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While many families celebrate the coming school year, some of us dread that our kids may not go back at all.

Our children are not refusing school. Their brains are inflamed, and their bodies are reading danger.

Some years the goal narrows to weathering a hard stretch, with the right support in place to do it.

Every August, some parents watch the school year approach with dread. Their children are not truant or defiant. They have a medical condition that makes a school building unbearable, and most people around them, including many clinicians, do not know it exists. This letter is for those parents, and for anyone who has wondered why such a family cannot get their child through the door.

What is actually happening to these children

A number of conditions share one feature: The immune system stays activated, inflammation circulates, and some of it reaches the brain. The most recognized of these are PANDAS and PANS, both of which are post-infectious neuropsychiatric conditions. Autoimmune encephalitis, different autoimmune conditions, Long COVID, and ME/CFS can all also trigger neuropsychiatric symptoms.

When inflammation settles in the brain regions that scan for danger, a child loses the ability to sort a real threat from a harmless one. A hallway, a cafeteria, a locker door—the body responds to each as it would to an emergency, and the result looks like school refusal. A child cannot move past the front door, cannot get into the car, or cannot get out of it, and spends whatever energy is left getting home to collapse.

Over years of clinical work with neuroimmune families, I have come to describe........

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