Separation Anxiety

Mom leaves the room, and suddenly the baby is inconsolable. Separation anxiety, or not wanting to be apart from a primary caregiver, often kicks in around 8 months of age and can last for several months.

Definition

Separation anxiety refers to a developmental stage in which a child experiences anxiety due to separation from the primary care giver (usually the mother). This phase is fairly standard at around 8 months of age and can last until the child is 14 months old.

In young children, unwillingness to leave a parent or a caregiver is a sign that attachments have developed between the caregiver and child. The child is beginning to understand that each object (including people) in the environment is different and permanent. Young children do not yet understand time, therefore they do not know when or even if a parent will ever come back. Children at this stage struggle between the desire to strike out on their own and the need to stay safe by a parent or caregiver's side.

While separation anxieties are normal among infants and toddlers, they are inappropriate for older children and may indicate separation anxiety disorder. To be diagnosed as such, the symptoms must cause distress or affect social, academic, or job functioning and must last at least 1 month.

Infants experience various emotions as they develop, usually in a relatively predictable sequence. Before 8 months, they are so new to the world that they cannot easily gauge what is ordinary and what may be dangerous, so new situations or experiences seem usual, not frightening.

In normal development, this early period involves establishing familiarity with the home environment, and feeling safe when parents or other known caretakers are present. After this time, lack of familiarity often produces fear as the infant recognizes that something unusual is going on.

Children recognize their parents as familiar and safe. When separated from parents, particularly when away from home, they feel threatened and unsafe. This is particularly strong when the child is between 8 and 14 months.

Separation anxiety is a normal stage in an infant's development. It helped keep our ancestors alive and helps children learn how to master their environment. It usually ends at around age 2, when toddlers begin to understand that a parent may be out of sight right now, but they will return later. At this age, a child also tends to want to test their autonomy.

Symptoms

Symptoms of separation anxiety:

  • Excessive distress when separated from the primary caregiver
  • Worry about losing or harm coming to the primary caregiver
  • Recurrent reluctance to go anywhere because of fear of separation
  • Reluctance to go to sleep without the significant adult nearby
  • Nightmares
  • Repeated physical complaints
  • Symptoms last four weeks or longer
  • Symptoms begin before 18 years of age
  • Impairment of school, social, or personal functioning as a result of anxiety

Causes

Though the cause of separation anxiety disorder is unknown, some risk factors have been identified. Affected children tend to come from families that are very close-knit. The disorder might develop after a stress such as moving or a death in the family, or in certain, cases, a trauma (such as physical or sexual assault) might bring on the disorder. It sometimes runs in families, but the precise role of genetic and environmental factors has not been established.

To resolve the feelings of separation anxiety, a child must develop an adequate sense of safety in the environment, as well as trust in people other than their parents, and trust in the parent's return.

Even after children have successfully mastered this developmental stage, separation anxiety may return during periods of stress. Most children will experience some degree of separation anxiety when in unfamiliar situations, for example if the child is in a hospital without parents, these symptoms are likely to return.

Treatments

It is helpful for a parent to accompany the child during medical examinations or treatments whenever possible. When a parent is not available, prior exposure to the situation, such as visiting the doctor's office before a test, will be helpful for the child. In these situations, many physicians will recommend the child taking a sedating medication. Otherwise, the child may display severe anxiety by begging, crying, screaming, and resisting treatment.

Some hospitals provide Child Life specialists who explain procedures and medical conditions to children of all ages. If your child is particularly anxious and needs significant medical care, you may consider asking your health care provider about such services.

Explain the situation and experience to the child and assure him or her that a parent is waiting, and specifically, explain WHERE the parent is waiting.

For older children, effective treatments may include counseling for the parents and child, changes in parenting techniques, and anti-anxiety medications.

Treatment for certain cases may involve individual psychotherapy, family education, and family therapy.

For younger children, there are courses of action a parent or caregiver can take:

  • Try to schedule departures after naps and mealtimes since your child will be more susceptible to separation anxiety when tired, hungry, or sick.
  • Prepare your child before the separation occurs by reassuring him that you will return. Treat the anxiety seriously and react with understanding, patience, and confidence: "I know you don't want me to go away right now, but I will be back after school." Do not tease: "You're so silly to cry about it." Or sound annoyed: "You make me feel so mad when you cry like that!"
  • Stay calm, matter-of-fact and, sympathetic: "I know you are upset that I have to go into the kitchen, but I need to cook the chicken for dinner." Go into the kitchen with the child on your leg if necessary.
  • Create feelings of security for your toddler by giving lots of love and attention. Young children learn faster when they receive necessary attention and affection than by the parent's taking a "learn the hard way" attitude.
  • Practice short-term separations around the house. As you go into the next room out of sight, talk to your child: "Where did mommy go?" When you return, let her know: "Here I am!" These repeated separations might help your child learn that your disappearance is only temporary.
  • Do not sneak away from your child. While tempting, this approach will only lead to more difficulty the next time you leave.
  • Maintain control over your own anxieties. If your child senses or sees your distress at leaving, that will tell him that there must be something wrong.

Sources

  • American Academy of Pediatrics
  • Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised
  • Touchpoints: Your Child's Emotional and Behavioral Development
  • What to Expect the Toddler Years
  • Psychiatric comorbidity in children after the 1988 earthquake in Armenia
  • DSM-IV Made Easy: The Clinician's Guide to Diagnosis
  • National Institutes of Health - National Library of Medicine
Last reviewed 02/17/2015