Separation anxiety

Separation anxiety is an extreme worry your child experience about something happening to mom and dad when your child is separated from mom and dad. It’s natural for your young child to feel anxious when you say goodbye. Part of a baby’s normal development is learning that separations from parents are not permanent. Young babies do not understand time, so they think a parent who walks out of the room is gone forever. Also, they have not yet developed the concept of object permanence that a hidden object is still there, it just cannot be seen. Without these concepts, babies can become anxious and fearful when a parent leaves their sight. Separation anxiety is usually at its peak between 10 and 18 months. Separation anxiety typically ends by the time a child is 3 years old. For example, toddlers who cling to mom as she’s leaving for work or wail when they’re handed to the babysitter are fairly common.

But for some children separation anxiety persists into the school years, even with a parent’s best efforts and becomes more rather than less pervasive. These children experience a continuation or reoccurrence of intense separation anxiety during their elementary (primary) school years or beyond. If separation anxiety is excessive enough to interfere with normal activities like school and friendships, and lasts for months rather than days, it may be a sign of a larger problem called separation anxiety disorder.

When kids with separation anxiety are away from caregivers they can develop extreme fears that sound melodramatic to the rest of adults, but are very real to them. For example, a child with separation anxiety might have a hard time concentrating in class because she might be afraid her father is going to have a car accident. She might be worried that her family will get hurt, or she will get hurt, or even that she might be abandoned. If a parent is five minutes late to picking her up from soccer practice, she might assume the family has left town without her.

Mobile phone technology, rather than easing anxiety, can actually exacerbate it, since now there is the expectation that you can always be in touch with each other. Many parents of kids with separation anxiety are used to getting dozens of worried text messages and phone calls throughout the day while they are at work or their child is at school, and some kids will start to panic when mom or dad doesn’t answer or is out of cell phone reception range.

Separation anxiety itself, when developmentally appropriate, is not necessarily a bad thing. Though it feels uncomfortable, anxiety can be useful because it spurs children to be more thoughtful and cautious when approaching a new situation.

At different stages of development it is normal to have problems around separation, because the world is not safe, and your child haven’t learned how to master being away from the people who take care of them. As your child develop, and as you begin to master situations and develop skills, it should get easier.

Signs of separation anxiety in babies

Babies experiencing separation anxiety fear that a parent will leave and not return. The fear may be worsened in the presence of a stranger. Typical responses of babies experiencing this normal phase of development may include the following:

• Crying when you leave the room
• Clinging or crying, especially in new situations
• Awakening and crying at night after previously sleeping through the night
• Refusal to go to sleep without parent nearby.

Separation anxiety in children

In early childhood, crying, tantrums, or clinginess are healthy reactions to separation and a normal stage of development. Separation anxiety can begin before a child’s first birthday, and may pop up again or last until a child is four years old. However, both the intensity level and timing of separation anxiety vary tremendously from child to child. A little worry over leaving mom or dad is normal, even when your child is older. You can ease your child’s separation anxiety by staying patient and consistent, and by gently but firmly setting limits.

For kids who have severe, persistent anxiety at separating, it doesn’t get easier. These kids will have an unusually hard time saying goodbye. If you think of anxiety as an alarm system which functions when you perceive a threat, kids with separation anxiety have faulty alarm systems. They have either an alarm system that’s on all the time, so they really never feel comfortable taking risks and moving forward, or they have one of these faulty alarm systems that go off every once in a while. Either way they can get locked onto a strategy of having someone there that can protect them—usually parents. This person can afford me safety, so I’m going to stay with them. Or this place is my safe place; I’m going to stay with it.

The distress these kids feel about separating prevents them from participating in age appropriate activities and learning opportunities like joining sports teams or even in some cases attending school. The anxiety takes a social toll as well—these are the nine-year-olds who still need mom to stand next to them during a birthday party or won’t consider attending a sleepover unless it is being hosted at their own home.

Over-attachment also persists at home, where children will often “shadow” one parent from room to room. Some kids with separation anxiety fear being left alone upstairs or sleeping alone in their beds. Parents tell us about kids who insist on sharing mom and dad’s bed at night or describe getting woken up “like an alarm clock” every morning at 5 or 6am when their child crawls into bed with them.

Anxiety at even the thought of separation

While younger children generally become anxious at the moment of separation, older children can experience anticipatory anxiety. These kids might also have nightmares about separating. Whether their distress is anticipatory or immediate, many kids also feel the physical symptoms of anxiety, which include headaches or stomachaches.

How can I help my child with separation anxiety?

For children with normal separation anxiety, there are steps you can take to make the process of separation anxiety easier. Children who feel secure are better able to handle separations. Cuddling and comforting your child when you are together can help him or her feel more secure.

