School refusal is almost always linked to anxiety, although this may only be apparent when attempts are made to get the child to school. The way in which school refusal presents in primary care is often with physical symptoms such as nausea, abdominal pains, headaches or diarrhoea. Minor forms of school refusal are common, and are likely to involve the general practitioner in assessing anxiety or physical symptoms. Complete refusal to attend school is rarer, and is likely to involve referral to child mental health services. Many parents can adopt this plan with the minimum of support and guidance. An incipient school attendance problem can be dealt with at an early stage, when it is easiest to resolve. The prognosis is better in younger children, and in those who have been out of school for only a short time. Behavioural treatments of the type described above are effective in about 90% of primary school children with a short history.