School Anxiety and School Avoidance: Help for Parents in the UK

If your child talks about feeling hopeless or very low, speak to your GP or school staff soon, and use the urgent routes above if you are worried about their safety. The YoungMinds Parents Helpline is on 0808 802 5544 (open on weekdays, check their site for the hours).

The NHS Healthier Together website describes emotionally based school avoidance as when a child finds it hard to come to school because of strong feelings such as anxiety, fear, low mood or distress. It says children often want to attend but the feelings are too big to manage. Signs it lists include saying they feel ill on school mornings (headache, tummy ache, feeling sick), being very upset, tearful or angry before school, struggling to sleep on school nights, worrying a lot about school, friendships or being away from home, refusing to get dressed or leave the house, or attending but finding it very hard to stay all day. It adds that even without a medical illness, the distress is genuine. Source: Healthier Together: EBSA.

YoungMinds adds that young people may not be able to explain what is wrong, and may show it through anger, withdrawing, panic or dropping grades. It notes that the term school refusal implies a choice, which many young people and parents dislike. Source: YoungMinds: school anxiety and refusal.

Healthier Together says there is usually more than one reason. Common ones include worries about learning or exams, friendship problems or bullying, big changes such as moving school or year group, feeling different from others, special educational needs or additional needs, family changes or stressful events, and low mood or anxiety. YoungMinds also mentions grief, parents separating, being a young carer, and unrecognised conditions such as autism, ADHD, dyslexia or dyspraxia, where school days can be very tiring. Sometimes there is no single clear reason. See also help for social anxiety, ADHD and autism support and sensory needs and autism support.

Healthier Together suggests you stay calm and listen, show understanding (for example, saying "I can see this feels really hard"), keep sleep and morning routines steady, take small steps such as visiting school after hours or slowly building up time in school, and praise effort, even small brave steps. It suggests avoiding long periods off school where possible, because time away can sometimes make worries grow. YoungMinds suggests helping your child say what is worrying them, preparing for the morning the night before, focusing on one next step at a time, making time for things that help them relax, and taking the pressure off on days when they cannot manage. It says to try not to shout, tell them off or physically force them into school, because making them go in without changing anything can make anxiety worse in the long term.

Healthier Together says schools and parents need to work together, and that schools can offer a safe adult to check in with, a quiet space, a short-term adjustment to timetable or workload, help with friendships, and links with outside services. YoungMinds suggests asking for a meeting with the class teacher, pastoral lead or the school's SENCO (special educational needs coordinator), agreeing changes and a date to review them, and following up in writing. Examples it gives are a calm start with a job to do, a flexible start time, a friend at the gate, a visual timetable, an exit card, a mentor or peer buddy, and a reduced timetable with regular reviews.

If your child cannot go in at the moment, YoungMinds says to be honest with the school that your child is too anxious to attend, to ask for a note from your GP, CAMHS (the NHS child and adolescent mental health service) or another mental health professional as early as you can, to keep a record of what you and the school are doing, and to keep a learning routine going at home. It says local authorities must provide alternative education if a child cannot attend school for a significant period, and names IPSEA, SENDIAS and Child Law Advice as sources of free advice. It also says that if absence goes on, your child may be referred to an Education Welfare Officer and the school may refer them to CAMHS.

Healthier Together says to speak to school staff, including the mental health support team if your school has one, if attendance is falling, morning distress is getting worse, your child talks about feeling hopeless or very low, or you feel stuck. It says you can also contact local counselling services or your GP, and that some children are referred to CAMHS. YoungMinds says seeing a counsellor or therapist, starting with your GP, is a good place to begin, and that if there may be unrecognised needs you can ask the SENCO to refer to an educational psychologist or a speech and language therapist while you wait for an assessment.

Different professions can help, and the right one depends on your child's age and what is going on:

• Counsellors and child and adolescent psychotherapists offer a place to talk through worries; play therapists work through play with younger children.
• Practitioner psychologists can look at anxiety, learning and wider needs, and CBT therapists offer a structured, step-by-step approach to anxiety.
• Family and systemic psychotherapists work with the whole family when home and school are both under strain.
• Occupational therapists can help where sensory or daily-living difficulties make the school day overwhelming, and speech and language therapists where communication is part of it.

For more, see which professional for my child, getting help for your child's mental health and questions to ask a child's therapist.

Whoever you choose, check their register and ask about fees, session length and how you will review progress together. See questions to ask before you book and how much therapy costs. On Therapist Circle, each practitioner's registration is checked when they join, and their profile shows the register and number so you can check it yourself.

YoungMinds says many parents in this position feel overwhelmed, burnt-out and isolated, and suggests accepting offers of help, talking to your employer about flexible working or parental leave, and getting support for yourself. Healthier Together says it is not about laziness or bad parenting. If the strain is affecting you, see help for stress and free and low-cost therapy.