Separation Anxiety and Separation Anxiety Disorder

What is separation anxiety?

It’s natural for your young child to feel anxious when you say goodbye. In early childhood, crying, tantrums, or clinginess—all the hallmarks of separation anxiety—are healthy reactions to separation and a normal stage of development. It can begin before a child’s first birthday and may reoccur until the age of four. While the intensity and timing of separation anxiety can vary tremendously from child to child, it’s important to remember that a little worry over leaving mom or dad is normal, even when your child is older. With understanding and the right coping strategies, your child’s fears can be relieved—and should fade completely as they get older.

However, some children experience separation anxiety that doesn't go away, even with a parent's best efforts. These kids 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.

How to ease “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. 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 important 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.

What is 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 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.

Symptoms of separation anxiety disorder

Kids with separation anxiety disorder feel constantly worried or fearful about separation. Many kids are overwhelmed with symptoms such as:

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.

Refusal 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.

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.

Physical sickness like a headache or stomach pain. At the time of separation, or before, children with separation anxiety problems often complain they feel ill.

Clinging to the caregiver. Your child may shadow you around the house or cling to your arm or leg if you attempt to step out.

Common causes

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.

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.

[Read: Attachment Issues In Children]

An overprotective 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.

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. By understanding the effects of traumatic stress on children, you can help your child benefit from the most fitting treatment.

Helping a child with separation anxiety disorder

None of us like to see our children 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.

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.

[Read: How to Stop Worrying]

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.

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: Tips for school

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.

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.

When to seek professional help

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. These include:

• 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.

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.

Treatment

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 their feelings. Having someone to listen empathetically and guide your child toward understanding their anxiety can be extremely helpful.

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.