<p>School refusal is a growing concern in child and adolescent psychiatry, often rooted in complex psychiatric, familial, and behavioral dynamics. In the digital age, excessive Internet and social media use may exacerbate emotional dysregulation and avoidance behaviors, potentially contributing to school absenteeism. This study aims to investigate the psychiatric diagnoses and digital media habits associated with school refusal. Forty-five children aged 6–18 who presented to a university hospital outpatient clinic with school refusal between January and February 2024 were initially evaluated through semi-structured interviews conducted by child psychiatry specialists. Of these, 31 children completed both baseline and 6-month follow-up assessments. Participants completed a sociodemographic form, the School Refusal Assessment Scale–Child Revised (SRAS-C-R), the Internet Addiction Test (IAT), and the Social Media Disorder Scale–9 (SMDS-9). Psychiatric diagnoses were present in 96.6% of the sample. The median daily duration of Internet-related activities was six hours. Complete school dropout occurred in 32.3% of cases. SMDS-9 scores showed a significant positive correlation with SRAS-C-R total scores (r = 0.381, <i>p</i> = 0.034). Duration of school refusal was positively associated with SRAS-C-R negative affectivity (r = 0.393, <i>p</i> = 0.029) and total (r = 0.373, <i>p</i> = 0.039) scores. Children who dropped out had significantly higher SRAS-C-R scores in the attention-seeking and negative affectivity subscales (<i>p</i> = 0.034, <i>p</i> = 0.019). Social media use was significantly associated with school refusal. Attention-seeking behaviors were linked to longer refusal duration, and both social avoidance and attention-seeking were related to school dropout. While the clinical and small sample limits generalizability, the findings point to the need for interventions that address both emotional symptoms and digital media use in children with school refusal.</p>