At Beijing Children’s Hospital’s “School Refusal Clinic,” doctors have encountered countless reasons why children are reluctant to attend school. Some children freeze up with stiff limbs, rapid heartbeats, and cold sweats as soon as they enter the school gate, but these symptoms vanish the moment they leave. Others often experience dizziness and headaches right before exams.
After exhaustive visits to various medical departments, parents finally arrive here, often asking, “Is he lying, or is this a sense of unreality?” The doctors repeatedly explain that the children’s feelings are legitimate, but the triggers stem from their emotions.
Fudan University’s Pediatric Hospital has seen its outpatient volume in the child psychiatry department exceed 4,200 visits monthly for several months now. Since the school year began in September, there has been a noticeable rise in cases of “school refusal” linked to emotional issues. On October 8, the Shanghai Children’s Medical Center’s mental health team launched a “Math and Spatial Learning Difficulties Clinic,” aimed at helping students struggling with subjects such as math, physics, and chemistry every Tuesday.
“The entire society is focused on academic performance,” Sun Jinhua, the director of child psychiatry at Fudan University’s Pediatric Hospital, told reporters, “but we need to pay more attention to the underlying factors affecting learning.”
At the “School Refusal Clinic,” some children have just taken a few days off; others have been on an extended break for a year. Some have skipped school for weeks but still wear their uniforms when accompanying their parents to the clinic. One mother was seen waiting outside for over four hours. “When the child can’t go to school, the parent can’t focus at work,” said Li Ying, a deputy chief physician in psychosomatic medicine at Beijing Children’s Hospital.
School refusal acts as a warning sign. “When a child cannot maintain basic social functions like attending school, it indicates that emotional issues have reached a significant level,” said Li. “School is a means of facilitating recovery, not the end goal.”
Li highlighted that before making the decision to stop attending school, children often endure a long, painful struggle. The clinic has witnessed many tense situations, with parents’ voices rising while their children remain silent. In one visit, a mother and daughter struggled over how many days the child would attend school, with the mother demanding five days and the daughter insisting on one. “If you want to take a break, you might as well go back to your hometown,” the mother challenged. “What’s your real reason for not wanting to go to school?”
The child mumbled, “I can’t explain it.” The mother’s tone grew urgent, “Because you can’t articulate it, I can’t ask your teacher for a leave of absence.” She added, “Right now, if I let you go with just one day, wouldn’t that mean you won’t want to go at all later?”
Repairing communication between parents and children is not easy. Doctors have encountered children who abruptly walk out of sessions, as well as parents who deceive their children into thinking they are seeking gastrointestinal care, only to have the child run away during psychological tests. Many parents struggle to bring their children in, citing, “My child says they aren’t sick,” leading doctors to rely on parental accounts for diagnoses.
In the clinic, parents often urgently express their demands: “She has gone to places she wanted to visit, but that hasn’t helped her learning! I fulfilled my promise; shouldn’t she fulfill hers?” One mother couldn’t hide her dissatisfaction.
“You made that promise because you love her,” the doctor countered. In the face of their children’s reluctance to attend school, parents often say they “can’t accept it,” while doctors remind them, “She just can’t do it right now.”
“Before making a decision to not go to school, children often go through a long and painful struggle,” said Li Yu, a child psychiatrist at Fudan University’s Pediatric Hospital. Doctors have seen many voiceless children with fresh scratches on their wrists or red marks from fingernails. Li Ying repeatedly explains to parents that children need adequate rest to build up their psychological energy, warning, “If you push them too hard, they will completely retreat.”
Li Yu believes that if a child struggles with academic pressure at school and repeatedly engages in self-harm, appropriate breaks and adjustments can help restore their ability to attend school.
Only children who have traveled down this path know just how important parental understanding is. Ye Yun, who found it hard to concentrate in her high school classes, frequently had nightmares that made her feel like a failure. Initially trying to hide her declining grades, she later suspecting her issues stemmed from emotional problems. She secretly sought treatment in a provincial capital, where she was diagnosed with severe depression and bipolar disorder. When she revealed this to her mother, the first reaction was to tell her to “keep it under wraps,” to “think less about it,” and “not to tell the teacher.”
