The Medical Minute: Dealing with the ‘back to school' butterflies

For most kids, there's nothing like the phrase “back to school” to throw cold pool water on an otherwise glorious summer vacation. At the first mention of back- to-school preparation, many children experience a passing wave of apprehension. However, for some children, the thought of going back to school can trigger anxiety that interferes with their daily life.

“Generally speaking, children might struggle with a few fears about how they'll like their new teacher or whether they will find their way around a new school. They have enough experience to know they've gotten through new situations before and they will again,” said Jeanne Logan, a pediatric nurse practitioner in the Department of Psychiatry at Penn State Health Milton S. Hershey Medical Center. “However, children who already have anxiety like predictability and the thought of a new school year can trigger debilitating fears.”

For these children, the “if” questions become huge: What if I can't find my classroom? What if I have no friends in my classes? What if my teacher doesn't like me? If a child asks these questions over and over despite repeated, logical and comforting answers, this can be a red flag that help is needed.

Kids might also complain of stomach aches and headaches, have interrupted sleep or nightmares and try to avoid anything remotely connected to school, including their friends, and even ask to skip the first day back.

While we all have a level of anxiety that is helpful – like “If I don't do my homework, I might fail so I better do it” – some anxiety is pathologic and keeps us from being able to function. It is important to look for a possible underlying cause, such as separation anxiety or fear of leaving a parent for an extended period, fear of bullying on the bus, or academic work that is too hard and causes feelings of being overwhelmed.

“The bottom line is that your child should be able to continue to eat and sleep normally, see friends when they want to and carry on activities of daily life,” Logan said. If, on the other hand, they display excessive clinginess, say they don't want to sleep alone or repeatedly ask “what if” questions for several weeks, it may be time to seek help.

Parents can pursue many avenues to obtain help for their child, including talking with their primary care provider, the school guidance office or child therapists and psychologists who may be able to provide specialized individual or group therapy.

Even an older child who's transitioning to high school may have some anxiety and can benefit from talking with parents about their fears. “Most students really enjoy the freedom of high school and end up doing much better than parents think they will,” Logan said.

Although watching a child's anxiety level rise can set parents on edge, it's imperative for them to remain calm.

“Offer reassurance and encouragement, even though you know this is something new and new things can seem scary, but you believe they can do it,” Logan said.

This article is adapted from a guest column by Jeanne Logan, a pediatric nurse practitioner in the Department of Psychiatry at Penn State Health Milton S. Hershey Medical Center, which appeared in the August edition of Central Penn Parent. The column can be viewed here.

The Medical Minute is a weekly health news feature produced by Penn State Health Milton S. Hershey Medical Center. Articles feature the expertise of faculty physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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