Is My Kid Really Sick? Or Just Avoiding School?

The Ask Lisa Podcast does not constitute medical advice and is not a substitute for professional mental health advice, diagnosis or treatment. If you have concerns about your child’s well-being, consult a physician or mental health professional.

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Reena Ninan:

Episode 196. Is My Kid Really Sick or Just Avoiding School? 

It all comes crashing down I feel like in December. You don’t realize it, but it slowly is. But between figuring out the holidays and school and finals, am I wrong?

Dr. Lisa Damour:

Well, not if I’m a yardstick for this, no. I don’t know how other people are doing, but Rena, so we celebrate Christmas and every year I’m like, next year I’m going to take care of all of this in the summer. I tell myself this, of course I never do. Of course I never do, and then what I really count on is Christmas, not coming too late in the winter break because I feel like I can’t relax until it’s over.

As much as I love it.

Reena Ninan:

It sounds like you start to hold your breath right about now because it’s like a four week sprint.

Dr. Lisa Damour:

Exactly.

Reena Ninan:

We’re going to talk about, I know a lot of kids end up getting sick during the school year, this point in the school year, but are they really sick or are they getting sort of the school blues? I want to read you this letter. 

Hi, Dr. Lisa and Reena. 

My teenage son has struggled with anxiety and self-harm in the past. He sees a therapist regularly and has not engaged in any self-harm recently. He, with a lot of support from us, has done a lot of work to manage his anxiety, address other underlying conditions and develop coping mechanisms. But I’ve noticed that he gets sick a lot, often complaining of nausea and headaches, but also runny nose cough as well. I do believe that he’s experiencing these things, but I wonder if it isn’t more psychosomatic and tied with anxiety or stress or wanting to avoid school. He’s a good student, but school can cause a lot of stress. We’ve tried different things proposing he go an hour later, go to school anyway, having a number of sick days, but I’m at a loss if I send him to school and he isn’t feeling great, the teachers often send him to the nurse’s office and say he should go home. There seems to be a lot of concern by teachers on getting sick from kids. Any other ideas? How do I talk with him about my concerns at the time he isn’t feeling well. How do I acknowledge what he’s experiencing and at the same time help him possibly use other coping mechanisms if it is psychosomatic, which doesn’t mean the symptoms aren’t real. 

Thank you and thank you for this podcast. 

I just got to say the sick part, at that point in the school year, should we be sending our kids to school sick to begin with? 

Dr. Lisa Damour:

This is a tough one and it’s true. It’s changed since covid. People feel differently about this and schools feel differently about this. Okay, so do you have a policy as a family about when a kid goes to school?

If they’re symptomatic? 

Reena Ninan:

Okay. I’m saying don’t send your kids sick, but I’m very guilty of being like, you know what? You’re good enough. Just go, right? So yes, Lisa? I think, I don’t think we have a policy. No, we, I don’t know if you should. 

Dr. Lisa Damour:

I’ll tell you, we have a policy very much informed by the fact that my husband is a high school teacher who has seen what happens when kids don’t come to school and how quickly they lose ground.

So the policy, I wouldn’t say it’s like you have to be bleeding from the eyes, but I will say it is, but no, our policy for real is if you’re vomiting or you have a fever, you don’t go to school, depending on where things are with covid, we do keep covid tests, and so if a kid has sniffly, runny cough, sore throat, we have sometimes said we want you to go, but if it’s covid, we’ll keep you home. So we’ll use a covid test at home to make a decision about sending a kid who’s got what could be covid symptoms. But we are very much on the side of like, you go to school, you don’t miss school. Now does your school deal with it differently since Covid?

Reena Ninan:

I think there are some teachers who just do not want any sort of illness in their classroom. They just see it, go home, and they feel like they’ve got to kind of police that and I can understand that, but I also feel like the tolerance, even if you have covid, people are sort of sending their kids because like, you know what? It’s just a runny sniffly nose. You’ll be fine. Or they’re just not testing even though.

Dr. Lisa Damour:

It’s been declared endemic. Right. 

Reena Ninan:

That’s right.

