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Tania García Abreu



After long weeks of family life, relaxed routines and different schedules, children and adolescents must return to the routine, often overloaded with extracurricular activities, transportation from school to another academy with a sandwich or a donut in the back of the car to then go back home and do homework, they are moments of transition that generate feelings of anxiety, and can be stressful and affect the whole family, children can be more introverted, and suddenly temperamental and irritable, they cry, they begin to complain of pains headache or migraines, or abdominal pain.

Often, psychological stressors play an important role in the onset of pain at the beginning of the school year.

Stress is a temporary response to an existing external stressor, anxiety is a sustained stress response typically disproportionate to the factor that produces stress and often focused on future events that have not yet occurred over time.

These stressors increase the likelihood of chronic childhood pain of acute pain.

Concerns are normal, anxious children and teenagers worry about many things related to going back to school like their teachers, friends, how to fit in and / or be separated from their parents. Many of these concerns are reflected in:

Who will be my new teacher?

What if my new teacher is very demanding?

Will my classmates be in my classroom?

Will I fit this year?

Will I have the right clothes?

Will I look stupid?

Who will sit at lunch with me?

What if I miss the bus?

What if I don’t understand the new subjects?

What happens if something bad happens to my parents while I am in school?

  • And if the children already suffer from chronic pain to the above, other concerns join:

How can I endure when my gut or head hurts?

Will I have to give explanations to everyone again?

Will they make fun of me?

Although it is normal to have all these concerns, it is crucial that children go to school. Avoiding it will only reinforce children’s fears in the long term, and will make it harder to attend.

Apart from losing school work, children who stay home lose:

  • Opportunities to develop and practice social relationships
  • Opportunities for improvement and education
  • Be recognized for their values and talents
  • Be close to classmates and friends.
  • And most importantly, these children do not realize that all these catastrophic challenges and fears are not real.




How to handle the fears of going back to school?

Together with basic strategies to use parents to handle all these concerns, following a scheme until the first day of school is a good idea:


No one can stand if they are tired or hungry, anxious children often forget to eat, do not feel hungry and do not get enough sleep. Frequently provide NUTRITIVE AND HEALTHY snacks for the child. During the previous days it is necessary to build regular routines, so that children’s lives are a little more predictable. These routines can involve schedule habits of going to bed and lifting them a little earlier, as well as meal schedule schedules.



Ask the children what worries them. Tell your child that it is normal to be worried. Before and during the first weeks of school, set regular times and places to talk. Some children feel comfortable talking in a private place with the exclusive attention of the parents (just before going to bed or during the meal). Teenagers often appreciate some kind of distraction that shortens the intensity of these feelings and concerns / (such as taking a walk or taking them by car).



Children often seek to be assured that bad things will not occur in order to reduce their concerns. Do not assure them: “Do not worry or everything will be fine”, instead encourage children WITH DIFFERENT ways to solve the problem. For example “if the worst happens, what can you do? Or we are going to think about a way to handle the situation, it gives us the opportunity to guide our children, to be a coach in how to handle and interpret both real and imaginary worrying situations. We also give our child the tools he needs to handle any unexpected situation that arises.

Everyone can play a role as a theater in a certain situation that can help your child make a plan and feel more confident in how to handle the situation.

Focus on the positive aspects Encourage children to redirect attention away from worries and towards the positive! Ask the children what are the 3 things that excite you most about their next school day. Most children can think of something good, even if it’s just eating something special or going home at the end of the day. The options are that the fun aspects have simply been overcome by repetitive concerns.




Pay attention to our own behavior. It can be stressful to pass responsibility for the education of our children to teachers. Children can bring their worries to parents so that to greater confidence and comfort your child will mostly think that there is nothing to worry about. Give support, but be firm. When you say Good morning in the morning say it with a cheerful tone only once, make sure you do not reward your child’s protests or anger to avoid going to school. Instead, in a calm tone, we MUST TELL YOU: “I see that going to school makes you worried, but you should also go. Tell me what worries you, so we can talk about it. The most normal thing is that your child is anxious about something that needs to be solved, and / or involving the teacher



  1. One week before

Start the school routine, get up, eat and go to bed at regular times. Explain that everyone in the family needs to adjust to a new organization chart so they don’t feel alone in these changes.

For children who are older and have trouble getting up, give them an “older” alarm clock and let them start practicing with it.

Ask your child to help with the school lunch during the first week.


Make a list of school supplies and make a fun shopping plan. Or shop online to avoid getting tired in the bustle of the big shopping centers.

Teach and practice how to drive when they feel nervous, such as using abdominal breathing and using cognitive management and control charts.



  1. A couple of days before going to school:

Go to school several times, walking, driving or taking the bus. Younger children make the bus route and draw the route, including where the bus goes how long it takes. It makes us feel safe.

For new students, make a route at school. Show the children the classroom, the cafeteria, the dining room and the bathrooms. If possible, meet the child’s teacher with the child present.

