Separation Anxiety

Separation anxiety refers to a developmental stage during which the child experiences anxiety when separated from the primary care giver (usually the mother). It is normal between 8 months of age and may last until 14 months old.

In young children, their unwillingness to leave a parent or a caregiver is a sign that attachments have developed between the caregiver and child. They are beginning to understand that each object (including people) in the environment is different and permanent. Young children cannot yet understand time, therefore they do not know when or even if you will ever come back. Children at this stage are struggling between feelings of striking out on their own and yet wanting to stay safe by a parent or caregiver’s side.

Although separation anxieties are normal among infants and toddlers, they are not appropriate for older children or adolescents and may represent symptoms of separation anxiety disorder. To reach the diagnostic threshold for this disorder, the anxiety or fear must cause distress or affect social, academic, or job functioning and must last at least 1 month (American Psychiatric Association, 1994). Children with separation anxiety may cling to their parent and have difficulty falling asleep by themselves at night. When separated, they may fear that their parent will be involved in an accident or take ill, or in some other way be ’lost’ to the child forever. Their need to stay close to their parent or home may make it difficult for them to attend school or camp, stay at friends’ houses, or be in a room by themselves. Fear of separation can lead to dizziness, nausea, or palpitations (American Psychiatric Association, 1994).

Separation anxiety is often associated with symptoms of depression, such as sadness, withdrawal, apathy, or difficulty in concentrating, and such children often fear that they or a family member might die. Young children experience nightmares or fears at bedtime.

About 4 percent of children and young adolescents suffer from separation anxiety disorder (APA, 1994). Among those who seek treatment, separation anxiety disorder is equally distributed between boys and girls. In survey samples, the disorder is more common in girls (APA, 1994). The disorder may be overdiagnosed in children and teenagers who live in dangerous neighborhoods and have reasonable fears of leaving home.

The remission rate with separation anxiety disorder is high. However, there are periods where the illness is more severe and other times when it remits. Sometimes the condition lasts many years or is a precursor to panic disorder with agoraphobia. Older individuals with separation anxiety disorder may have difficulty moving or getting married and may, in turn, worry about separation from their own children and partner.

Separation anxiety symptoms

• Excessive distress when separated from the primary caregiver
• Worry about losing or harm coming to the primary caregiver
• Recurrent reluctance to go to school or other places 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

The cause of separation anxiety disorder is not known, although 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 death or illness in the family or a move. Trauma, especially physical or sexual assault, might bring on the disorder (Goenjian et al., 1995). The disorder sometimes runs in families, but the precise role of genetic and environmental factors has not been established.

Resolution of separation anxiety depends on an adequate sense of safety and trust in people other than parents, safety in the environment, 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.

When children are in situations (such as hospitals) and are experiencing stress (such as illness or pain), they seek the safety, comfort, and protection of their parents. When parents cannot be with their children in these situations, the child experiences distress.



It is helpful for a parent to accompany the child during medical examinations or treatments whenever possible. When a parent cannot accompany the child, prior exposure to the situation is helpful.

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

Treatment for dysfunctional cases may include individual psychotherapy, family education, and family therapy.

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

• Since your child will be more susceptible to separation anxiety when tired, hungry, or sick, try to schedule departures after naps and mealtimes (American Academy of Pediatrics, 1993).
• Prepare your child before the separation occurs by reassuring him that you will return (Brazelton, 1992). Treat the anxiety seriously and react with understanding, patience, and confidence ("I know you don’t want me to leave, but I will be back after lunch") instead of by teasing ("Oh, you’re so silly crying like that") or annoyance ("You make me feel so mad when you cry like that!") (Eisenberg, Murkoff, & Hathaway, 1994).
• Stay calm, matter-of-fact and, sympathetic. "I know you are upset that I have to go into the kitchen, but I need to cut up the carrots for dinner." Go into the kitchen with the child on your leg if necessary (Eisenberg, Murkoff, & Hathaway, 1994).
• Create feelings of security for your toddler when you’re around by giving lots of love and attention. Young children will learn faster when they receive necessary attention and affection than by the parent’s taking a "learn the hard way" attitude (Eisenberg, Murkoff, & Hathaway, 1994).
• "Practice" short-term separations around the house (American Academy of Pediatrics, 1993; Eisenberg, Murkoff, & Hathaway, 1994). 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 (Eisenberg, Murkoff, & Hathaway, 1994). While tempting, this approach will only lead the child to be more guarded and resistant the next time you leave.
• Maintain control over your own anxieties (difficulty in letting go, anxiety about the caregiver, guilt about leaving). If your child senses or sees your distress at leaving, that will tell him that there must be something wrong (Eisenberg, Murkoff, & Hathaway, 1994).