Dr. Lisa Damour:

I totally see that position and people are across the spectrum on this. I think in terms of how to handle this situation, the first thing this parent needs to do is get on the same page with the school because it sounds like sometimes the parent is saying, “You’re good enough to go to school” and maybe has a policy like ours. You’re not vomiting, you don’t have a fever, you don’t have covid, go to school. Well, that policy’s not going to work if the school’s undercutting it. Yeah, he’s kind of sniffly sending them home. So I think that you can’t really make much traction on this without coming to agreement with the school. And all schools can do their own thing or may have their own policies. It’s very hard for me to picture a school saying, you cannot send a child who has any symptom of any kind to school because the common cold is the common cold. That’s really common. Totally. Yeah. So I think that no matter what as step number one, this parent needs to come to agreement with the school about sending a kid who may have a runny nose and having that kid not have the nurse send him home.

Reena Ninan:

So beyond the same page, if you’ve decided what your family’s policy is on this, especially if there’s a lot of sickness happening, and calling the school nurse or the guidance counselor to let them know this is where we are. Please don’t send them back home.

Dr. Lisa Damour:

Yeah, I think you need that clarity. Because what I’m hearing in this letter is that this parent is really trying to hold the line and is doing a really beautiful job and knows her kid is aware that he has struggled with coping in the past, has engaged in self-harm in the past, has done good work it sounds like in therapy to get through and pass that. I hear that this is a parent who’s not taking lightly to what it means to hold this kid to the expectation that he’s going to go to school, even if he’s not feeling a hundred percent. And to hold that kind of line, you’re going to need to know that the school is going to back you up or that you’re in agreement with the school about the contingencies for when a kid does come to school with a symptom or two.

Reena Ninan:

I remember when my brother went to preschool and mom would drop him off, he would all of a sudden need to go to the bathroom. Then he would need something else. Then he would say he wasn’t, and it wasn’t until, I think my mom kind of figured it out soon, but we talked about it years later and he just didn’t like there’s something about this teacher that he just didn’t like and kind of a bad energy or I don’t know what it is, but what if that anxiety of whatever it is at school is really kicking in? How do you deal with that?

Dr. Lisa Damour:

Well, it’s so interesting. What you’re describing is suddenly your brother got all of this sort of physical stuff going and do you think maybe he really did have to go to the bathroom, the physical stuff was real. Maybe he wasn’t just making up stuff.

Reena Ninan:

Some people get nervous and they’ve got to go to the bathroom. It just sort of triggers that. But I do think there was some anxiety, which we probably didn’t even use the word anxiety back then in 1985, but I think there was some reason that made him uncomfortable. And knowing what we know now, what could we have done to my toddler brother at that time that would’ve helped him feel better?

Dr. Lisa Damour:

You’re onto something here because, and I think this parent is saying, my kid gets stressed about school. He gets anxious about school. And when we think about how do we help kids on the spot with anxiety, my favorite and perhaps the most powerful intervention is you get them going on their breathing. You help them to slow and calm their breathing. Part of why you do that is that anxiety is a biological phenomenon. It is a feeling that plays out in the body. It’s a very primitive ancient emotion. So it sends our heart rate up. It makes our breathing get quick and shallow. It actually, Reena, the thing you said about people needing to urgently go to the bathroom when anxious, that is part of anxiety and what the deal is on this, this is sort of fascinating, very bathroomy, when we are having an anxiety response, it’s essentially like a fight or flight response.

Our body’s getting ready to flee or attack. It actually halts the digestive system. It just pulls the emergency brake on the digestive system. And the reason for that being, it’s so that you can, if you’re running from a saber-tooth tiger, you don’t have to be like, oh wait, tiger, take a moment. I need to use the restroom. So it’s got this biological basis. And then when the worst of the anxiety has passed, and we call it the parasympathetic nervous system, but it’s the part of the system that comes and resets us back to our baseline. When that parasympathetic response kicks in, it starts the digestive system up again and causes this urgent sense sometimes of needing to use the restroom very urgently.

Reena Ninan:

Wait, wait. So you’re saying when you have that sense and you’re going, that’s actually good. Maybe your system has literally worked through that anxiety.

Dr. Lisa Damour:

Yes. You’re sort of now trying to come down from the anxiety, and so your body’s like, all right, slow the heart, slow the breathing, start the engines down south, right? I mean, that’s what’s happening. Isn’t that fascinating?

Reena Ninan:

Nobody has explained poop and anxiety to us the way you have Dr. Damour. 

Dr. Lisa Damour:

You are welcome, Reena, you are welcome. You’ll always think of me now.

Reena Ninan:

Bathrooms across the world.