Some parents do not pay enough attention to their child’s struggles in the clinic: one emphasized their child’s past excellence, “Third in the grade out of 21 classes,” while another fixated on educational planning, having moved their child to a prestigious school, insisting they “can’t afford to fall behind.” Others have already planned the next steps, wanting to transfer their child to an international school, which includes interviews and exams, hoping the doctor will persuade their child. Some parents think their child’s refusal to go to school is due to poor academic performance, believing tutoring will enhance motivation.
Investigating the causes of “school refusal” relies heavily on detailed consultations, with each session lasting nearly half an hour. The doctor’s notes cover aspects as meticulous as “mother’s attention to the child,” “parent-child relationship,” “primary caregivers,” and “personality traits.” This consultation process helps parents re-evaluate their child. Through standardized assessments of the child’s learning abilities and emotional states, parents can gain a more objective understanding of their child’s current situation, allowing for a discussion on whether their expectations are reasonable.
“Now is not the time to focus on academics,” stated Li Ying. During initial consultations, he often adopts a technique called “piercing the emotional core,” helping release the tension, anxiety, and restlessness masked by a parent’s forced calmness. During one visit, a parent emphasized their child was already in the third year of middle school, declaring, “There isn’t time to wait.” Li Ying posed a direct challenge: “Would you be okay if they didn’t achieve anything for ten years? What about nine years? Eight years?” As the parent shook their head in tears, they ultimately admitted, “I realize I’ve been pushing them a bit too hard.”
Anxious parents have suffered from high blood pressure, thyroid cysts, and many find themselves balancing looking after their child with seeking their own medical help. Soothing parents is often the first step in care. While they all come with hopes of facilitating their child’s return to school, Li Ying emphasizes, “Going back to school isn’t the priority; the child’s physical and mental recovery is what truly matters. When a child has the energy to face external challenges, they will naturally want to return to school.”
Li Ying also sees refusal to go to school as a form of vitality—a resistance to excessive external pressure that may sacrifice some academic performance, necessitating a balance. Sometimes, children are in immense pain yet feel like they “owe it to their parents” to attend school. He advises parents to counsel their children not to push themselves and first work on emotional adjustments.
These children often carry a burden of long-repressed emotions.
In the clinic, parents frequently ask, “Why aren’t other children like this?”
The triggering factor for each child can vary greatly—whether it’s an argument with a teacher, a poorly performed exam, an unanswered phone call from parents, pre-dawn jogs, or late-night study sessions. What often goes unnoticed, however, are the long-suppressed feelings of the children.
Once, a fifth grader presented a pie chart entitled “Things I Hate About School,” with sections like “Fear of forgetting things,” “Fear of making mistakes,” “Dislike for some classes,” “Lack of freedom,” and “High expectations leading to disappointment.” A first-year middle school student once tearfully expressed to a doctor the mounting pressure from school, shouting, “Daily school wears me out, and when I get home, I don’t even want to lift the blanket.”
Li Ying believes that school refusal results from a convergence of factors. He categorizes these into three main areas: individual personality traits, such as being sensitive or precocious; family dynamics, including the parent-child relationship and intergenerational conflicts; and school-related issues, including academic pressure and social relationships.
However, many parents tend to blame digital devices before seeking help from the clinic. To shift their child’s attention away from screens, some parents cut off their child’s internet access at bedtime or have destroyed several iPads. Li Ying argues that the internet alone cannot be blamed for school refusal. He suggests that smartphones have become the new caregiver for children due to the instant and unconditional feedback they provide, unlike the evaluative judgment of parents.
He likened the struggle between parents and technology to a “battle for control,” suggesting that the best approach is to replace the screen time with engaging parental interaction. Li Ying often encourages parents to keep behavior logs that detail what their child does throughout the day—not just for analysis but also to enhance the parents’ understanding of their child.
Some children study in their hometown while their parents work in Beijing; some attend boarding school and only return home once a month. Faced with overwhelming academic pressure and lacking time to speak to their parents, doctors recommend changing to a day school structure. Parents who travel frequently may lose track of their child’s whereabouts, prompting doctors to suggest “investing time” to enter the child’s world and reconnect.
