Social/ School Avoidance




Social Cognition in Children Born Preterm: A Perspective on Future Research Directions
Norbert Zmyj,1,*† Sarah Witt,1,† Almut Weitkämper,2 Helmut Neumann,2 and Thomas Lücke2

Children born very preterm are at increased risk of social competence difficulties throughout childhood and adolescence. Several developmental trends were also evident including social adjustment difficulties, evidence of poorer interpersonal behaviour and suggestions that social-cognitive processing may be spared in children born very preterm, at least during early childhood.

Parents, teachers, or service providers, such as psychologists, can positively influence an at-risk child's social competence by guiding the child, and giving advice and feedback, by providing opportunities for social interaction and prompting appropriate behaviours. By teaching children about their emotions, they can understand and cope with them as well as interpret how peers may be feeling.


What is social avoidance? This can be seen in premature kids around the school age of 6 – 12 years old. Social avoidance typically affects older children and teenagers, but it can be seen in kids younger. If you are wondering what the difference is of social avoidance and being just shy? You are right, there is a difference. Being shy means that you are just happy to be around people without anxiety, just needing time to warm-up. All children are different and some children just have different temperament, which makes children unique.

Social Avoidance may look more like:

  • More withdrawn
  • Trouble meeting new people and joining into groups
  • Have only a couple of friends or none at all just acquaintances
  • Avoiding social situations where they might stand out, like answering questions in class

Social Avoidance or Anxiety has symptom’s too, such as:

  • Nausea
  • Stomach Aches
  • Blushing and trembling
  • They might not talk about their fears or worries


How can you help?
Understanding why kids may be showing signs of social avoidance:

  • One of the main reasons for social avoidance is kids may be afraid to fail or make mistakes. 
  • They may be afraid to let others down and be embarrassed in front of others.

It is important to intervene because social anxiety can prevent children from trying new things and taking risks.

Talk to your child about social avoidance, make some goals and prepare your child with the skills needed to make some friends.

International Friendship Day: July 30th - a day to promote friendship in positive ways.



You would be surprised to hear that school refusal occurs in 1–5% of all school children, peaking at ages 5–7 years, then 11 years and 14 years. It occurs across all socioeconomic groups, and equally among boys and girls. But because of the risk factors in learning and the interpersonal communication among peers’ ex-premature children are at risk for this behaviour so knowing this ahead of time could be helpful. The term ‘school refusal’ refers to avoiding or problems attending school consistently or difficulties remaining in school for the entire day. Usually the child stays or returns home and does not attempt to conceal their nonattendance. School refusal is often associated with anxiety such as fears of separation, of tests or teachers, or of the constant changes needed during the day. Many children say they want to go to school but just can’t.

There are physical symptoms that are usually heard:

  • headache, abdominal pain, nausea, shakiness or dizziness. Symptoms present in the morning may disappear if the child stays at home.
  • In contrast, children who truant are usually not anxious, and conceal their truancy from parents, lack interest in school work, do not conform to the school’s codes of conduct, and often engage in delinquent behaviour.
  • School refusal usually starts gradually with vague complaints and reluctance to attend.


A school return plan will help if put into place straight away and if this has only been a problem for a short time. This will minimise continuing problems of missed class work and social isolation from gaps of time away from friendships and developing avoidance behaviours. The best things to do is validate their feelings, work together to plan a school return and dealing with anxious feelings with relaxation techniques and social skills training. Plan calm morning routines with easy achievable instructions.

Questions for parents, health care provider or school guidance counsellor:

  • What is the underlining problem fuelling this behaviour?
  • Where can I get support and what does this kind of support look like?
  • What can the school do to help?
  • Would an EP help? EP planning meetings or “case conferences” are important because they set the formal goals or objectives that your child's school team will be pursuing for the next school period, usually 3 to 6 months.

International Youth Day: August 12th is International Youth Day, which focuses on tweens and teens and their place in society. It’s not just to protect them, but to include them in the development of communities around the world, whether they’re rich or poor.

International Friendship Day: July 30th - a day to promote friendships in positive ways. 

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Disclaimer: This publication by Miracle Babies Foundation is intended solely for general education and assistance and it is it is not medical advice or a healthcare recommendation. It should not be used for the purpose of medical diagnosis or treatment for any individual condition. This publication has been developed by our Parent Advisory Team (all who are parents of premature and sick babies) and has been reviewed and approved by a Clinical Advisory Team. This publication is not a substitute for professional medical advice. Miracle Babies Foundation recommends that professional medical advice and services be sought out from a qualified healthcare provider familiar with your personal circumstances.To the extent permitted by law, Miracle Babies Foundation excludes and disclaims any liability of any kind (directly or indirectly arising) to any reader of this publication who acts or does not act in reliance wholly or partly on the content of this general publication. If you would like to provide any feedback on the information please email [email protected].