It's a rare parent who doesn't need to drag a reluctant child out of bed for school at times, whether it's because of a forgotten homework assignment, a playground problem or trouble at home.
But deciding when youthful jitters become serious enough to get help is a tough call.
One Munster mom, who did not want to be identified, recalled seeking professional assistance for her daughter in first grade.
"She started not wanting to go to school," the mom remembered.
"She would cry before school and have a stomach ache for three weeks in a row." This escalated to dry heaves and vomiting, to the point where the youngster missed one or two days of school weekly.
Tests ruled out a physical ailment, but the family's physician suggested something at school probably was causing the girl's fear.
"Keep getting her to school, or one day (off) will turn into 50," he said.
"It was very hard," the woman said.
"I became sick also. I went on ulcer medicine. My gut and my heart were telling me, she needs counseling."
Through role playing and art therapy, in which the girl drew pictures of situations in her life, it came out that another student was intimidating her on the playground and in the classroom.
About three months of treatment enabled the girl to deal with difficult situations, even later in life, according to her mom.
"Counseling was the best thing I ever did for my kid," the woman said.
"(The therapist) helped me to understand everything about my kid."
Angie Valente, a therapist with New Leaf Resources, a professional mental health agency with offices in Crown Point, Lansing and Elmhurst, said symptoms such as stomach pain often signal it's time for parents to seek help.
"If the child is experiencing significant distress -- stomachaches, trouble sleeping, worrisome thoughts -- and if it's happening on a consistent basis, it's more of a problem," she said, adding changes in eating habits and social relationships also are good indicators. Grades may start to slip.
Besides bullying, other causes of anxiety can include events such as divorce, or the recent area flooding.
"A lot of kids in the Munster and Highland area are grieving," she said. "If they seem hyper, they could be anxious."
Valente pointed out separation anxiety differs from being school-phobic, in which something (such as school) that normally is not dangerous becomes associated with danger.
However, if you avoid the source of your fear, you "never get the chance to learn it's OK," she said."You try to restore (the child's) thinking process so they won't be in alert mode anymore, so they learn to deal with it and not avoid it."
An alternative learning environment can help with school phobia, but "you don't want to feed the phobia," she warned. "The school needs to be on board."
An "anxiety hierarchy," in which children list what they are afraid of at school and imagine themselves in that situation, can be helpful.
Other methods of coping include relaxation and breathing techniques, in which the person visualizes their stomach as a balloon being blown up. Thought restructuring involves "challenging beliefs about school or themselves," Valente added.
A sand tray or dollhouse allows the youngster to play out uncomfortable situations, or they may draw pictures of events that distress them or detail them in narrative form.Praying or meditation with parents can help, as does systematically relaxing various parts of the body. Sometimes holding a tangible object, such as a rock from a fish tank, is beneficial.
Counseling sessions usually last 45 or 50 minutes and take place weekly, but how many and their duration varies.
"The goal is to not need therapy," Valente said.
"With teens, a lot (of the solution) is helping the parents to help their child. Often, anxiety issues or depression issues go undetected. Adolescents are more susceptible to issues because of hormonal changes, etc. Depression rates jump, especially in girls."
Medication can be effective in some instances but provides "only part of the benefits" of therapy, Valente said.
"It's important to get a full evaluation."
Clinical social worker Kristen Gloff has been working with a fifth-grade student who developed separation anxiety this year, saying she missed her mother and wanted to go home.
Her father's job loss and issues with another student "sent her into a tailspin," according to Gloff, a Munster resident who works in an Illinois school district. She became tearful in class and developed stomachaches, so was sent to the school nurse, and then to Gloff.
Therapy involved breaking the girl's day into 15-minute increments, checking off each of those time periods as they passed.
"She still misses her mom, but she's coping much better," Gloff said.
"There was some backsliding when she was home for Thanksgiving but she recovered."
Gloff agreed skipping school isn't the answer.
"It's hard to see them clutch you, but if you allow them to stay home, it's almost like you're enabling them to be that way," she said.
She recommended looking for a pattern of troublesome behavior to determine the severity of the problem.
"If a child's functioning is impaired, and you don't see them moving out of that -- sleeping, eating, grades, teacher feedback -- you need to look at getting some external supports," Gloff said. "With the flood, you expect fallout from that."