Dr. Lisa Damour:

Think of me now. Okay. Actually though. So to that end, to that end, if that is a symptom your kid has where their stomach gets queasy and or it’s followed, kids will be like, oh, I get the runs when I’m anxious. We, and they’ll see all sorts of things. I have found it to be so helpful to kids to explain the physiology of it, to say, oh, here is why your stomach gets queasy. It is your anxiety pulling the emergency break because it thinks it’s a saber-tooth tiger when in fact it’s just your English teacher. And so it causes this queasiness in your stomach because it affects your digestion. And then when you get past English class and you get to the next class and you feel better, the reason you suddenly urgently need to go to the restroom is your body has decided you’re safe.

And so now you suddenly have an urgent need. It’s so helpful for kids when they’re like, oh. I’m thinking now. This is a wonderful adolescent girl I cared for. And she was so funny. She was so direct and she came into my office, she was like, all right, Dr. Damour, I’m going to the school dance, but I always get the runs at the school dance. What am I going to do? And I’m like, why don’t I explain to you the physiology of why you get the runs? And she thought this was the greatest thing ever. Did not want my help with preventing it. She just was like, oh no. As long as I know what’s happening, I’m fine with it.

Reena Ninan:

But isn’t that true? This is why I love this podcast. You’re explaining what is happening in the brain and today in the gut.

Dr. Lisa Damour:

Yep. Yep. This is just things psychologists know that we forget to tell everybody, okay, so if this kid is nauseous and the parent thinks it is stress related, having this explanation may actually satisfy him quite a bit. And if he’s like, well, but how do you make the nausea stop? This is where breathing comes in. So what breathing does is it signals to the parasympathetic nervous system to go ahead and get started sooner rather than later. It tells our body that we are safe. And so what this parent can do with this boy is to say, look, if you’re starting to feel anxious, start your deep and slow breathing and people can look it up. They can do box breathing, they can do, there’s all sorts of wonderful kinds of breathing. All I care is that they’re breathing deep and slow. That will keep your anxiety from cresting. That will likely reduce all of the side effects of having an anxiety response. So that’s a place to start.

Reena Ninan:

I used to be so dismissive of box breathing, but you have mentioned it so many times, and I have tried it in moments where I just feel overwhelmed, just way overwhelmed, and it really works. So I love being able to teach this to kids at an early stage so they have it for life.

Dr. Lisa Damour:

I was so dismissive of it, Reena, for years. I mean, anytime somebody mentioned breathing for anxiety, I’d be like, oh, for goodness sake, that is this woo woo California stuff. I am a very seriously trained psychologist. And then of course I was totally wrong. And so box breathing, just so people know if you want to teach it to your kids, you breathe in on a count of three, you hold it for a count of three, you exhale on a count of three, and you wait for a count of three. And it does two things at once, actually, Reena. One is it slows your breathing, deepens your breathing, which signals to your anxiety system that you are now safe. The other thing it does is it’s harder than it sounds doing that like I’m breathing in on three, I’m holding it for three, I’m exhaling on three, I’m waiting takes up most of your brain and you can’t keep thinking about, or really in this case, worrying about or freaking out about the thing that you were upset about. It sort of stops that in your brain. And that’s helpful too.

Reena Ninan:

It’s what you said a couple of weeks ago on the horrible rumor spread about a child. That distraction really helps.

Dr. Lisa Damour:

Yup, and box breathing is both breathing and distraction at once.

Reena Ninan:

I know our school system, our school district here in Connecticut, started using mental health days especially. We had a couple of suicides which we had never had before in our high school. Do you think that these mental health days really work to reduce stress? Because my kids would say to me, Hey mom, next week I’m going to be taking a mental health day.

Dr. Lisa Damour:

Okay, I’m going to give you an answer and then I’m going to contradict myself completely. So I’m not actually a huge fan of mental health days.

Reena Ninan:

Why?

Dr. Lisa Damour:

I feel like if school is so stressful that it could only be endured, if school is so stressful for all right? I mean when districts are mandating mental health days, they are saying this is across the board. If school is so stressful for all that, it can only be tolerated if occasionally you don’t go, then school is too stressful. I would rather see a more systematic look at what has taken the baseline levels of stress so high in our school. Are kids taking too many APs? Do they have too much homework? Do they not have enough time during the school day to get their homework done? There are a lot of things schools can do that can chip away at stress levels. I’ll tell you one that is my favorite. They can get rid of the A+. There’s no reason for kids to have a pluses if a college knows that a school does not give A+’s, they do not ding kids for not having A+’s. If you give kids A+’s, there are kids who will strive for an A+. I don’t really see the value of that. So there are things that can be done that can lessen overall levels of stress and not make it so that kids need mental health days to get through the school year.

