School Refusal or Phobia. School refusal is separating.

fear of attend-ing school. It is a type of

Because the problem of school refusal is
“social phobia” similar to agora-phobia
usually only
(fear of going outside the home). Children
who re-sist attending school this way may partly the child’s, the entire family
develop physical signs of generally requires coun-seling to resolve
the issue. As a rule, once it has been
illness, such as vomiting, diarrhea,
estab-lished the child is free of any illness
headache, or abdominal
and the resistance stems
pain on school days (Tyrrell, 2007). This
from separation anxiety or phobia, the
lasts until after
child should be made
the school bus has left or the child is
to attend school. Reinforcement by
allowed to stay home
parents to go to school
for the day.
this way helps to prevent problems such
A particular child may be reacting to a as school failure,
situation such as
peer ridicule, or a pattern of avoiding
a harsh teacher, having to shower in gym difficulties. Some chil-dren may benefit
class, or facing a from a gradual program of school involve-
ment, such as walking to school but not
class bully every day. In these instances,
going in for one day,
the child’s fear
then going to school but staying for only 1
may be well grounded. Counseling may
hour the next day,
help the child
then staying for half a day, and so on,
manage the situation better. If not,
until the child can stay
parents can attempt to
all day every day. Give support to parents
have the child transferred to another
so they can treat
classroom or perhaps
the child’s illness symptoms matter-of-
excused from a disliked situation such as
factly (a great deal of
showering to stop
reassurance that these symptoms are not
the school resistance.
major will be neces-sary) so they can take
School refusal may occur from fear of the child firmly to the bus or to the
separation from
classroom.
parents. The child may be overly
Managing school refusal requires
dependent on the parents
coordination among the
or may be reluctant to leave home
school, school nurse, and health care
because of worry that
provider who diagnoses
younger siblings will usurp the parents’
the problem. A nurse is the ideal person
affection. The anxi-ety of separation may
to coordinate such
also result because the parent is over-
protective of the child or is the one having
the most difficulty
efforts and to help parents allow the child
some indepen-dence not only in going to
school but in other activities. A
few children have such difficulty they
require psychiatric
therapy to resolve their difficulties with
school.
Home Schooling
Because of religious or personal
preference or because of dis-illusionment
with the school system, a growing number
of
children are home schooled today
(Gaither, 2008). It is
important to identify these children at a
health care visit be-cause with their less
extensive experience with peers than
other children, they may not be as
comfortable with peer in-teraction. As
their main contact has been with parents
at
home, their vocabulary may be advanced
or can suggest they
are older than their real age. They may be
experts at com-puter searching but know
less than other children about
health prevention measures as they have
not had contact with
school nurses or health courses. When
discussing home
schooling with parents, assess if children
do have peer expe-riences, perhaps
through participation in community sports
teams. Ask if they receive exposure to
other cultures or fam-ilies so they can
better adjust to people different from
them-selves at college or a first work
position.
Latchkey Children
Latchkey childrenare schoolchildren who
are without adult
supervision for part of each weekday. The
term alludes to the
fact they generally carry a key so they can
let themselves into
their home after school.
Latchkey children have become a
prominent concern be-cause in as many
as 90% of families today in the United
States, both parents work at least part-
time outside the home.
Few parents have work hours so flexible
they can always be at
home when a child leaves for or returns
from school.
Extended family members who once
watched children after
school are often working as well or may
no longer be close at
hand; many communities are no longer
close-knit enough to
have neighbors who can be depended on
to help out with in-formal child care.
A major concern of children staying alone
is that they will
develop an increased tendency toward
accidents, delinquent
behavior, alcohol or beginning drug
abuse, or decreased
school performance from lack of adult
supervision. For chil-dren who feel safe in
their community, however, a short pe-
riod of independence every day may
actually be beneficial; it
encourages problem solving in self-care.
Suggestions for parents whose children
must spend time
alone before or after school are given in
Box 32.8. Many

communities offer special afterschool

programs so children

do not have to be home alone. Nurses are

in a position to ed-ucate parents about
such services so their children can feel

both safe and stimulated creatively during

this time. Boy

Scouts and Campfire Girls are examples of

organizations that

offer programs to help children adjust to

being home alone.

Many communities are organizing hotline

numbers a child

who is alone can call if a problem arises.

At health visits, as-sess whether parents
and a child appear to have a problem

with or are uncomfortable about

afterschool arrangements.

For a child who is extremely fearful or

impulsive or who finds

problem solving difficult, time alone after

school may not be

appropriate. Determine the individual

circumstances, and

recommend changes when appropriate.

Sex Education