Other ways to help your child with “normal” separation anxiety include the following:

• Comfort and reassure your child when he or she is afraid.
• At home, help your baby learn independence by allowing him or her to crawl to other (safe) rooms for a short period of time alone.
• Tell your baby if you are going to another room and that you will be back; then come back.
• Plan your separations when your baby is rested and fed, rather than before a nap or meal.
• Introduce new people and places gradually, allowing your baby time to get to know a new care provider.
• Do not prolong good-byes and have the sitter distract your baby or child with a toy as you leave.
• Introduce a transitional object such as a blanket or soft toy to help ease separations.
• For night awakenings, comfort and reassure your child by patting and soothing, but avoid letting your child get out of bed.
• Practice separation. Leave your child with a caregiver for brief periods and short distances at first. As your child gets used to separation, you can gradually leave for longer and travel further.
• Schedule separations after naps or feedings. Babies are more susceptible to separation anxiety when they’re tired or hungry.
• Develop a quick “goodbye” ritual. Rituals are reassuring and can be as simple as a special wave through the window or a goodbye kiss. Keep things quick, though, so you can:
• Leave without fanfare. Tell your child you are leaving and that you will return, then go—don’t stall or make it a bigger deal than it is.
• Follow through on promises. For your child to develop the confidence that they can handle separation, it’s import you return at the time you promised.
• Keep familiar surroundings when possible and make new surroundings familiar. Have the sitter come to your house. When your child is away from home, encourage them to bring a familiar object.
• Have a consistent primary caregiver. If you hire a caregiver, try to keep them on the job long term to avoid inconsistency in your child’s life.
• Minimize scary television. Your child is less likely to be fearful if the shows you watch are not frightening.
• Try not to give in. Reassure your child that they will be just fine—setting consistent limits will help your child’s adjustment to separation.

Separation anxiety disorder

Separation anxiety disorder is NOT a normal stage of development, but a serious emotional problem characterized by extreme distress when a child is away from the primary caregiver. However, since normal separation anxiety and separation anxiety disorder share many of the same symptoms, it can be confusing to try to figure out if your child just needs time and understanding or has a more serious problem.

Separation anxiety disorder is defined as excessive worry and fear about being apart from family members or individuals to whom a child is most attached. The main differences between normal separation anxiety and separation anxiety disorder are the intensity of your child’s fears, and whether these fears keep them from normal activities. Children with separation anxiety disorder may become agitated at just the thought of being away from mom or dad, and may complain of sickness to avoid playing with friends or attending school. When symptoms are extreme enough, these anxieties can add up to a disorder. But no matter how fretful your child becomes when parted from you, separation anxiety disorder is treatable. There are plenty of things you can do to make your child feel safer and ease the anxiety of separation.

Children with separation anxiety disorder fear being lost from their family or fear something bad happening to a family member if they are separated from them. Symptoms of anxiety or fear about being separated from family members must last for a period of at least 4 weeks to be considered separation anxiety disorder. It is different from stranger anxiety, which is normal and usually experienced by children between 7 and 11 months of age. Symptoms of separation anxiety disorder are more severe than the normal separation anxiety that nearly every child experiences to some degree between the ages of 18 months and 3 years of age.

All children and adolescents experience some anxiety. It is a normal part of growing up. However, when worries and fears are developmentally inappropriate concerning separation from home or family, separation anxiety disorder may be present. separation anxiety disorder occurs equally in males and females. The first symptoms of separation anxiety disorder usually appear around the third or fourth grade. Typically, the onset of symptoms occurs following a break from school, such as Christmas holidays or an extended illness. Children of parents with an anxiety disorder are more likely to have an anxiety disorder.

Child psychiatrists, child psychologists, or pediatric neurologists can diagnose and treat separation anxiety disorder. These trained clinicians will integrate information from home, school, and at least one clinical visit in order to make a diagnosis. Keep in mind that children with separation anxiety disorder frequently have physical complaints that may need to be medically evaluated.

Specialists can address physical symptoms, identify anxious thoughts, help your child develop coping strategies, and foster problem solving.

Separation anxiety disorder causes

Anxiety disorders are believed to have biological, family, and environmental factors that contribute to the cause. A chemical imbalance involving 2 chemicals in the brain (norepinephrine and serotonin) most likely contributes to the cause of anxiety disorders. While a child or adolescent may have inherited a biological tendency to be anxious, anxiety and fear can also be learned from family members and others who frequently display increased anxiety around the child. A traumatic experience may also trigger anxiety.