Reena Ninan:

The tiger bomb in me is saying, don’t tell me you’re going to be taking away AP classes. I want you to take all the AP classes you can. I don’t have to pay for that. And you’re halfway through college practically. If you take all these AP classes.

Dr. Lisa Damour:

I know.

Reena Ninan:

It’s hugely stressful.

Dr. Lisa Damour:

The tiger mom, and you may also be thinking, I want my kid to have a reasonable shot at a highly selective school and bluntly, that’s going to require taking a lot of APs. Let’s solve that on another day, Reena. But you and I both know that is very stressful for kids. That is very stressful for kids. 

Okay, so not a big fan of mental health days. Now I’m going to contradict myself. So I was a kid who just didn’t get sick that much. And actually so far, knock on wood, as an adult, I don’t get sick that much. I would win the attendance awards at school.

Reena Ninan:

We got a blue ribbon with gold writing. Still have them somewhere.

Dr. Lisa Damour:

And so in high school, my mom said to me, if you have not missed a school day and you need a day and you don’t have anything big that day, you can’t not go to school on a day, you can’t take a mental health day when you’ve got a test. Right? She’s like, you can take one a semester. So I really appreciated that.

Reena Ninan:

But I bet you never used it.

Dr. Lisa Damour:

No, I used them.

Reena Ninan:

Did you really?

Dr. Lisa Damour:

Yeah.

Reena Ninan:

You took one a semester. I cannot see you doing that. Really?

Dr. Lisa Damour:

I know I did. No, I did. And it was great. And just like that one day at home was enough for me to get my feet under me and it would be like the one day I missed all semester.

Reena Ninan:

Tiger moms everywhere are shaking their head. But you really believe that that could make a difference?

Dr. Lisa Damour:

Well, no. I believe it was great for me, but I also am not a fan of policy level mental health days because I think it tells us kids the baseline levels of stress are too high. So that’s my take on the mental health day situation. 

Reena Ninan:

Can I have you give us sort of a sense, if you are feeling that instinctively your kid is struggling at school, meaning there’s some sort of component that’s stressful, sometimes they’ll tell you, sometimes they won’t. You’ve got to try to slew and figure it out. What are sort of the alarm bells for you when you realize we need to do something that this situation should not be the stressful for this kid at school?

Dr. Lisa Damour:

I think that’s what this parent is wondering, right? She’s like, my kid’s a really good kid and he’s a really serious student and these symptoms are real, but I don’t think they’re without a stress component. What should I make of this? What should I do? How do I deal with stress when it’s showing up as sickness?

And I think this wasn’t voiced in the letter, but I think that often adults find themselves in the situation, which is, I don’t want to seem dismissive of the fact that he’s sick. But I do think it’s stress related because sometimes when people talk all the time about having a kind of lousy thing going on physically and going to a doctor and the doctor’s like, eh, it’s just stress. And even if the doctor’s right, that doesn’t feel very helpful, that doesn’t feel very welcome. So here’s what I have found. Sometimes those people will then get referred to me. I had a kid who had terrible headaches, terrible, terrible headaches. And headaches are tricky because at least if your kid’s nose is running and they’re coughing, you can see it. Headaches I think sometimes parents are really, really? But this kid had terrible headaches. Went to a neurologist who was like, eh, it’s stress sent her to me. And what I said to her, and I found this was a good way to both put the stress on the table without seeming dismissive. What I said to her is, our bodies break down under stress and everybody’s body breaks down in a different way. 

Reena, this hasn’t happened for a while, so I’m probably going to bring one on. I used to get eye infections only when I was very stressed.

Other people will have stomach stuff. Do you have a place where your body breaks down under stress?

Reena Ninan:

It’s funny you mentioned the eye. My eye starts twitching, like an involuntary twitch. It looks really weird, but I think that is possibly stress.

Dr. Lisa Damour:

That’s your symptom. And this kid, I just gave her the benefit of the doubt. It was headaches. Headaches were how her body broke down under stress. And so then I would say, so our job here is to reduce your overall stress levels so that your body’s not breaking down underneath them. So I never had to say, are they really real headaches or are you really sick? There’s no winning in that line of attack. But instead to say, I hear that your body’s breaking down, we’ve ruled out all possible medical explanations. We are to the medical explanation of stress causing your body to break down. Let’s start to take an assessment of all of the things that are causing you stress. And let’s see if we can bring these down a few so that your body’s not breaking down.

