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Separation Anxiety

Dealing With Separation Anxiety

Does your little one cry or cling to you or both as you’re leaving the room or heading out the door? Your toddler may be experiencing separation anxiety. At this age, your child doesn’t have a strong sense of time, so he doesn’t know when you’ll return. Learn how to identify signs of toddler separation anxiety in order to soothe away the tears.

For some toddlers, goodbyes are full of tears, screams, and outbursts. Young children form tight relationships with their parents, so it’s natural that as a child grows, she’ll be hesitant to let go of feelings of familiarity and security. Learn more about separation anxiety to ease your little one.

Why Do Toddlers Experience Separation Anxiety?

Children go through feelings of separation anxiety for different reasons, but on a basic level, they believe their survival is dependent on having a primary caregiver close by. Toddlers are also still too young to understand the concept of time. Leaving them in a room for a few minutes or with a babysitter or at day care for a few hours feels like the same amount of time for them. So instead of sneaking off, which a toddler can interpret as leaving forever, be sure to say adieu, but keep the parting simple and short. Try to convey that the time apart is temporary and is not a cause for alarm. Also, “somewhat ironically, anxiety can be a sign of the child’s increasing autonomy,” says Miranda Goodman-Wilson, assistant professor of psychology at Eckerd College in St. Petersburg, Florida. “They have their own opinion on the situation — that Mom shouldn’t leave — and want to exert control.”

What Are the Signs of Separation Anxiety?

Erin Boyd-Soisson, Ph.D., associate professor of human development at Messiah College in Grantham, Pennsylvania says separation anxiety is “typically most prevalent between 8 and 18 months or so.” Indications of separation anxiety are usually present while a caregiver is departing or has left. Children may cling, throw a tantrum, or resist other caregivers in an attempt to convince the parent not to leave, whether for work or to run an errand. A child can also show signs of fear and restlessness when a parent is in another room, when he’s left alone at bedtime, or is being dropped off at day care. The outbursts usually subside once the caregiver is out of view. “This anxiety serves to keep the child close to the caregiver, who is their source of love and safety,” Dr. Boyd-Soisson says.

Will All Children Outgrow Separation Anxiety?

Separation anxiety decreases as a child ages, but similar feelings may return for short periods of time, for other reasons. “When older toddlers or preschoolers are sick or stressed, separation anxiety can be triggered again,” Dr. Boyd-Soisson says. “For example, most 2-year-olds who have been in day care for a while are often fine when their parents leave. However, when they are starting to get sick, or if they are under stress, it is not uncommon for them to cling to their parents at drop-off.” Despite this, rest assured this behavior is a normal part of development and will disappear over time. Every child is unique and there is no set time frame for when separation anxiety appears or disappears. It may even take a few months for a child’s anxiety to dissipate, so be prepared for regression, especially when routines change because of vacation, illness, or a move.

How Can You Ease Separation Anxiety?

Although it may be difficult to hear a child cry, remember that separation anxiety does have a positive aspect: It indicates that a healthy attachment has bonded a caregiver and child. Try talking a child through the process of leaving; tell him that you love him and let him know you will return. If it helps, offer him a favorite stuffed animal as a soother in your absence. Keeping a regular routine can help children develop a feeling of control over daily situations. Say “See you later, alligator” or share a secret handshake as a clear and consistent indicator when saying goodbye.

When Should You Worry About Separation Anxiety?

Watch your child to see if her separation anxiety appears extreme, says Julia F. Heberle, Ph.D., associate professor of psychology at Albright College in Reading, Pennsylvania. Dr. Heberle recommends analyzing the situation surrounding your child’s feelings. Is there parental conflict, divorce, or something wrong with the child-care setting? If so, the symptoms of separation anxiety may be amplified. If a toddler is showing excessive symptoms, such as vomiting or unrelenting worry, contact your pediatrician.

When is anxiety in children normal and when not?

In early childhood, crying, tantrums, or clinginess are healthy reactions to separation. Separation anxiety can begin before a child’s first birthday, and may pop up again or last until a child is four years old, but both the intensity level and timing of separation anxiety vary tremendously from child to child. A little worry over leaving mom or dad is normal, even when your child is older. You can ease your child’s separation anxiety by staying patient and consistent, and by gently but firmly setting limits.

Some kids, however, experience separation anxiety that doesn’t go away, even with a parent’s best efforts. These children 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.

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.