Separation anxiety disorder occurs because a child feels unsafe in some way. Take a look at anything that may have thrown your child’s world off balance, made them feel threatened, or upset their normal routine. If you can pinpoint the root cause—or causes—you’ll be one step closer to helping your child through their struggles.

Common causes of separation anxiety disorder in children include:

• Change in environment. Changes in surroundings, such as a new house, school, or day care situation, can trigger separation anxiety disorder.
• Stress. Stressful situations like switching schools, divorce, or the loss of a loved one—including a pet—can trigger separation anxiety problems.
• An over-protective parent. In some cases, separation anxiety disorder may be the manifestation of your own stress or anxiety. Parents and children can feed one another’s anxieties.
• Insecure attachment. The attachment bond is the emotional connection formed between an infant and their primary caretaker. While a secure attachment bond ensures that your child will feel secure, understood and calm enough for optimal development, an insecure attachment bond can contribute to childhood problems such as separation anxiety.

If it seems like your child’s separation anxiety disorder happened overnight, the cause might be something related to a traumatic experience rather than separation anxiety. Although these two conditions can share symptoms, they are treated differently. By understanding the effects of traumatic stress on children, you can help your child benefit from the most fitting treatment.

Separation anxiety disorder prevention

Preventive measures to reduce the incidence of separation anxiety disorders in children are not known at this time. However, early detection and intervention can reduce the severity of the disorder, enhance the child’s normal growth and development, and improve the quality of life experienced by children or adolescents with separation anxiety disorder.

Separation anxiety disorder signs and symptoms

Children with separation anxiety disorder feel constantly worried or fearful about separation. The following are the most common signs of separation anxiety disorder. However, each child may experience symptoms differently. Many kids are overwhelmed with symptoms such as:

• Refusal to sleep alone or reluctance to go to sleep. Separation anxiety disorder can make children insomniacs, either because of the fear of being alone or due to nightmares about separation.
• Repeated nightmares with a theme of separation
• Excessive distress when separation from home or family occurs or is anticipated
• Excessive worry about the safety of a family member
• Excessive worry about getting lost from family
• Refusing to go to school. A child with separation anxiety disorder may have an unreasonable fear of school, and will do almost anything to stay home.
• Fearful and reluctant to be alone
• Frequent stomachaches, headaches, or other physical complaints
• Muscle aches or tension
• Excessive worry about safety of self
• Excessive worry about or when sleeping away from home
• Excessive “clinginess,” even when at home. Your child may shadow you around the house or cling to your arm or leg if you attempt to step out.
• Symptoms of panic and/or temper tantrums at times of separation from parents or caregivers
• Fear that something terrible will happen to a loved one. The most common fear a child with separation anxiety disorder experiences is the worry that harm will come to a loved one in the child’s absence. For example, the child may constantly worry about a parent becoming sick or getting hurt.
• Worry that an unpredicted event will lead to permanent separation. Your child may fear that once separated from you, something will happen to maintain the separation. For example, they may worry about being kidnapped or getting lost.
• Physical sickness like a headache or stomachache. At the time of separation, or before, children with separation anxiety problems often complain they feel ill.

The symptoms of separation anxiety disorder may resemble other conditions or psychiatric problems. Always consult child psychiatrists, child psychologists, or pediatric neurologists for a diagnosis. Child psychiatrists, child psychologists, or pediatric neurologists can diagnose and treat separation anxiety disorder.

Separation anxiety disorder diagnosis

A child psychiatrist or other qualified mental health professional usually diagnoses anxiety disorders in children or adolescents following a comprehensive psychiatric evaluation. Parents who note signs of severe anxiety in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.

Separation anxiety disorder treatment

No parents like to see their child in distress, so it can be tempting to help your child avoid the things they’re afraid of. However, that will only reinforce your child’s anxiety in the long term. Rather than trying to avoid separation whenever possible, you can better help your child combat separation anxiety disorder by taking steps to make them feel safer. Providing a sympathetic environment at home can make your child feel more comfortable. Even if your efforts don’t completely solve the problem, your empathy can only make things better.

Specific treatment for separation anxiety disorder will be determined by your child psychiatrist, child psychologist or pediatric neurologist based on:

• Your child’s age, overall health, and medical history
• Extent of your child’s symptoms
• Your child’s tolerance for specific medications or therapies
• Expectations for the course of the condition
• Your opinion or preference

Professional treatment for separation anxiety disorder may include:

• Talk therapy. Talk therapy provides a safe place for your child to express their feelings. Having someone to listen empathetically and guide your child toward understanding their anxiety can be powerful treatment.
• Play therapy. The therapeutic use of play is a common and effective way to get kids talking about their feelings.
• Counseling for the family. Family counseling can help your child counteract the thoughts that fuel their anxiety, while you as the parent can help your child learn coping skills.
• School-based counseling. This can help your child with separation anxiety disorder explore the social, behavioral, and academic demands of school.
• Medication. Medications may be used to treat severe cases of separation anxiety disorder. It should be used only in conjunction with other therapy.

