Inflammatory Bowel Disease Center | Managing School Stress

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Heading back to school can often create a lot of emotional changes for children. There's the anticipation—or nervousness—of new teachers, friends and classes, as well as the return of more rigid bedtimes, mealtimes and wake up times.

For some students with inflammatory bowel disease (IBD), all these schedule and workload changes can cause stress, trigger gastrointestinal symptoms and affect a child’s well being. Parents who are aware of the effects the “back-to-school” period has on their child can make this transition easier.

"Change in any routine can be disruptive for kids with IBD, both emotionally and physically," says Janis Arnold, MA, LICSW, a social worker at Boston Children's Hospital's Inflammatory Bowel Disease Center." Anytime you experience a big lifestyle shift, like going from the lazy days of summer to a more rigorous school year schedule, it can create stress, and that stress can often lead to an uptick in IBD symptoms."

New routines, surroundings and demands brought on with a new school year can create excitement and/or stress for many children. Stress and excitement have both been linked to triggering symptoms such as abdominal pain in children with and without IBD, thus making the new school year particularly hard for some kids.

"There's a complex physical relationship between the brain and gut, and while the exact extent of that connection is largely unknown, there is an undeniable relation between our emotions and the body's response, especially in our stomach," Arnold says.  "Regardless of whether a child with IBD is super excited for the upcoming school year or completely dreading it, the flurry of emotion she is feeling can lead to GI distress." 

To make the transition from the beach to the books a little easier for children with IBD, Arnold suggests paying attention to what you already know about your child’s temperament and routine a little before the school year begins. If she seems nervous, or you're concerned a shift in schedule could lead to problems, being proactive is your best bet.

“Awareness is key. Knowing your child could be dealing with potential triggers means you can try to anticipate them and plan accordingly," says Arnold. "If changes in routine or stressful experiences tend to create symptoms for your child, start getting her on a new school year medication or sleep schedule early, maybe a week or two before school starts. This way there are fewer new variables with the inevitably new structure the school day itself will bring."

Here are some suggestions for preparing your child with IBD for going back to school:

  1. Use the summer vacation time to get your child’s IBD under control. If your child has symptoms like abdominal pain, diarrhea, rectal bleeding or poor appetite, check in with your child’s gastroenterology specialist to make sure your child does not need any adjustment in medications. 
  2. Check in with your child’s school team (including the guidance counselor, school nurse and teachers) in order to familiarize them with the condition, its treatment and how it affects your child's school participation and academic workload. If appropriate, your child’s individualized education program or 504 plan may need to be modified.
  3. Review your child’s medications carefully, and figure out which medications need to be taken during school hours. In general, a child’s school day is easier if medication does not need to be given during school hours. A parent can check with the child’s health care team to figure out the precise timing of medication and if there is flexibility in the time a medicine can be given. 
  4. Try to get a sense of how “stressed out” your child is about heading back to school. For some children, discussing these feelings may keep her from “bottling up” emotions, which may lead to physical symptoms like abdominal pain. If you decide to have a discussion with your child, try to do so in a way that doesn't create fear or worry. 

 “If the child is upset, it will then be a good opportunity to talk about her concerns so you can help address them," Arnold says. "Use the time to remind her that there is a whole team of people working hard to keep her well."

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