Develop a “goodbye” ritual. Rituals are reassuring and can be as simple as a special wave through the window or a goodbye kiss.

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 him or her on the job.

Leave without fanfare. Tell your child you are leaving and that you will return, then go—don’t stall.

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 he or she will be just fine—setting limits will help the adjustment to separation.

Routines that Toddlers Can Understand

Children function best with structured schedules. Toddlers and preschoolers, especially, feel small in the world. Most things happen TO them. They crave predictability, knowing what will happen, because it gives them some sense of control. A predictable routine allows children to feel safe, and to develop a sense of mastery in handling their lives.

Kids who understand the routine, rather than feeling pushed around by what seems like arbitrary circumstance, are more likely to cooperate. Creating a regular routine is an essential way to give toddlers the security of knowing “what happens next” in their day. It also develops the prefrontal cortex, the planning and executive function part of the brain.

Having a plan for the day can also be important for adults caring for kids. True, many of us love the freedom of deciding on the spur of the moment what comes next, and sometimes that is the basis of creativity. But that works best when WE decide what rules to break. Without a routine, life with children can overwhelm and derail us, leaving us feeling run over by life, rather than in charge.

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 separation anxiety 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: worries and fears

Kids with separation anxiety disorder feel constantly worried or fearful about separation. Many kids are overwhelmed with one or more of the following:

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. Kids with separation anxiety disorder may fear that once separated from a parent, something will happen to keep the separation. For example, they may worry about being kidnapped or getting lost.

Nightmares about separation. Children with separation anxiety problems often have scary dreams about their fears.

Refusals and sickness

Separation anxiety disorder can get in the way of kids’ normal activities. Children with this disorder often:

Refuse 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.

Display reluctance to go to sleep. Separation anxiety disorder may make these children insomniacs, either because of the fear of being alone or due to nightmares about separation.

Complain of physical sickness like a headache or stomachache. At the time of separation, or before, children with separation disorder often complain they feel ill.

Cling to the caregiver. Children with separation anxiety problems may shadow you around the house or cling to your arm or leg if you attempt to step out.

Common causes of separation anxiety disorder

Separation anxiety disorder is a condition that causes a child extreme distress when she is separated from her parents or caregivers. Difficulty separating is normal in early childhood development; it becomes a disorder if the fear and anxiety interfere with age-appropriate behavior, whether it’s an 18-month-old who can’t bear to be out of sight of his mother or a 7-year-old who can’t tolerate a school day apart from his parents. Symptoms of separation anxiety disorder commonly become noticeable in pre-school and early grammar school, but in rare cases it becomes problematic later, in early adolescence. An estimated 4% of children have the disorder.

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, or made him or her feel threatened or could have upset your child’s normal routine. If you can pinpoint the root cause—or causes—you’ll be one step closer to helping your child through his or her struggles.

The following are common causes of separation anxiety disorder in children:

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.

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. Help your child benefit from the most fitting treatment.

Helping a child with separation anxiety disorder

You can help your child combat separation anxiety disorder by taking steps to make him or her feel safer. Providing a sympathetic environment at home can make your child feel more comfortable, and making changes at school may help reduce your child’s symptoms. Even if your efforts don’t completely solve the problem, your empathy can only make things better.

Tips for dealing with separation anxiety

The following tips can help you create a stable and supportive environment for your child.

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.

Listen to and respect your child’s feelings. For a child who might already feel isolated by his or her 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 the child—gently—that he or she survived the last separation.

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.

Tips for helping your child feel safe and secure

Provide a consistent pattern for the day. Don’t underestimate the importance of predictability for children with separation anxiety problems. If your family’s schedule is going to change, discuss it ahead of time with your child.

Set limits. Let your child know that although you understand his or her feelings, there are rules in your household that need to be followed.

Offer choices. If your child is given a choice or some element of control in an activity or interaction with an adult, he or she may feel more safe and comfortable.

Tips for encouraging healthy separation and independence

Keep calm during separation. If your child sees that you can stay cool, he or she is more likely to be calm, too.

Support the child’s participation in activities. Encourage your child to participate in healthy social and physical activities.

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.

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.

Easing separation anxiety: Tips for school

Address the cause for avoidance of school. Initiate a plan for your child to return to school immediately. This may include gradual reintroduction with partial days at first.

Accomodate 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 the 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 his or her lunch box or locker. A quick “I love you!” on a napkin can reassure a child.

Provide assistance to the child during interactions with peers. An adult’s help, whether it is from a teacher or counselor, may be beneficial for both the child and his or her peers.