Ye Yun is the second of three siblings. Her parents were often away for work and divorced during her time in middle school. From a young age, she was told, “Crying doesn’t solve anything,” and “Be stronger.” When she announced her decision to take a gap year during her second semester of high school, her parents chose to evade the issue, with her father’s friend signing off on her leave and her grandparents handling administrative tasks. Initially, they regularly urged her to return, but as her self-harm worsened and her eating habits deteriorated, her mother dropped her work commitments to stay with her at home, hoping to coax her into eating more.
Looking back, Ye Yun frequently mentions the “deconstruction effect,” realizing that only when situations worsen do parents become aware of their child’s fundamental emotional needs: “If a window could solve the issue, there’s no need to let the child lose the roof over their head.” Li Ying believes that repressed emotions tend to circulate within the family; he has seen children interrupting parental disputes under the guise of a stomachache.
In the path to recovering and returning to school, families provide the most crucial support. “Every family matures at its own pace; hospitals can only offer a venue for catharsis and breakthroughs.”
For many families, making parents aware of their own issues isn’t easy. Before their daughter entered middle school, Wang Yiyong and his wife took every possible step to prepare for her education, including securing a school district apartment and enrolling her in multiple tutoring classes. Their daughter, who excelled academically, smoothly transitioned into a prestigious school in Haidian District, but soon began suffering from insomnia, followed by bouts of panic whenever it came time to attend school.
They began seeking therapy, attending educational seminars to reflect on systemic family issues: improving their marital relationship and addressing the mother’s pent-up frustrations, which manifested in controlling behavior towards their child. As they gradually learned to listen more and accept their daughter unconditionally, she began to transition from locking herself away to eventually playing video games in the living room and accompanying her parents on walks.
Wang Yiyong connected with other parents facing similar challenges, forming a support group and sharing experiences in regular gatherings. One parent recounted their “darkest moment,” when their child’s self-injury escalated. They even crafted a 3D figure of their child during a trip to Disneyland, thinking, “If something ever happened, I’d still have this memory.”
“When a family is overwhelmed with conflict and hatred, those inner struggles are manifestations of love,” Li Ying commented. Parents like Wang Yiyong discovered that over time, their goal shifted from merely wanting their children to go back to school to fostering their independence and capacity for happiness. If their child doesn’t want to attend school but wants to start working, they support them as long as they aren’t financially dependent.
“Let children find their own rhythm,” he advised.
Colleague Hu Na has found that many children visiting the “School Refusal Clinic” show emotional issues that do not necessarily require medication. Early interventions—such as reducing stress, providing psychological support, and optimizing parenting styles—can effectively improve their emotional state.
One child with depression once confided that they had tried to get their parents to seek treatment a year earlier, but to no avail, as the parents felt the child was “overthinking.” The establishment of the “School Refusal Clinic” has been instrumental in reducing the stigma surrounding mental health for parents and encouraging early screening.
Though Li Ying has seen emotional issues improve with medication, it remains difficult for some children to return to school. “The longer the period of refusal, the harder it is to return,” he noted, suggesting parents help facilitate their child’s first steps rather than waiting indefinitely.
He also cautions parents against excessive self-reflection, urging them to focus on the present rather than retracing their perceived mistakes back to pre-birth. Action, he believes, is more crucial than dwelling on the past. He encourages parents to concentrate on tangible matters, such as increasing their child’s physical activity—offering rewards for steps taken—and collaborating with teachers about homework loads, to help the child find their own pace.
Some children tend to exaggerate the obstacles to returning to school, leading Hu Na to break down the tasks involved in education: “What will you do at home? What subjects do you enjoy? What are your academic plans? How long can you study at home?” This encourages parents to liaise with teachers regarding adjustments.
When a first-year student initially wanted to change classes due to struggling to adapt to a rigorous academic environment, but later expressed fears about adapting regardless of a change, Hu Na systematically laid out his concerns on paper, presenting different paths for him to consider. “Don’t shut off all your possibilities; give yourself a chance.”
Additionally, she promotes the retention of interest-based activities