Reena Ninan:

That’s great. Sitting down, taking an assessment.

Dr. Lisa Damour:

Yeah. Okay. So let’s make the list of the stressful things. And of course school is stressful. School’s supposed to be stressful. We are always feeling stressful when we’re growing and learning and being challenged. So the goal is not make school a non-stressful experience, but if this kid’s taken four APs or has a huge athletic commitments that take up huge amounts of time and get in the way of his sleep, I mean there’s often something where there is the possibility of adjusting things.

Reena Ninan:

I like that advice of really sitting down because sometimes you just don’t know and they don’t want to share and that could be a great opportunity. What else, Lisa, do you feel like when parents are in this situation that you know there’s something and the kids are stressed and they’re not wanting to go to school necessarily and they feel they’re sick. What else would you offer parents to consider? 

Dr. Lisa Damour:

I bet you can guess. One word. My favorite word. Sleep. I would check into this kid’s sleep. 

Reena Ninan:

Good point.

Dr. Lisa Damour:

It’s funny, Reena, all I do is look at research. I’m looking at it all the time. I’m always working on projects where I’m pulling research papers. There are very few research papers that have changed how I live. And I can tell you a billion years ago when I was co-authoring a textbook in abnormal psychology, I was writing the section on stress and I was writing, we call it psycho neuroimmunology, which is the interaction of the brain and the immune system. And I came across a research paper about what not sleeping does to your immune system. And it was a really easy study. I think it was with medical students. They brought ’em in, they did a blood draw, they looked at their white blood cell count, it was fantastic. And then they kept them up all night and then they looked at their white blood cell count the next day and it was in the toilet.

When we don’t get enough sleep, we are very vulnerable to illness. When we don’t get enough sleep, we are very vulnerable to feeling stressed about things more than they need to be felt as stressful. It hasn’t come up and it’s not in the letter, but I’m not going to let it go. The number one thing I would do, I would check with the school about coming to agreement about when this kid can still go to school with a symptom. And then the number two thing I would do would be to take a very hard look at how much sleep this kid is getting and if there’s anything that is getting in the way of his sleep. Is he in his room but he’s on his phone? What is it? Because no matter what, sleeping more won’t make him feel bad. And no matter what, sleeping more will both reduce stress and probably reduce how often this kid’s getting sick.

Reena Ninan:

It comes back to sleep. So often, one of the basic things, I know. 

Dr. Lisa Damour:

I will always bring it back to sleep.

Reena Ninan:

But I always forget when things are falling off. I just forget that that’s number one place to check. 

Dr. Lisa Damour:

So I hate getting sick and we’re really rigid about sleep in my house and especially at this time of the year when there are so many viruses going around. And I wish I could say in all honesty that I’m insistent that my kid gets enough sleep. I only have get one kid at home right now so that she doesn’t get sick. But I’ll say it’s almost as much, I’m like, I don’t want you to get sick. I don’t want to get sick. Of course. So I’m like, they’re going to bed.

Reena Ninan:

Oh my gosh. Yes, I know. I know. Those early toddler years were really difficult for that exact reason. You know that you were going to get it.

Dr. Lisa Damour:

When your kid coughs in your mouth.

Reena Ninan:

Do not miss that. Do not miss that. So Lisa, what do you have for us for Parenting To Go?

Dr. Lisa Damour:

There’s something else in this letter I just love so much and it was about the boy having come through a hard time that he used to self-harm and that he doesn’t anymore. Even though self-harm is how kids is a way kids manage stress. He’s not doing that anymore. If anything, he’s moved towards just not feeling well when you’re sick. I think this is such a wonderful opportunity to reinforce when kids are getting it right, and I think so often as parents and caregivers, we can notice when kids are on the wrong track and talk about it. But for any adult in a situation like this who’s helping a kid with something like this, it’s a great opportunity to say, look, you have come so far in the management of things. A couple of years ago you would’ve been hurting yourself. You don’t do that anymore, but stress is still getting to you and we’re going to figure it out. But I don’t want to miss this opportunity to tell you how proud I am of how far you’ve come on this. That kind of reinforcement can really help keep things moving in the right direction.

Reena Ninan:

A lot to think about and it’s that time of the year so I feel like this is such a great episode and a great way to get everyone to rethink their routines as well and examine what we’re doing at this point in school year. 

And next week we’re going to have a special guest talking about belonging. Dr. Alfie will join us. 

I’ll see you next week. 

Dr. Lisa Damour:

I’ll see you next week.