Reward a child’s efforts. Just like at home, every good effort—or small step in the right direction—deserves to be praised.

Anxiety interferes with learning

“Untreated, these kids can become very inhibited individuals who are risk-avoidant,” notes Steingard, “which is a bad thing in childhood, because childhood is filled with risk-taking and learning. Kids are at the moment where they’re expanding. By necessity, their universe has to expand. Everything that they’re exposed to is novel, and exposure to novel events is essentially anxiety-provoking.

Most of us learn how to master that anxiety, develop skills that allow us to walk into new situations, meet new people. We need to help these kids catch up in development of mastery and accrual of skills until they’re at the point where they’re strong enough to stand on their own.”

Parent training is part of treatment

Another important component of treating separation anxiety is parent training. Sympathetic parents who want to spare their kids worries may inadvertently be strengthening them.

“Parents are usually very reluctant to separate themselves because they know their child is worrying,” explains Dr. Jerry Bubrick, a clinical psychologist at the Child Mind Institute who works with kids who have separation anxiety. “But by being reluctant, they’re actually reinforcing the fear rather than reinforcing the effort to separate.” Parents can help by offering positive reinforcement every time a child successfully completes one of her goals. Some doctors teach parents to give a child points towards a reward for each goal she completes.

Important Factors That Help

Nourishment

If you child is not getting his/her own time to wake up and deal with the day in their own way, or enough time to eat in order to balance out their own blood sugar.  Then this is likely a large contributing factor to you child not being able to deal with being dragged out of bed and forced to tackle a day they would rather not cooperate with. Having enough time to wake up rested and eat some food will go a very long way in helping your child deal with the day.

Establish a Bedtime Routine

It cannot be stressed enough how important it is for your child to have a bedtime routine in order to put them to sleep at an appropriate time so that they get enough rest.  Bedtime routines work best if you reserve the hour before bedtime for quiet play. This will lower your child’s activity level and prepare his nervous system for relaxation. Roughhousing, running, playing tickling games, and even watching action-packed TV shows or videos make peaceful transition to sleep especially difficult. The following illustrates beneficial routines. Yours can be anything that works for you and your child:

  • Set a specific time and stick to it. Your child’s body clock will adjust much more quickly to the routine if the routine follows a natural and consistent pattern.
  • Give a warning. Just before bedtime, give your child advance notice that the day is winding down. Your child may be too young to judge time yet, so saying something like “five more minutes” is not likely to be understood. Instead teach your child by association. Begin the first part of your routine — running the bath water, putting the toys away, or however your particular routine begins to signal the start of the wind down. Some parents signal impending bedtime with the ringing of a kitchen timer for five minutes; the child learns that the sound means bedtime. This allows an impersonal third party to announce bedtime and reduces the desire to complain, since even a toddler knows that you can’t argue with a machine.
  • Offer a snack. A light snack that includes both protein and carbohydrates — for example, a small piece of cheese and one half slice of whole-wheat bread — will induce sleep and help her stay asleep through the night. The carbohydrates make her sleepy, and the protein will help keep her blood sugar level on an even keel until breakfast. Be sure to brush her teeth after she eats.
  • Give your child a warm bath. By raising your baby’s body temperature slightly, you’ll make him more prone to sleepiness. Also, playing with his bath toys allows him to relax.
  • Get dressed for bed. Choose comfortable, non-binding pajamas, that are neither too warm nor too light.
  • Read a favorite story to your child. This is a particularly comforting routine for your toddler, particularly if it’s a favorite story that’s associated with bedtime, such as Goodnight Moon. (As your child grows, he’ll want more stories and more variety.)
  • Play soft music while you read. It’s okay to let the music play as the child drifts off.
  • Make sure your child has a friend to sleep with. A favorite doll or teddy bear provides comfort.
  • Limit or eliminate bottles. If your child needs a bottle to fall asleep, make sure it contains only water. Milk, formula, or juice can pool around her teeth causing cavities, even in infants.
  • Keep last “goodnights” brief. Say “goodnight” when it’s time for you to leave the room and try not to come back if your child calls for you. This sounds harsh, but if you keep coming into the room you will have taught your child that “If I call to Mommy, she’ll come back.” Kids learn how to “condition” parents very quickly! Any hesitations on our part may be picked up by your child as an indication that maybe you really aren’t serious about this bedtime business and if she yells loudly enough you’ll come back and play some more.

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