Separation Anxiety in Children

Dealing with a child’s separation anxiety is challenging for many parents. Maybe your child sheds tears at daycare drop-off or hides behind your leg when a neighbor approaches. They may even scream when grandpa comes near for a hug or kiss. 

Anxiety in a new situation or near a new person is common in babies and young kids. In fact, it’s often a sign of healthy attachment to a parent or caregiver, says John T. Parkhurst, PhD, a child and adolescent psychologist at Lurie Children’s.  

“We expect kids to be hesitant in new situations,” Dr. Parkhurst says. “It’s a process almost all kids go through.” Here, Dr. