Separation Anxiety and Separation Anxiety Disorder
What You Can Do to Ease Your Child’s Separation Anxiety
It's natural for your young child to feel anxious when you say goodbye. Although it can be difficult, separation anxiety is a normal stage of development. With understanding and these coping strategies, separation anxiety can be relieved—and should fade as your child gets older. However, if anxieties intensify or are persistent enough to get in the way of school or other activities, your child may have separation anxiety disorder. While this condition may require professional treatment, there is a lot that you as a parent can do to help ease your child’s fears and make him or her feel safer.
When is anxiety in children normal and when not?
In early childhood, crying, tantrums, or clinginess are healthy reactions to separation. Separation anxiety can begin before a child’s first birthday, and may pop up again or last until a child is four years old, but 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.
Some kids, however, experience separation anxiety that doesn’t go away, even with a parent’s best efforts. These children experience a continuation or reoccurrence of intense separation anxiety during their elementary 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: separation anxiety disorder.
Easing "normal" separation anxiety
For children with normal separation anxiety, there are steps you can take to make the process of separation anxiety easier.
Practice separation. Leave your child with a caregiver for brief periods and short distances at first.
Schedule separations after naps or feedings. Babies are more susceptible to separation anxiety when they’re tired or hungry.
Develop a “goodbye” ritual. Rituals are reassuring and can be as simple as a special wave through the window or a goodbye kiss.
Keep familiar surroundings when possible and make new surroundings familiar. Have the sitter come to your house. When your child is away from home, let him or her bring a familiar object.
Have a consistent primary caregiver. If you hire a caregiver, try to keep him or her on the job.
Leave without fanfare. Tell your child you are leaving and that you will return, then go—don’t stall.
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 he or she will be just fine—setting limits will help the adjustment to separation.
Symptoms of 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.
The main differences between healthy separation anxiety and separation anxiety disorder are the intensity of your child’s fears, and whether these fears keep him or her 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.
Common symptoms: worries and fears
Kids with separation anxiety disorder feel constantly worried or fearful about separation. Many kids are overwhelmed with one or more of the following:
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. Kids with separation anxiety disorder may fear that once separated from a parent, something will happen to keep the separation. For example, they may worry about being kidnapped or getting lost.
Nightmares about separation. Children with separation anxiety problems often have scary dreams about their fears.
Refusals and sickness
Separation anxiety disorder can get in the way of kids’ normal activities. Children with this disorder often:
Refuse 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.
Display reluctance to go to sleep. Separation anxiety disorder may make these children insomniacs, either because of the fear of being alone or due to nightmares about separation.
Complain of physical sickness like a headache or stomachache. At the time of separation, or before, children with separation disorder often complain they feel ill.
Cling to the caregiver. Children with separation anxiety problems may shadow you around the house or cling to your arm or leg if you attempt to step out.
Common causes of separation anxiety disorder
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, or made him or her feel threatened or could have upset your child’s normal routine. If you can pinpoint the root cause—or causes—you’ll be one step closer to helping your child through his or her struggles.
The following are common causes of separation anxiety disorder in children:
Change in environment. In children prone to separation anxiety, it is possible that changes in surroundings—like a new house, school, or day care situation—could trigger separation anxiety disorder.
Stress. Stressful situations like switching schools, or the loss of a loved one, including a pet, can trigger separation anxiety disorder.
Over-protective parent. In some cases, separation anxiety disorder may be the manifestation of the parent’s own anxiety—parents and children can feed one another’s anxieties.
Separation anxiety or trauma?
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. Help your child benefit from the most fitting treatment.
Helping a child with separation anxiety disorder
You can help your child combat separation anxiety disorder by taking steps to make him or her feel safer. Providing a sympathetic environment at home can make your child feel more comfortable, and making changes at school may help reduce your child’s symptoms. Even if your efforts don’t completely solve the problem, your empathy can only make things better.
Tips for dealing with separation anxiety
The following tips can help you create a stable and supportive environment for your child.
Educate yourself about separation anxiety disorder. If you learn about how your child experiences this disorder, you can more easily sympathize with his or her struggles.
Listen to and respect your child’s feelings. For a child who might already feel isolated by his or her 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 the child—gently—that he or she 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.
Tips for helping your child feel safe and secure
Provide a consistent pattern for the day. Don’t underestimate the importance of predictability for children with separation anxiety problems. If your family’s schedule is going to change, discuss it ahead of time with your child.
Set limits. Let your child know that although you understand his or her feelings, there are rules in your household that need to be followed.
Offer choices. If your child is given a choice or some element of control in an activity or interaction with an adult, he or she may feel more safe and comfortable.
Tips for encouraging healthy separation and independence
Keep calm during separation. If your child sees that you can stay cool, he or she is more likely to be calm, too.
