A Swiss survey suggests that children’s difficulties at school are increasingly becoming a medical concern. The remedies may lie less in the clinic than in the classroom. For Swiss paediatricians, school is increasingly part of the medical workload.
A new study by gfs.bern, commissioned by Stiftung Mercator Schweiz, surveyed 469 practising paediatricians and supplemented their answers with 17 interviews with specialists in education, psychology and medicine. Forty-four per cent of doctors encounter school-related problems at least once a day as the stated reason for a consultation; 89% of those who treat such problems say they have become more common during their careers.
That does not mean school itself is making children ill. The education specialists interviewed for the study stress that school can also provide structure, belonging and protection. What matters is the fit between a child, the demands placed on them and the relationships around them.
The symptoms change with age. Younger children tend to present with stomach aches, troublesome behaviour and difficulty concentrating. By secondary school the picture becomes more serious. Among paediatricians treating pupils in years seven to nine, 75% frequently encounter depressive moods linked to school problems, 58% eating disorders, 54% self-harm and 51% suicidal thoughts. Concentration and attention problems remain common throughout.
This helps explain why doctors have become involved. But it also creates a risk: problems that are partly educational or social can acquire a medical label because medicine offers one of the few routes to extra help.
The paediatricians themselves seem alert to this. Most think at least some school problems could be prevented more effectively through educational measures than medical ones. The report describes a system in which a diagnosis can sometimes become the ticket to extra resources, therapy or accommodation at school. Its authors therefore suggest making low-threshold educational support available before a formal diagnosis is obtained.
There is no single culprit. Doctors most often point to bullying or social exclusion, a mismatch between the difficulty of schoolwork and the child, and a strained relationship with the teacher. The report argues that school problems arise from an interaction between the child, the class, the school and wider society.
Two themes stand out. The first is pressure. Paediatricians frequently mention performance pressure, while interviewees point to marks and other forms of assessment, later amplified by comparison on social media. Reducing performance and selection pressure is regarded across professional groups as one of the most promising interventions.
The second is relationships. Seventy per cent of paediatricians frequently suspect a strained teacher-pupil relationship as a cause of school problems; 60% point to frequent changes of teacher. Across the interviews, a stable relationship with a teacher emerges both as a protection and as a potential source of difficulty, especially for younger children.
The remedies are therefore strikingly unglamorous. The report calls not for a radical change, but for strengthening what already surrounds the child.
That begins before school. Nearly a third of paediatricians have encountered children whose developmental difficulties were recognised before enrolment but insufficiently taken into account afterwards. Services already exist, from paediatric practices to early special-education and parental counselling, but they are often poorly connected.
In school, teaching should be more closely adapted to children’s developmental stage. The report favours learning environments that accommodate variation from the outset, as well as later grading and later academic selection where possible.
Continuity also matters. Frequent changes of teacher,and specialist support outside the classroom can weaken relationships. One proposal is permanent team-teaching by two qualified professionals, which could give pupils more stability while reducing the burden on teachers.
None of this can be done by schools alone. Paediatricians already work with psychologists, psychiatrists, teachers and other specialists. Yet such collaboration tends to begin late, after a problem has become serious. The obstacle is not friction between professions but shortages of time, staff and money.
That is an important distinction. Governments often respond to problems of co-ordination by urging greater collaboration. But overloaded doctors and teachers do not gain extra time because a policy document stipulates more interaction.
The study argues instead for making interprofessional work explicitly funded and built into workloads, while involving parents and children earlier. Its broader conclusion is simple: move upstream. Rather than waiting until an individual child is in distress, schools and health professionals should co-operate earlier, work more preventively and make better use of services that already exist.
More on this:
Study (in German)
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