In early childhood, crying, tantrums, or clinginess are typical, expected and even healthy reactions to separation. Separation anxiety can begin before a child’s first birthday, and may resurface again at a later date or last until a child is four years old. Keep in mind that both the intensity level and timing of separation anxiety vary from child to child. A little worry over leaving mom or dad is normal, even when your child is older. But severe out of characteristic reactions could be something more serious. You can ease your child’s anxiety by staying consistent, patient and by setting limits gently, but firmly.
Some kids, however, experience separation anxiety that does not go away, even with the love and nurturing of a parent. These children experience a continuation or reoccurrence of intense separation anxiety during their elementary school years or beyond. If anxiety is excessive enough to interfere with normal activities like school, activities and friendships, and lasts for months rather than days, it may be a warning sign of separation anxiety disorder.
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 a 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 of separation anxiety disorder: worries and fears
- Fear that something terrible will happen to a loved one. The most common fear children with separation anxiety have is the worry that harm will come to a loved one when the child is away from the adult. I have met with many children who fear a parent will be in a car accident and die if they are not with them.
- Nightmares about separation. Children with separation problems often have scary dreams about their fears. Many times these dreams will have themes of separation. These dreams can become problematic leading to difficulty waking in the morning, irritability or moodiness, trouble with concentration and/or falling asleep in school the next morning.
- Persistent and excessive worry that separation will occur. Many children will worry about being kidnapped or getting lost in public places. This might lead to a child’s reluctance to be alone or without their major attachment figure.
Common symptoms of separation anxiety disorder: refusals and sickness
- Refuse to go to school. Many children may engage in crying, tantrums and avoidance at the time to leave for school. They may miss many days of school during the school year, simply because the parent or caregiver is unsuccessful in getting them to attend.
- Display reluctance to go to sleep. Many children will want to sleep in the parent’s bed, cry hysterically at bedtime, and avoidance (or what appears to be disobedience) with staying in their bed when the caregiver leaves the room. Often children might say they are scared and are unable to identify what is triggering their acute fear.
- Complain of physical sickness like headaches, stomachaches, nausea or vomiting when separated from caregiver. Children may go to school, but the parent receives multiple phone calls from the school due to the child complaining of being ill.
- Cling to the caregiver. Physically holding on to the parents legs or side are common. Children will often hide in the shadow and remain in close proximity to their parent.
Common symptoms of separation anxiety disorder: mood and changes in appetite
- Irritability.
- Moodiness.
- Sleeping in school.
- Lack of concentration in school or home.
- Increase or decrease in appetite.
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.
- 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 this person for good.
- Leave don’t stall. Tell your child you are leaving and that you will return, then go—don’t stall.
- Try not to give in. Reassure your child that he or she will be just fine—setting limits will help the adjustment to separation.
- Build the bonds of attachment. Children who have a secure attachment with a primary caregiver are able to separate in a healthy manner. You can build attachment through nurturing and eye to eye gaze from the moment your child enters your life. Remember: A child is never to old to nurture.
Common causes of separation anxiety disorder
Separation anxiety disorder occurs because a child feels unsafe in some way. Try to examine what in your child’s life has caused this feeling. If you can identify the root cause(s) you will be one step closer to helping your child through their struggles. The most common causes of separation anxiety disorder are as follows:
- 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.
Helpful ideas for dealing with separation anxiety
The following thoughts can help you establish a stable and supportive environment for your child.
- Talk about the issue. It is more helpful for children to talk about their feelings. They do not get better from “not talking about it.” Be empathetic, but also remind the child that nothing bad happened at the last separation.
- Listen to and respect your child’s feelings. For a child who might already feel isolated by his or her problem, the experience of being listened to can have a powerful healing effect. This can build confidence and lessen fear.
- Anticipate separation problems. 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.
- 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.
Helpful ideas for helping your child feel safe and secure
- Provide a routine for the day. Do not underestimate the importance of predictability for children with separation problems. If your family’s schedule is going to change, discuss it ahead of time with your child. Plan for these changes accordingly.
- Offer choices. If your child is given a choice, it gives them some control, in an activity or interaction with an adult; they may feel more safe and comfortable.
- Set limits. Let your child know that although you understand their feelings, there are rules in your household that need to be followed.
When to seek professional help for separation anxiety disorder
Your own patience and ability to help your child can go a long way toward helping your child with separation anxiety disorder. But some children with separation anxiety disorder may need professional assistance and help.
To decide if you need to seek help for your child, look for symptoms that go beyond milder warning signs. If your attempts to reduce these symptoms do not work, it may be 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 very important to see a child trauma specialist.
Warning Signs
If you see any of the following “warning signs” and your interventions are not enough, a professional evaluation may be needed to diagnose and help your child.
- Age-inappropriate clinginess or tantrums
- Constant complaints of physical sickness
- Withdrawal from friends, family, or peers
- Refusing to go to school for weeks
- Preoccupation with intense fear or guilt
- Excessive fear of leaving the house
- Nightmares impacting sleep and mood more than three times a week for longer than four weeks.
Treatment for separation anxiety disorder
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.
- Play therapy. The therapeutic use of play is a common and effective way to assist children in 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.
- Medication. Medications may be used to treat severe cases of separation anxiety disorder. It should be used only in conjunction with other therapy.