For pediatricians, summer is a time when their office schedule is filled with routine physical examinations. Visits for respiratory infections are usually low, and families have the time to schedule a visit to the doctor for their otherwise busy adolescents.

If I could ask only a single question of each adolescent at these visits, it would be: How many days of school did you miss this year? The answer would tell me a lot about how much stress the adolescent was experiencing and also provide insight into how the household was functioning.

At this age, school is the adolescent’s job. Studies show that kids with high rates of school absenteeism have less success in their working careers. When the problem becomes chronic, and it frequently does, a referral to a mental health specialist may be necessary to work on deeper issues in both the adolescent and the household.

School avoidance is a typical presentation in many young people dealing with stress. It usually starts in the early teen years and is seen more frequently in boys than girls. Typically, these kids have recurrent and vague physical, or what physicians call somatic, complaints. These symptoms are most common on Monday mornings when it is time to go to school. Yet, when these children come into the office for evaluation, they have a normal examination.

I remember one creative patient who was faking fevers (factitious fevers) by rolling the thermometer in his hand when his mother left the room.

Another, I came to think, wanted to stay at home to emotionally protect his mother after his stepfather had abandoned the marriage.

A third came from a home with a strong family history of anxiety. His anxiety was described as being produced by social interactions of all types, and his parents simply could not make him attend school. This refusal went on for two years, and the school became an active participant and enabler by working with the family to make many accommodations. Undoing all of this was quite difficult.

Though this adolescent never admitted to being bullied, I believed that may have been the source of his stress.

While school avoidance might seem to be a relatively minor issue, it isn’t and should not be shrugged off by your pediatrician. Your physician needs to take a very careful history and perform a thorough examination if your child is exhibiting this behavior. If the results are normal, parents should expect that the advice will be for your child to return to school immediately. Also, it is important for you to anticipate that Mondays and mornings will be the most common time to hear about physical complaints and that, if you cannot get your child to school, take them to the doctor’s office for an examination as soon as possible so that they might still be able to attend school later that day.

Lastly, perhaps your pediatrician never asks this simple question, and you have a routine physical examination scheduled for your teen in the coming weeks. Your instinct may be not to divulge this piece of critical information — keeping secrets from your pediatrician is quite common, especially if you think that sharing something sensitive will expose your parenting ability to immediate scrutiny.

Give it a rest. Your kid needs help. You need answers and help as well.

Bring it up so that your family can begin to do the work necessary to get your adolescent back on track.

Richard Lazaroff is a retired pediatrician who practiced in St. Louis County for nearly 40 years. Married for 42 years, he is the father of two, grandfather of four and the author of “Some Assembly Required, A Guide to Savvy Parenting.” His latest book is the novel “Illumination.”

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