Support the child's participation in activities. Encourage your child to participate in healthy social and physical activities.
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.
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.
Easing separation anxiety: Tips for school
Address the cause for avoidance of school. Initiate a plan for your child to return to school immediately. This may include gradual reintroduction with partial days at first.
Accomodate 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 the 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 his or her lunch box or locker. A quick "I love you!" on a napkin can reassure a child.
Provide assistance to the child during interactions with peers. An adult's help, whether it is from a teacher or counselor, may be beneficial for both the child and his or her peers.
Reward a child's efforts. Just like at home, every good effort—or small step in the right direction—deserves to be praised.
Combat separation anxiety by relieving your own stress
Kids with anxious or stressed parents may be more prone to separation anxiety. In order to help your child overcome separation anxiety disorder, you may need to take measures to become calmer and more centered yourself.
The following strategies can help to keep your stress and anxiety levels in check:
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 be mindful of what you eat.
Practice relaxation. You can control your stress levels with relaxation techniques like yoga, deep breathing, or meditation.
Get enough sleep. Feeling tired will only increase your stress, causing you to think irrationally or foggily.
Keep your sense of humor. The act of laughing helps your body fight stress in a number of ways.
When to seek professional help for separation anxiety disorder
Your own patience and know-how can go a long way toward helping your child with separation anxiety disorder. But some kids with separation anxiety disorder may need professional intervention.
To decide if you need to seek help for your child, look for “red flags,” or extreme symptoms that go beyond milder warning signs. If your efforts to reduce these symptoms don’t work, it may be the time to find a mental health specialist. Remember, these may also be symptoms of a trauma that your child has experienced. If this is the case, it is important to see a child trauma specialist.
Red flags for separation anxiety disorder
If you see any of the following "red flags" and your interventions don't seem to be enough, it may be necessary to get a professional to diagnose and help your child:
- Age-inappropriate clinginess or tantrums
- Withdrawal from friends, family, or peers
- Preoccupation with intense fear or guilt
- Constant complaints of physical sickness
- Refusing to go to school for weeks
- Excessive fear of leaving the house
Treatment for separation anxiety disorder in children
Child psychiatrists, child psychologists, or pediatric neurologists can diagnose and treat separation anxiety disorder. These trained clinicians 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. Professional treatment for separation anxiety disorder may include:
Talk therapy. Talk therapy provides a safe place for your child to express his or her feelings. Having someone to listen empathetically and guide your child toward understanding his or her 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 his or her anxiety, while you as the parent can help your child learn coping skills.
School-based counseling. This can help a 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.
Where to find help
If you suspect your child has separation anxiety disorder, start by consulting your pediatrician, a child development specialist, or one of the organizations listed in the blue box below.
Resources and references
Normal separation anxiety in young children
Separation Anxiety – Describes symptoms and strategies concerning normal separation anxiety, that which doesn’t rise to the level of a disorder. (Children, Youth and Women’s Health Service, Australia)
Separation Anxiety – Describes typical phase of separation anxiety in infants. (HealthyChildren.org, powered by the American Academy of Pediatrics)
Separation Anxiety in Young Children – Gives a detailed description of normal separation anxiety, with tips for parents and teachers. (Northern County Psychiatric Associates)
Separation anxiety disorder in children
Separation Anxiety: What Is It? – Guide to recognizing and treating separation anxiety disorder in children. (Child Mind Institute)
Anxiety and Children – Provides an overview of separation anxiety disorder, symptoms and treatment options. (American Academy of Child and Adolescent Psychiatry)
Childhood Anxiety Disorders – Provides information on anxiety disorders of children and adolescents, including separation anxiety. (Anxiety and Depression Association of America)
Dealing with separation anxiety
Separation Anxiety – Offers practical suggestions for parents dealing with separation anxiety disorder, as well as books to read to children. (KidsHealth / Nemours Foundation)
5 Parent-Tested Ways to Ease Separation Anxiety – Provides tips from parents who have helped their children overcome separation anxiety. (Scholastic.com)
School Refusal – Describes the symptoms of school refusal and what parents can do about the problem. (Anxiety and Depression Association of America)
Where to find help for separation anxiety disorder in children
In the U.S.:
- ZERO TO THREE: National Center For Infants, Toddlers and Families: (202) 638-1144
- The New York Foundling 24-Hour Parent Helpline: 1-888-435-7553
- Anxiety Disorders Association of Canada: 1-888-223-2252
In the UK:
- Anxiety UK: Helpline 08444-775-774
- Early Childhood Australia: Helpline 1800-356-900
Emotional Trauma Video – Provides a thirty-minute documentary about preventing, recognizing, and healing psychological trauma in children. (HealingResources.info)