School Refusal: Why Your Child Can't Face School and How to Help Them Go Back
School refusal is usually driven by anxiety, not defiance. Learn the warning signs, how to plan a calm return and when a psychiatric evaluation helps.
Your child is struggling, and you're trying to judge how serious it is. Is this a child mental health emergency that needs the ER tonight, something to call the doctor about today, or a concern that can wait for a scheduled visit? This guide walks through all three levels so you can act quickly and with more confidence.
If your child is in danger right now: Call 911 in an emergency, or go to the nearest emergency room. You can call or text 988 to reach the Suicide and Crisis Lifeline at any hour, or text HOME to 741741. More options are on our crisis resources page.
Key takeaways
- Immediate danger, a suicide attempt or plan, signs of psychosis, or a child who won't eat or drink calls for 911, 988 or the ER.
- Worrying changes without immediate danger call for a same-day phone call to your child's doctor or psychiatric provider.
- Ongoing struggles that have built up over weeks or months call for a scheduled evaluation.
- Locking up medications and other means of harm at home is one of the most protective steps a parent can take.
- After an ER visit, a follow-up appointment within days matters as much as the visit itself.
Three levels of care at a glance
Most situations fall into one of three levels.
| Level | What it can look like | What to do |
|---|---|---|
| Emergency | A suicide attempt or plan, threats to hurt others, psychosis, not eating or drinking, a possible overdose | Call 911, call or text 988, or go to the ER |
| Urgent | New talk of death without a plan, self-harm that doesn't need medical care, a sudden sharp change in behavior | Call your child's doctor or psychiatric provider the same day |
| Routine | Sadness, worry, irritability or attention problems that have lasted weeks or months | Schedule an evaluation |
If you can't tell which level fits, treat it as the higher one. It's always okay to call 988 and talk it through.
Signs of a child mental health emergency
These signs mean your child needs help right away:
- Your child has made a suicide attempt, or talks about suicide and has a plan or intent
- Self-harm that causes a serious injury
- Threats or actions to seriously hurt someone else
- Signs of psychosis, such as hearing or seeing things others don't, holding beliefs that are clearly not real, or seeming unable to tell what's real
- Refusing to eat or drink, or being unable to take care of basic needs
- Agitation so severe that your child can't be calmed and may get hurt
- A possible overdose or dangerous intoxication
What to do in an emergency
Call 911 if anyone is in immediate physical danger or your child needs medical care. If your child is calm enough to travel safely, you can drive to the nearest emergency room, ideally one with pediatric services. If your child is very agitated or might try to leave the car, call 911 instead of driving.
Calling or texting 988 is another option when you're unsure. Trained crisis staff can help you decide on next steps and connect you with local crisis services.
Urgent concerns: call the same day
Some situations aren't an immediate danger but shouldn't wait for next month's appointment. Call your child's pediatrician or psychiatric provider the same day if you notice:
- Comments like "I wish I weren't here" with no plan, when your child can stay safe with you
- Self-harm that doesn't need medical care
- A sudden, sharp change, such as refusing to go to school, barely sleeping for several nights, or daily panic attacks
- New agitation, restlessness or darker moods after starting or changing a medication
- Rapid weight loss or eating much less than usual
Many offices have an after-hours line. If you can't reach anyone, call or text 988. If things get worse, treat it as an emergency.
Routine concerns: schedule an evaluation
Many mental health problems in children build slowly. Weeks of low mood, constant worry, irritability, trouble focusing, falling grades, pulling away from friends or changes in sleep and appetite are all good reasons for an evaluation.
Our guide on whether your child needs a psychiatrist can help you sort out what to watch for. A thorough evaluation with a child and adolescent psychiatry provider looks at your child's history, development, school life and family background before any diagnosis is made.
What to do while you wait
While you wait for help, a few steps make a difference:
- Stay close. If you're worried about safety, don't leave your child alone, even briefly.
- Stay calm and keep it simple. Speak slowly and quietly. You don't need perfect words. "I'm here, and we're going to get help" is enough.
- Ask directly. It's okay to ask, "Are you thinking about killing yourself?" Asking does not put the idea in a child's head, and it often brings relief.
- Gather information. Bring a list of your child's medications, diagnoses, allergies and the names of their doctors.
- Get support. Call a partner, relative or friend to help with siblings or to sit with you.
Safety at home
Reducing access to the means of self-harm is one of the most effective ways to protect a child in crisis. Suicidal crises are often brief, and putting time and distance between a child and a means of harm can save a life.
- Lock up all medications, including over-the-counter medicines and your child's own prescriptions. Give doses yourself.
- If there are firearms in the home, store them locked and unloaded with ammunition kept separately, or ask a trusted person to hold them temporarily.
- Lock up or remove alcohol and other substances.
- Put away sharp objects and anything else your child's care team suggests.
Supervision matters too. During a crisis, keep doors open and check in often.
What happens after an ER visit
In the ER, staff will check your child's physical health and assess safety. Depending on what they find, your child may be admitted to a hospital unit, transferred to a psychiatric facility, or sent home with a plan.
If your child comes home, ask for written discharge instructions and a safety plan before you leave. The days and weeks after an ER visit or hospital stay are a time of higher risk, so follow-up care matters. Aim for an appointment with a psychiatric provider within a few days, and within a week at most.
Bring the discharge paperwork so your child's provider can review what happened, adjust medications if needed and plan next steps. Our medication management visits are built for this kind of close follow-up.
The value of mental health screening at checkups
Regular screening at well-child visits can catch problems before they turn into a crisis. The U.S. Preventive Services Task Force recommends screening for depression in children ages 12 to 18 and for anxiety in children ages 8 to 18. Many pediatricians use short questionnaires to do this.
If your child's doctor hasn't brought up mental health, ask.
Frequently asked questions
Should I call 988 or go straight to the ER?
If your child is in immediate danger or needs medical care, call 911 or go to the ER. If you're unsure how serious things are, 988 can help you decide. Both are available at any hour.
Will my child be admitted to the hospital?
Not always. Many children are evaluated and sent home with a safety plan and follow-up care. Admission is more likely when the team believes your child can't stay safe at home.
What if my child refuses to go to the ER?
If your child is in danger and won't go, call 911. Emergency responders are trained to help in these situations. Try to stay calm and avoid physical struggles that could hurt either of you.
Can a psychiatrist's office handle a mental health emergency?
Outpatient offices, including ours, aren't set up for emergencies and don't offer 24/7 crisis services. In an emergency, use 911, 988 or the ER. A psychiatric practice is the right place for urgent follow-up, ongoing care and routine evaluations.
Getting your child the right care
At Musec Medical, our psychiatrist and psychiatric physician assistants see children ages 4 and up for evaluations, follow-up after an ER visit and ongoing care, in person in Chicago or by telehealth anywhere in Illinois. Request an appointment when you're ready.
