Separation anxiety is a normal stage in a baby’s development that helps them to understand relationships and master their environment. Crying, clinginess or tantrums are healthy reactions to separation and are a normal stage of child development. Typically, it ends around 2 years of age, as toddlers start to understand that a parent/caregiver may be out of sight but will return later. Separation anxiety disorder exists when the anxiety symptoms are excessive for the developmental age and cause significant distress in daily functioning.
At around 8 months old, a child may fear less familiar people and places. This usually peaks between 10-18 months of age and disappears by 2 years of age, however both attachment and the ability to easily separate may develop at an older age in a child with developmental delays or special needs. Some children experience severe anxiety—even as newborns—that does not improve over time and may even worsen. These children are often diagnosed later with a mood disorder or a neurological disorder such as autism or ADHD.
While some separation anxiety shows that a child has formed attachments with loved ones, leaving a child with child care providers or others can be stressful for everyone. To ease typical separation anxiety, parents can make partings easier for a child in several ways:
-follow a goodbye ritual; children with special needs find structure reassuring
-stay with him until he becomes familiar with a new person or place
-do not sneak away or scold a child for being upset
-reassure the child that you will be back after naptime or at dinnertime; keep that promise
-do not leave a child when he is tired, hungry or ill
-leave your child with his favorite blanket or other “lovey”
Separation anxiety disorder is not the same as separation anxiety and is not a normal stage of development. It is a serious emotional problem characterized by extreme distress when a child is away from the primary caregiver. Since both situations share many symptoms, it is sometimes difficult to differentiate which your child is experiencing. The main differences are the intensity of your child’s fears and whether these fears keep him from normal activities. Separation anxiety disorder is the most common anxiety disorder in children under 12 years of age. Symptoms must be present for at least four weeks for separation anxiety disorder to be considered.
Some causes and risk factors for separation anxiety disorder in children include: change in environment (new house, school, or day care), major stressor or loss (death of a loved one or pet, change of schools, divorce) and overprotective or intrusive parents.
Symptoms of separation anxiety disorder may include:
-excessive distress when separated from attachment figures or the home
-worry about harm coming to attachment figures
-refusal to go to school because of fear of separation
-refusal to sleep away from home or to go to sleep without attachment figures nearby
-nightmares involving themes of separation from home or attachment figures
-repeated physical complaints such as headache or nausea when separate has occurred or is anticipated
-clinging to the caregiver; the child may shadow you around the house or cling to your leg if you try to leave
-for a child with special needs, he may show distress by regressing or becoming hyperactive
It can be very upsetting to see your child stressed, and sometimes parents inadvertently reinforce the anxiety by helping a child avoid things they are afraid of. Instead of avoiding separation, it is helpful to learn more about the disorder and take steps to make a child feel safer. Strategies for dealing with separation anxiety include:
–start with very brief separations: begin with increments of 5 minutes and gradually increase time spent apart
–teachers should use positive language: try “your dad will pick you up after story time” instead of “he left”
–try a photo story: make a picture story that includes photos of your child with alternate caregivers and school classrooms; if possible, you can arrange for a school/teacher visit before school starts so you child can see the photo of his teacher and classroom before school begins; he’ll know exactly what to expect on the first day of school
-“magic bracelet”: this bracelet can chase away anxiety; it can be made of materials that remind the child of his parents, or it may be something that belongs to the parents; it is used as an attachment object to transfer emotional security from the parent to the child
–say goodbye with a smile: try to say goodbye while the child is engaged in something positive; tell him briefly what you will be doing while you are apart, and give a return time
–let your child walk away from you: for many children, it’s easier to leave than to watch a parent/caregiver retreat
–try field trips: take trips together to reduce sensitivities and increase awareness of other people and life experiences
–play therapy: a play therapist directs play to work through specific issues a child is having
For children with separation anxiety disorder, a common symptom is refusal to go to school. There are tips for both parents and teachers that may help reduce a child’s symptoms. Parents can try the following suggestions:
-help a child who has been absent from school return as quickly as possible: if a shorter day is necessary initially, symptoms may decrease once they discover they can handle the short separation upon return
-ask for late arrival accommodations: additional flexibility to talk and separate at a slower pace can help a child separate
-have a safe place: find a place at school where your child can go to reduce anxiety, perhaps the nurse’s office or the library
-allow contact with home: sometimes during times of stress, a brief phone call with family can reduce separation anxiety
-send notes for your child to read: a note in his lunch box can work wonders
-reward your child: every good effort deserves to be praised
Parents might also want to discuss the following classroom tips for dealing with separation anxiety with their child’s teacher.
-make sure the child is prepared ahead of time: be sure the child has a morning routine and knows what to expect, and knows an exact time a parent will pick her up
-be sure to share background information about your child with the teacher: share info about your child’s daily routine and how he copes with change, including methods for soothing
-consider providing a comfort item such as a stuffed animal or a laminated family photo
-provide distraction: picture books are good distractions; consider stories that explain how a parent comes back
-try a little extra TLC: sometimes a child just needs a bit more attention, whether it’s holding her close or just an extra hug or time to sit alone with the teacher
-engage the child: if a child is busy making a special art project for mommy or daddy, he will be distracted and excited to surprise them when he gets picked up
As your child moves through ages and stages, if you feel his/her separation anxiety is causing significant stress regarding daily activities, you should seek professional help. Your child’s pediatrician can refer you to professional specialists who can help your child and your family. Anxiety disorders can be effectively treated, and treatment should be based on a comprehensive evaluation of the child and family. Treatment often involves cognitive behavioral therapy for the child, focusing on helping the child learn skills to manage his anxiety and help him master situations that contribute to anxiety. Some children benefit from treatment with medication that helps them feel calmer. Family therapy and consultation with the child’s school may also be recommended.
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 with separation anxiety disorder.
Note: The information in this article is for informational purposes only. It is not an attempt to diagnose or treat any medical condition. Always consult your child’s pediatrician with any specific medical questions. MKSA is also available to answer questions about child development. Contact us at 516-731-5588 or www.mksallc.com.