Miri gets so worried about her tests at school that she develops severe headaches. Nothing I say seems to relax her tension. What should I do?"

"Richie complains of stomach aches all during the week, but on the weekends he feels fine. Then on Sunday night, they come back again. Just when I think he's trying to avoid going to school, he actually throws up. What’s going on?"

Tzippy’s teacher called to ask if there’s a problem at home that’s making her so sad and withdrawn. At home, she seems fine to us. I have no clue what is troubling her.”

Many students adapt very well to school; they feel good about themselves and their school work. But for others, getting through an average school day for some children is fraught with anxiety-producing situations and painful moments.

Like Miri, Richie and Tzippy, these children may develop physical or emotional symptoms that seriously hamper their performance and social integration.

Long-standing unhappiness in school can be part of a vicious cycle. A child having trouble in one or more aspects of school life may become saddened and anxious. These feelings make it hard to concentrate which, in turn, generates further failure – and consequently, more anxiety.

Such cycles can be hard to break. Mastering them depends, in part, on a good understanding of the sources of a child’s feelings of sadness. The following, say childhood experts, are the most common patterns.

General anxiety

Some youngsters feel anxious most of the time for no apparent reason. Their anxiety has no specific boundaries. It may be part of their temperament, or it may be part of a pattern of behavior that is shared with other members of the family – almost a family trait. (“We’re all worriers. We’re all high-strung.”) If the anxiety becomes very severe, it may evolve into depression, interfering with the child's ability to go to school, to concentrate and learn, and to socialize with others.

Anticipatory Anxiety

Children with this type of anxiety have an exaggerated fear of the future. They are very aware of how things may go wrong and tend to fear the worst. They perpetually ask questions regarding the future, especially “What will happen if…?” type of queries that reflect their anxiety. Very young children continually ask the teacher “When are we going home?” “When are we going to lunch?” “When are we coming in?”

Such students may gradually lose their anxiety as they become more confident, or may evolve into chronic worriers, fearing the possibility of illness, death or some other tragedy.

School Phobia

Anxiety in children can lead to school avoidance. These youngsters may outright refuse to attend school or create reasons why they should not go, complaining of not feeling well, with vague, unexplainable symptoms.

Many of these children have anxiety-related symptoms over which they have no conscious control. Perhaps they have headaches, stomachaches, hyperventilation, nausea or dizziness. School refusal symptoms occur most often on school days, and are usually absent on weekends. When these children are examined by a doctor, no true illnesses are detected or diagnosed.

The child’s fear may represent a form of separation anxiety from parents or an irrational concern that something bad might happen while the child is away. This is especially true if there has been a death, divorce or other serious loss suffered in the home.

Fear of bullying, or problems with friendships, are also common. Trouble with school work or with teachers may also play a part. Anxieties over using a public bathroom are not uncommon.

In most cases, the child is unable to pinpoint the precise reason for their anxiety, or lacks the language to put that fear into words.

Milder forms of school phobia are encountered in children who do attend school but who show bodily preoccupations, such as headaches and recurring abdominal pains. They make frequent trips to the nurse’s office or are absent excessively due to minor medical complaints.

Obsessive-Compulsive Behavior

Obsessive-compulsive patterns are often associated with anxiety. Affected children practice various repetitive or ritualistic behaviors such as excessive hand-washing and endlessly writing and erasing to make something perfect. Often these youngsters feel bound to perform certain actions in a specific order and experience extreme anxiety when that order is changed. They may become distressed with any departure from routine.

Such children may work extremely slowly in order to ensure that the work is flawless. If his or her understanding of all new material is not perfect and complete, the child may be suffused with anxiety.

What are the signs?

  • Feeling fearful or panicky
  • Feeling breathless, sweaty, or complaining of `butterflies' or pains in the chest or stomach
  • Feeling tense, fidgety, using the bathroom often.

These symptoms may come and go. Young children can't tell you that they are anxious. They become irritable, tearful and clingy, have difficulty sleeping, and can wake in the night or have bad dreams.