Anxiety disorders can be effectively treated. Treatment should always be based on a comprehensive evaluation of the child and family. Treatment recommendations may include cognitive behavioral therapy for the child, with the focus being to help the child or adolescent learn skills to manage his or her anxiety and to help him or her master the situations that contribute to the anxiety. Some children may also benefit from treatment with antidepressant or antianxiety medication to help them feel calmer. Parents play a vital, supportive role in any treatment process. Family therapy and consultation with the child’s school may also be recommended.

Separation anxiety disorder treatment at home:

• Educate yourself about separation anxiety disorder. If you learn about how your child experiences this disorder, you can more easily sympathize with their struggles.
• Listen to and respect your child’s feelings. For a child who might already feel isolated by their disorder, the experience of being listened to can have a powerful healing effect.
• Talk about the issue. It’s healthier for children to talk about their feelings—they don’t benefit from “not thinking about it.” Be empathetic, but also remind your child—gently—that they survived the last separation.
• Anticipate separation difficulty. Be ready for transition points that can cause anxiety for your child, such as going to school or meeting with friends to play. If your child separates from one parent more easily than the other, have that parent handle the drop off.
• Keep calm during separation. If your child sees that you can stay cool, they are more likely to be calm, too.
• Support the child’s participation in activities. Encourage your child to participate in healthy social and physical activities. They’re great ways to ease anxiety and help your child develop friendships.
• Praise your child’s efforts. Use the smallest of accomplishments—going to bed without a fuss, a good report from school—as reason to give your child positive reinforcement.

Help your child by relieving your own stress

Kids with anxious or stressed parents may be more prone to separation anxiety. In order to help your child ease their anxiety symptoms, you may need to take measures to become calmer and more centered yourself.

• Talk about your feelings. Expressing what you’re going through can be very cathartic, even if there’s nothing you can do to alter the stressful situation.
• Exercise regularly. Physical activity plays a key role in reducing and preventing the effects of stress.
• Eat right. A well-nourished body is better prepared to cope with stress, so eat plenty of fruit, vegetables, and healthy fats, and try to avoid junk food, sugary snacks, and refined carbohydrates.
• Practice relaxation. You can control your stress levels with relaxation techniques like yoga, deep breathing, or meditation.
• Get enough sleep. Feeling tired only increases your stress, causing you to think irrationally or foggily, while sleeping well directly improves your mood and the quality of your waking life.
• Keep your sense of humor. As well as boosting your outlook, the act of laughing helps your body fight stress in a variety of ways.

Tips for helping your child feel safe and secure

• Provide a consistent pattern for the day. Routines provide children with a sense of security and help to eliminate their fear of the unknown. Try to be consistent with mealtimes, bedtimes and the like. If your family’s schedule is going to change, discuss it ahead of time with your child. Change is easier on kids if it’s expected.
• Set limits. Let your child know that although you understand their feelings, there are rules in your household that need to be followed. Like routines, setting and enforcing limits helps your child know what to expect from any given situation.
• Offer choices. If your child is given a choice or some element of control in their interaction with you, they may feel more safe and comfortable. For example, you can give your child a choice about where at school they want to be dropped off or which toy they want to take to daycare.

Easing separation anxiety disorder

For children with separation anxiety disorder, attending school can seem overwhelming and a refusal to go is commonplace. But by addressing any root causes for your child’s avoidance of school and by making changes at school, though, you can help reduce your child’s symptoms.

• Help a child who has been absent from school return as quickly as possible. Even if a shorter school day is necessary initially, children’s symptoms are more likely to decrease when they discover that they can survive the separation.
• Ask the school to accommodate your child’s late arrival. If the school can be lenient about late arrival at first, it can give you and your child a little wiggle room to talk and separate at your child’s slower pace.
• Identify a safe place. Find a place at school where your child can go to reduce anxiety during stressful periods. Develop guidelines for appropriate use of the safe place.
• Allow your child contact with home. At times of stress at school, a brief phone call—a minute or two—with family may reduce separation anxiety.
• Send notes for your child to read. You can place a note for your child in their lunch box or locker. A quick “I love you!” on a napkin can reassure a child.
• Provide assistance to your child during interactions with peers. An adult’s help, whether it is from a teacher or counselor, may be beneficial for both your child and the other children they’re interacting with.
• Reward your child’s efforts. Just like at home, every good effort—or small step in the right direction—deserves to be praised.