School refusal is often more than reluctance—it can be a sign that a child’s needs aren’t being met in their learning environment. Rather than focusing solely on attendance, it’s important to understand the underlying sensory, emotional, or social factors contributing to a child’s distress. In this article, we explore how paediatric occupational therapists work collaboratively with families and schools to identify these needs and implement tailored supports. By creating safer, more responsive environments, children can gradually build the confidence and regulation skills needed to re-engage with learning and daily school routines.