School refusal is often a symptom of an underlying anxiety disorder. The child may get anxious on separating from their primary caregiver and this manifests itself in different ways depending on the age of the child as much as anything. There are 2 peak age groups who develop school refusal, 5-7 year olds and 11-14 year olds. 25% of school children refuse to attend school at some point in their school career but it becomes a routine problem in about 2% and the longer it goes on, the harder it is to reverse. It is not the same as truancy. It is not a mental illness in itself but many children who feel unable to attend school over a long period do have an underlying mental health issue. Unfortunately funding for CAMHS is being eroded and it is difficult to find good, and timely, help for school refusers. The websites I have listed in December 2010 Paediatric Pearls for GPs may help give parents pointers for why it is happening and how to set about managing it.