Managing School-Related Anxiety At Home

Excessively anxious children need sensitive care and understanding. Parents should make every effort to create a safe and confidential atmosphere in which children can discuss their anxieties. Don't trivialize a child's fears or concerns. Be emotionally supportive.

Comments that dismiss the child’s fears such as “That’s nothing to worry about,” “Just ignore it,” or “That’s silly,” are not helpful and simply communicate to the child that parents don’t understand.

1) Do everything possible to identify the sources of the child’s anxiety. If a problem like a school bully or an unreasonable teacher is the cause of your child’s anxiety, become an advocate for him or her and discuss these problems with the school staff. The teacher or principal may need to make some adjustments to relieve the pressure on your child in the classroom or on the playground.

2) Children with extreme anticipatory anxiety often benefit from keeping a diary in which they record each night their current worries. At certain intervals, with the help of an adult, they should review the concerns they harbored. Realizing that most of the time, these worries did not materialize can help alleviate patterns of anxiety.

3) If your child stays home, be sure she is safe and comfortable, but she should not receive any special treatment. Her symptoms should be treated with consideration and understanding. However, her day should not be a holiday. There should be no special snacks and no visitors.

4) It is important to make a commitment to be extra firm on school mornings when children complain most about their symptoms. Keep discussions about physical symptoms or anxieties to a minimum. For example, do not ask your youngster how he feels. If he is well enough to be up and around the house, then he is well enough to attend school.

Managing School-Related Sadness in School

1) Many anxious children improve dramatically when they feel school is a safe place. Teachers need to make classes as emotionally safe as possible.

One way to do this is to avoid causing the anxious child public embarrassment, such as calling her up to the front of the class to recite or perform when she is unwilling. Punishment that entails being made to sit out in the hallway to be viewed by all who pass by is never appropriate for such a child.

2) When dealing with an anxious child, a teacher should look of roles or activities in which the student feels competent and needed. Specific responsibilities, even errands, can give anxious students a feeling of self-worth.

3) Communication with the parents about their child’s anxieties is imperative. If the source of the anxiety is connected to schoolwork or testing, the sensitive teacher knows how to alleviate exaggerated worrying by reassuring the child that effort –not grades – is what counts.

4) If the child’s anxiety is connected to trouble with a fellow student or students, the teacher should make every effort to defuse the situation by calling the students aside and speaking to them individually or jointly – whatever is more appropriate.

5) If the anxiety is anticipatory – that is, the child is deeply preoccupied with possible dangers or problems and tragedies looming ahead in the immediate future, drawing the child out about these fears and offering sincere reassurance usually helps to minimize them.

Relief often comes from asking the child “What’s the worst thing that can happen to you if the thing you are worried about (the bus breaks down/ you get lost/ no one’s home when you arrive/) actually takes place?”

Together with the teacher, the child can then explore solutions and alternatives that drastically lower the anxiety threshold.

In extreme cases, children who are chronically anxious or who exhibit the signs of depression or obsessive-compulsive disorder should be evaluated by a competent child psychiatrist or psychologist. In severe cases, anti-anxiety medication may be indicated.

It is unkind to expect a child to simply endure living with extreme anxiety. Remember, most adults would take pro-active measures to avoid experiencing this oppressive state of mind. We should not expect children to endure experiences that few adults would tolerate.

Do Children Grow Out Of It?

The good news, advises childhood expert Dr. Mel Levine in Educational Car , is that most children do outgrow anxiety. Those who do not, however, may suffer side effects that can have long-lasting ramifications. Not going to school, for example, means missing out on education and on making friends. Loneliness and lack of confidence can be long-term problems.

Often children are anxious in large measure because their parents are anxious. Children absorb the tension and fear from the atmosphere in the home. In this is the case, the child is unlikely to outgrow the condition until the parents learn to deal positively with their anxieties and problems.

Often, observing their child’s anxiety serves as the strongest impetus for parents to work out their own issues. With the parents’ growth and change almost always comes dramatic improvement in the anxious child.