Just about anyone will occasionally feel unsettled in new surroundings or amid unfamiliar people. A toddler's reluctance to go into the arms of a new person is a natural reaction, and so are youngsters’ start-of-school jitters.
These feelings are understandable reactions in both cases, as long as they are mild and brief.
But stress that is long lasting or intense enough to interfere with daily functioning might be separation anxiety—and that’s not OK.
“Chronic separation anxiety can interfere with normal learning, playing and relationships,” says Dr. Danita Czyzewski, pediatric psychologist in the Psychiatry and Psychology Service at Texas Children’s.
Parents need to watch for early signs. The line between common emotions and separation anxiety can blur, and symptoms change as children mature.
Virtually all babies go through a fussy stage between 14 and 18 months. At that age, tears are normal when strangers intrude; so is clinging to a parent or other familiar caregiver. As toddlers, children start opening to their surroundings and lessening dependence on caregivers’ constant presence.
As peers’ confidence with the expanding world grows, some children hold tight to the comforting presence of parents or other major attachment figures. Doctors start to diagnose separation anxiety around age 7.
“Anxious children may have the pervasive fears that an undefined catastrophe is about to befall—either to themselves or to their caregiver—if they separate even for a while,” Czyzewski explained.
The disorder manifests in children as pleading, extreme shyness, temper tantrums, nightmares, fear of being alone, fear of the dark, refusing to sleep without the caregiver nearby or refusing to leave home for school. On school days, there may be excessive headaches and stomachaches. Later issues can focus on school and sleepovers. Summer camp is fraught with such concerns, but children who are merely homesick release fears in a reasonable time. Separation anxiety lingers.
Older children, too, can be affected as they go to college, especially if they must leave family or if old friends are about to scatter.
Although experts cannot predict in which children separation anxiety will show up, they do see common traits, including:
- Age. Elementary ages are most common, with the average onset at 7.5 years.
- Genetics. Twin studies hint that a tendency probably is inherited.
- Gender. Girls are affected slightly more often than boys.
- Single parents. Children in one-parent homes are affected more often than those in two-parent homes.
- Parents. Children of overprotective parents are more susceptible.
- Family history. Anxiety is more frequent in families where one or both parents have emotional issues, possibly because fearfulness is modeled at home.
- Experience. Onset can be triggered by change or loss, such as a new school, serious illness (a child’s own or others’) or departure or death of a family member, friend, even beloved pet.
As a first step in an anxiety checkup for your family, think about your children’s fears. Do they occasionally fret about a few justifiable issues? Or are their worries frequent and hard to define? Is anxiety limiting or getting in the way of normal childhood experiences, such as going to school and playing with friends?
Comparing perspectives with teachers who observe your child’s daily interaction with other children can shed light, too.
Unless problems ease very quickly, it is important to consult a counselor.
“Once identified, separation anxiety is treated primarily with cognitive-behavioral therapy—a type of talk therapy designed specifically to help kids learn skills to manage their anxious feelings,” Czyzewski said. “At the same time, it is important for parents to be aware of these skills and reinforce their use at home.”
In rare, extreme cases, antidepressant drugs might be tried.
The good news is that most children get better. But the symptoms may return in times of stress. So it’s important to spot early signs and get the child quickly back on track.
