Separation Anxiety: What’s Normal and When to Worry

When most parents hear the term “separation anxiety” they think of babies crying for their caregiver. While that is a normal developmental milestone, it’s not the only time children may experience anxiety due to separation from parents or loved ones.

“Separation anxiety in babies between 9 and 18 months of age is very normal, and typically fades over time,” says Katie K. Lockwood, MD, MEd, a Pediatrician at Children’s Hospital of Philadelphia (CHOP).

CHOP Psychologist Billie S. Schwartz, PhD, adds: “It’s a very important developmental milestone and completely healthy. They’ve formed an attachment to you and miss you.”

While most children will grow out of this type of anxiety by the time they are ready for preschool, for some the feeling lingers. About 3% of children will continue to experience separation anxiety into elementary school. And, perhaps surprisingly, the percentage grows during adolescence: about 8% of teens aged 13+ experience separation anxiety.

The cause of separation anxiety changes depending largely on a child’s age and development. Young children are typically self-focused; they worry about their needs not being met if their usual caregiver is not around. Teens are often more worried about outside forces – violence, accidents, etc. – that may take their parent/caregiver from them permanently.

Symptoms of separation anxiety

Anytime there’s a change in your child’s routine, there’s a possibility they may exhibit symptoms of separation anxiety.

Symptoms can include:

• Excessive distress when separated from home or family (or when separation is anticipated)
• Constant worry that something bad will happen to a loved one (i.e., illness, disaster)
• Excessive worry about losing a parent/guardian
• Not wanting to be home alone or without a parent in the house
• Reluctance or refusing to leave home without a parent/guardian
• Frequent checking (i.e., calling, texting) to learn a parent’s whereabouts or needing reassurance that they are available
• Excessive “clinginess,” even when home
• Frequent complaints of stomachaches, headaches and other physical symptoms before anticipated separation from parent/guardian
• Panic and/or temper tantrums when separated from parents/caregivers

One or more of these symptoms may become evident when your child starts daycare, a new school or experiences a significant life event. But life happens and we can’t always do the exact same thing every day. As adults, we’ve learned to adapt; now we need to teach our children how to do the same.

Tips to help your child with separation anxiety

Drs. Lockwood and Schwartz offer the following suggestions to support your child with separation anxiety, to smooth transition periods, and help build their coping skills.

Prepare ahead of time. Whenever possible, let your child know what to expect before a change in routine. If your child will be beginning or resuming daycare or school, talk about the positive activities they’ll do there. Make sure to mention things you know your child enjoys, but mention that other activities will also take place. The same goes for a change in a regular routine. Is someone else picking them up from school that day? Tell them in advance. By preparing your child, you can ease their anxiety, and your own.

Make transitions, short, sweet and consistent. Create a simple goodbye ritual with your child, such as “I love you. You’re going to have a fun day with your teacher and friends, and I want to hear all about it tonight at dinner.” Not only is this a positive way to start your child’s day, it also reinforces that you will be back and when.

Validate their feelings. It’s important for children to feel heard and seen but wallowing probably won’t improve the situation. Let them talk or worry or cry for few minutes to share their distress, then try to refocus their attention on something positive. Let them know you’ll miss them too, but that you packed their favorite foods for lunch or added something special (a sticker or a little note) to let them know you are thinking about them. For teens, a quick text may reinforce your bond and confirm when you’ll see each other again. Remind your kids that it’s OK to feel sad, and at the same time be brave and do what they need to do.

Follow through with what you say. Whether you’ll be gone for an hour or the whole day, make sure you follow through with what you tell your child as much as possible. Build trust through consistency. Don’t sneak away while your child is distracted, even if that makes saying goodbye harder. It’s important that they know they can trust you to say goodbye and return later. If an emergency occurs, try to speak directly to your child and reinforce when you will be able to reunite.

Emphasize patience. As your child gets used to the new routine, separations should get easier. After returning to them day after day, they will likely become less anxious and worried. New routines may require advance planning, but the more you can get your child involved in the decision making, the more control they will feel they have – which will help lessen their anxiety.

Enlist help. Ask your child’s caregivers, teachers and aides for support in making your child feel comfortable in their new setting. They can also reinforce your parent/child connection by encouraging children to share what they learned or did during the day with you at home.

When more support is needed

If your child has significant issues with separation anxiety – especially by school-age – talk to your child’s pediatrician. They will be able to give you additional coping strategies that may help your child. If needed, the pediatrician can also direct you to appropriate therapists or psychological resources in your community.

Katie K. Lockwood, MD, MEd, is an Attending Physician at CHOP Primary Care, South Philadelphia. Billie S. Schwartz, PhD, is an Attending Psychologist in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at CHOP.