suppose you decide to let your child stay home once because he is so upset at school; you figure he’ll get over it and be better the next day. This “cure” does work briefly, because it allows children to avoid what they fear: school. Tomorrow, you’ll have a much tougher battle getting him to go.

Teachers and principals also contribute to the problem without meaning to do so. While it may seem obvious that sending a child home rewards his refusal, teachers and principals are stuck in a no-win situation.  If parents are strong enough to leave a crying child behind, that child’s commotion can be quite disruptive to the class. If the teacher spends half the morning calming a child, the other students can’t get the attention they need. On the other hand, if the teacher ignores the upset child, his crying distracts the rest of the class. Eventually, school personnel run out of options.

In the short term, sending the child home makes the behavior better, but in the long run, the refusal will get much worse, setting up a self-perpetuating cycle.  Eventually, the child may be sent home repeatedly … sometimes after being at school for less than an hour.  Obviously, a child who has to be picked up every day cannot learn, and his parents cannot keep their jobs.  What’s worse, severe school refusal leads to tension between parents and teachers, the very people who must be able to work together if they hope to fix the problem.

School refusal has several causes. Usually, it’s separation anxiety; children worry that something bad will happen to them or to their parents while they are in school. Other times, something about school troubles them. Perhaps they’re being teased, or maybe they have trouble with the work.  Regardless of the cause, one thing is clear: allowing a child who is anxious about school to stay home only makes the problem worse. It’s much more important to treat the underlying problem while showing the child how to face that fear.

Fortunately, although school refusal is more difficult to treat the more severe it is, it’s usually a very treatable problem. Treatment requires figuring out what’s driving the behavior, then teaching everyone involved to keep the child in school unless he is injured, has a fever, or is vomiting. Together, teachers, principals, parents and therapists must develop creative strategies to soothe the child at school.

In treatment, parents usually struggle with mixed feelings: sympathy for the child’s fear vs. frustration over the child’s inability to control it. Often, the therapist’s work targets the parents’ responses just as much as the child’s. It’s extremely difficult for most parents to set limits on a child’s anxious behaviors, but school isn’t just about learning to read and write. It’s also about learning how to get along in society and to cope with things we’d rather not do. Children who can overcome school fears are better prepared to face other challenges down the road.

Tamara Stevens, MA, is a child psychologist at Washington Pediatrics, 1206 Brown St., Washington. She may be reached by calling 252-946-4134. This column was originally run in the Washington Daily News on Aug. 18, 2013.