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Q. I have an 11-year-old son who is in 6th grade. Overall, he is kindhearted, smart, and fun-loving, but he struggles with anxiety and is quickly triggered by situational stressors. He struggles academically as well, and from time to time he feels he doesn’t have enough friends in school. The issue that takes front and center stage, however, is that he often complains about physical pain such stomachaches, headaches, and colds. I have taken him to several doctors to rule out any underlying medical issues but was told that there are none. Sporadically, he does run a low fever, but nothing substantial. I often let him stay home from school, specifically when he complains that I don’t believe that he’s in pain. He typically misses a week of school each month. He does see a therapist weekly and connects well with him. I guess my question is when do I push him to go to school and when should I allow him to stay home? Is it possible that some of his pain is triggered by emotional pain? If so, how can I help him manage his pain so he misses less school?

A. Thanks for submitting your question. I believe that many of our readers with school-aged children can identify with this struggle. Before we address your main question, I’d like to address some underlying factors you have mentioned. You stated that your son struggles with anxiety and social and academic difficulties. I believe that even if he wouldn’t suffer from any physical pain, attending school would still be quite difficult for him. It seems that when he does go to school, he struggles to find an area he feels successful in. Typically if students are academically weak, they look forward to lunchtime and recess so they can socialize. However, if a student struggles with anxiety along with academic and social difficulties, there are limited times throughout the school day where he can thrive. Therefore, regardless of your son’s physical health, I’m happy to hear that he attends therapy on a weekly basis. 

As far as attending school, I believe it’s important for you to sit down with your son and communicate openly with him. It’s important to communicate with him when he is feeling well. Validate him and stress how proud you are that he pushes through and attends school even though he faces many stressors throughout the day. Break down all of his struggles and discuss them each separately. For example, discuss anxiety triggers he faces in school and how he can overcome them. Encourage him to breathe deeply and go to the bathroom to wash his face when he feels overwhelmed. Empower him by stressing his strengths and mentioning how lucky his classmates would be to have him as a friend. Discuss some social skills and self-esteem strategies he could utilize. Moreover, assess whether he would benefit from one-on-one help to achieve his academic potential. Let him know you are proud of his efforts. Then begin discussing his physical pain in an objective manner. Assess whether the stressors mentioned above trigger it. Discuss the mind-body (somatic) connection to help him identify any physical pain triggered by painful emotions. Then draw an emotional ruler (also called a Likert scale) numbered from 1-10 to help him rate his physical pain when he experiences it. Empower him to attend school if his pain rates lower than a five. Discuss ways you can reward him for pushing through his pain when it is not severe. Teach him to close his eyes and slowly picture the pain melt away. Also, tell him that you are an advocate for sporadic mental health days. Let him know that if in the future he communicates with you and lets you know that he is struggling with anxiety and would like a day off, you will allow him to stay home. Help him understand that even adults occasionally need a mental health day. Help him understand that if he communicates with you effectively and helps you distinguish between a day where he feels sick physically or stressed emotionally, you are more likely to grant him a sick day as well.

If you find that you communicated with him effectively but he is still missing a substantial amount of school, I recommend that he see a somatic therapist. This will help him release the stress his body is holding which has been affecting his physical state. I wish you and your precious son lots of hatzlacha.