Goodshoot
The question
My seven-year-old daughter has been saying she's too sick for school a lot recently. How do I know if she's actually sick, or if she's anxious about school? Or is she just faking altogether?
The answer
The Chinese call the gut our second brain - likely because when we get tense, our gastrointestinal tract often acts up.
Stomach pain often is a symptom associated with anxiety; if your child is anxious about school, it's possible that this is the case. But before you assume that her stomach pain is nerves-related, make sure she's not showing symptoms of something more serious: these signs include weight loss, blood in the feces, vomiting or constipation. You should see your doctor right away if that's the case.
If you get a call from school asking to take her home due to an upset stomach, do not ask leading questions such as: "Is your stomach hurting?" or "It is not sore, is it?" Instead, just observe her at home. If the pain goes away as soon as you get home and she asks for food, plays normally and does not appear to be in pain when she walks around or watches TV, then that may well be due to nerves or anxiety.
If the pain then returns when you take her back to school, the suspicion of stress as the cause becomes stronger.
Look for other symptoms associated with anxiety such as headaches, lack of energy, nightmares, irrational excuses, breathing fast, using the washroom more often or becoming withdrawn and fixated on the same issues over and over.
Unless you get to the root of school refusal, this can progress to the point where the anxiety will affect other areas such as sleep, self-esteem, and even blood pressure. Make it a priority to talk to her teacher or principal.
But it's possible she's faking, in order to get out of school. If your daughter does not have a fever, no abdominal pains or headaches and if she acts completely well while at home, the chances of a medical issue become much less.
When she is at home, does she bounce back within minutes? Does she sleep through the night with no pain, vomiting, headaches or any other symptoms? If the symptoms she has decrease over holidays and long weekends, only to return once school starts, that may also be a reason to suspect she is faking things.
Most of the time when a child fakes symptoms to avoid school it is due to anxiety or stress. Arrange a one-on-one meeting with her teacher to see if there are factors at school that would cause her to be stressed out about school.
Send pediatrician Peter Nieman your questions at pediatrician@globeandmail.com. He will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.
Read more Q&As from Dr. Peter Nieman.
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The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.
Send pediatrician Peter Nieman your questions at pediatrician@globeandmail.com. He will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.
Read more Q&As from Dr. Peter Nieman.
Click here to see Q&As from all of our health experts.
The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.