Ask your child to help choose the clothes and accessories (the new backpack or case) that he will wear on the first day of school.

Next to your child, put things in the backpack the night before, including some extra reward (your favorite doll, a chocolate snack for the elderly)

Children who are nervous about separation, suggest that they bring a special object to school that reminds them of home. A small note at lunch can avoid the anxiety of separation.


  1. The first day of school:

Take your child to school with a friend the first couple of days

Tell the teacher that your child has some separation anxiety – many teachers are experts in this area, have years of experience.

And most importantly, encourage and reward your child for his behavior.



The reaction to stress, even in the short term causes an increase in muscle tension, this leads to stronger pain regardless of suffering from migraines, abdominal pain or headache, muscle tension leads to increased pain.

The pain itself naturally contributes to the stressful reaction, if all this is maintained over time, it will cause the painful stimulus to be perceived more strongly by the center of the pain.

Parents who live with children with pain are also physically stressed (exactly like their children), not being a hysterical overreaction, but a simple expression of their love for their children.

Almost 1 in 4 children live with a condition that leads to pain. Being headache, abdominal and skeletal muscle the most common pain. School is a great challenge, for children it can mean a disruptive state: from lack of sleep to issues of friendships. The school becomes complex because of the mixture of high academic demands, emotional, social and cognitive demands.


For parents living with children with chronic pain we suggest:

  1. Think about your children’s abilities, as well as the demands of the school. Some children require a more gradual return to school, starting with shorter periods of a few hours a day, then increase them if the child tolerates sitting, standing and walking….

2.Do not overload the child with pain: ”It can be tempting at the beginning of the year that one wishes that their child who has not been involved in many activities make an immediate immersion. Instead it is preferable to start with few activities, adding others throughout the year if the child is doing well.

3.Si the child suffers exacerbations of pain in school, it would be useful for them to have a place to go well in the study room, the bookstore or another class where they can take a 10-minute break. Make a plan to manage pain. Here are several ideas: get up and stretch during class, take 10-15 minutes of rest during the day at school, use distraction techniques (e.g. painting, listening to music or asking classmates for a joke or funny story) talk to your child to plan on how to feel more at ease at school. Once your children have decided and shared ideas, talk to school professionals so they know what they can do to help.

  1. For children who already work with pain, the attitude of parents is important, should you ask how the day at school was and not how to count from 1 to 10 your pain at mealtime,, so you always focus on the positive , what the children were able to do.

Tell the children to expect the school year to go well. Children and adolescents may act as if they don’t care what parents say or think, but this is not true. Your children watch the clues carefully to see if you think they can or can’t overcome the challenges. We have the opportunity to create a tone for our children to match our optimism. Tell him, “We’re going to work together to help you succeed during the school year.”

5.You want to do everything so that you feel at ease and leaned even in the distance so that you can overcome it. This can mean seeking help from pediatric physical therapists, pediatrics, or psychologists. Some children benefit from an individualized education plan.

Physical activity helps kids function much better. Swimming is an option for children who require low-impact exercise.

6.Pay attention to our children’s efforts at school especially if they don’t feel well. Do you stay at school instead of coming home early?

Do you complete your homework on time? Praising the work works even better if it’s specific, for example, “You’ve done a great job staying until the end of classes even though you weren’t feeling well” or “you worked hard to finish your homework before dinner”: well done! We can also interpret difficult situations more favorably, for example, if your child complains about being at school on a peak of pain, we can tell them “learning to be in school even when you’re not feeling good will help you stay on track to be able to graduate. So you won’t have to do everything later, you won’t have to go to review classes and next summer you’ll have plenty of time to do fun things.”

Here are multiple things we suggest to help children with chronic pain as parents. Working alongside the school’s professional group will help you get off to a great start to the school year.

If you have doubts or experiences of school with your children with chronic pain make them arrive and tell us if everything is going well and what challenges are you encountering.




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  2. Natoshia Raishevich Cunningham, Ph.D.,1,2 Anjana Jagpal, B.A.,1 Susan T. Tran, Ph.D.,3 Susmita Kashikar-Zuck, Ph.D.,1,2 Kenneth R. Goldschneider, M.D.,2,4 Robert C. Coghill, Ph.D.,2,4 and Anne M. Lynch-Jordan, Ph.D.1,2,4 Anxiety Adversely Impacts Response to Cognitive Behavioral Therapy in Children with Chronic Pain. J Pediatr. 2016 Apr; 171: 227–233.Published online 2016 Feb 12. doi: 10.1016/j.jpeds.2016.01.018.


  1. Managing Your Child’s Chronic Pain 1st Edition

by Tonya M. Palermo (Author), Emily F. Law (Contributor).

6.How to stop chronic pain in children Michael Dobe, Boris Zernikow.2nd edition.2019

7.Chronic pain and illness workbook for teens. Rachel Zoffness 1st edition 2019.

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