A small amount of separation anxiety is developmentally normal for young children (usually from 9 months of age – early school age). When strategies (such as the ones listed below) are used, this anxiety should be very manageable and should not interfere with day to day tasks. However, if strategies are used and the anxiety persists enough to interfere with normal tasks, such as attending school or leaving the child with a babysitter, professional help should be sought.
In this post, separation anxiety refers to when children are concerned about leaving parent/caregiver. This concern may appear through crying, having tantrums, or displaying clinginess when separated from parent/caregiver. This takes place between infancy (around 9 months) to early school age years.
Separation anxiety disorder is characterized by the following symptoms: Anxiety that interferes with normal activities of daily living, such as going to school or daycare. Persistent nightmares surrounding leaving parents/caregiver. A child’s refusal to leave parent, and severe distress when leaving parent. Reluctance to sleep at night. Intense worry that an unpredicted event will lead to being separated forever. Separation anxiety disorder is also commonly characterized by complaints of physical illness (such as headache or stomach ache).
If the symptoms of separation anxiety disorder sound familiar, it is important to talk to your family health provider or counsellor to receive suggestions that are individualized to your child’s needs. Current literature shows cognitive behavioural therapy to be the most effective treatment for children diagnosed with separation anxiety disorder.
As previously stated, many (if not most) children may struggle with some form of mild separation anxiety in their toddler/early childhood years.
The following steps have been shown in the research as well as in my professional experience to be effective when helping children manage separation anxiety.
4 steps to help children with separation anxiety
Step 1: Coping strategies
Work with your child to come up with a list of strategies that they can use when they are feeling stressed out. These may include deep breathing, looking at a picture of a TV/movie character they like, thinking of a funny memory, and/or holding a special item. Any coping strategy that works for your child can be used.
Be creative with this! You may want to print out some different coping strategy ideas and make a lanyard with different “coping cards” on it for your child to carry with them. For example, coping cards may include: a picture of Paw Patrol, a picture of Mom and Dad, a picture of a person taking a deep breath, or a picture of the family pet. All of these cards can be put together on a lanyard for the child to carry with them when they know they will be in a difficult situation.
Step 2: Practice separation (using the following steps)
Start by explaining to your child why separation has to occur, when it will occur, and when it will not occur. Ensure that your child understands this by getting them to repeat what you have explained back to you (repeat as many times as necessary).
Role play what will happen when you separate. Practice saying goodbye and leaving the room. Let your child play the role of you while you play the role of your child, modelling to your child what they can do when you separate.
Once your child has seen you act out separation, reverse the roles and give them a chance to role play what they learned. Make it fun! Show your child that there is nothing to be worried about when you separate. Role play this as many times as needed, until your child feels comfortable and knows exactly what they will do when separation happens.
If a problem arises during roleplaying (such as your child feeling anxious), problem solve with them in the moment. Help them use their coping strategies and work through any challenges that may come up.
It is also very important to offer your child praise throughout roleplaying to show them that there is nothing to be concerned about when you separate.
Step 3: Set up a successful environment
After practicing separation, you will want to try it in a real life environment. When implementing this in the real world, ensure that your child’s environment is set up for success. This can be done in the following ways:
Prior to separation, ensure that the child has had adequate sleep, such as their nap or a good night of sleep. Also ensure that they are well fed (children are often more susceptible to anxiety when feeling tired or hungry).
Minimize scary television or movies that might trigger anxiety.
Review coping strategies with your child and provide them with coping cards. Practice using these strategies in non-stressful situations and show your child how you also use coping strategies when you feel stressed. Modelling these strategies will allow your child to learn how to use them in appropriate settings.
Stay calm! If you are feeling emotional and anxious, it is likely that your child will feel the same. Make sure you are taking care of your own emotions regarding separation. If you are unable to control your emotions, it may be helpful to talk to your family health care provider about receiving therapy for yourself surrounding separation.
Praise your child’s efforts before and after separation occurs.
Remind child that you love them and clearly tell them when you will be back.
Start with very small increments of time away and gradually increase these increments as you and your child become more comfortable with the separation.
Leave your child with a familiar and trusted person that they feel comfortable with as you start practicing separation.
Step 4: Follow Through
Finally, it is important to follow through with the plan that was roleplayed with your child, praising your child’s efforts throughout the process. When you follow through you with your plan, you give your child a sense of safety and security. Following through allows your child to know what to expect, and to know that you will return safely in the amount of time you said you would. Consistency is key!
If you follow through with the plan and your child is still struggling, it might be time to visit steps 1 and 2 again. Repeat these steps as needed!
Take home message
As previously mentioned, there is a difference between developmentally normal separation anxiety and separation anxiety disorder. Make sure you talk to your health care provider if you feel that your child’s separation anxiety may be more than what is developmentally normal.
Using the four steps outlined in this post can help children with developmentally normal separation anxiety manage their symptoms. Try these steps if you have a child who has tantrums and/or outbursts of crying when leaving you or another caregiver, shows concern about attending school or daycare, and is in their early school age years.
Interested where I found this information? Find the journal articles here:
James AC, James G, Cowdrey FA, Soler A, Choke A. (2015). Cognitive Behavioural Therapy for Anxiety Disorders in Children and Adolescence, Cochrane Database Syst. Rev. (2):CD004690.
Fagiolini A, Shear MK, Cassano GB, et al. Is lifetime separation anxiety a manifestation of a panic spectrum? CNS Spectrums 1998; 3(4): 63–72
Masi, Muchi, & Milliepiedia (2001). Separation Anxiety Disorder in Children and Adolescents. Epidemiology, Diagnosis and Management, 15(2), 93-105.
Miltenberger, R. (2004). Behaviour Modification: Principals and procedure (3rd ed.) Belmont, CA. Wadsworth Publishing.
Spence, S., Donovan, C., & Brechman-Toussaint, M. (2000). The Treatment of Childhood Social Phobia: The Effectiveness of a Social Skills Training-based, Cognitive-behavioural Intervention, with and without Parental Involvement. The Journal of Child Psychology and Psychiatry and Allied Disciplines, 41(6), 713-726.
Steward, K.K., Carr, J.E., & LeBlanc, L.A. (2007). Evaluation of family-implemented behavioural skills training for teaching social skills to a child with asperger’s disorder. Clinical Case Studies, 6, 252-262.