Pediatrics and Society

A considerable portion of a child's life is spent in school. His adjustment to this experience is of utmost importance for the later adjustments he will have to make as an adult. It is part of the pediatrician's duty to supervise the child's emotional and physical health and to help him and his parents maintain it in optimal condition. Reluctance to attend school is a problem frequently encountered and of great importance. The pediatrician should be familiar with its various facets because he may be the first to be consulted if such a problem arises. The child may openly express his fear or unwillingness to go to school or may present physical symptoms which prevent him from attending school. A precipitating factor, such as a minor illness of the child or an upsetting event in the family, is usually present. The underlying cause may be connected with the school itself, such as fear of teacher or children, too great demands for achievement by teacher or parents in relation to the capacities of the particular child, or inability of the child to face competition with peers or siblings. The cause may lie in anxiety caused by fear of separation between mother and child, the attendance at school being the first occasion when such a separation becomes mandatory. Treatment consists of early return of the child to school, concurrent with, or followed by, treatment of the underlying cause, whenever such treatment is indicated, available and accepted by the parents. Delay in return to school increases the difficulties in the child's readjustment to normal acceptable behavior and makes treatment of the underlying cause more difficult. Brief examples of the above situations are cited from experience with 38 children. The incidence of the presenting problems, the adjustment following treatment and the duration of treatment are presented.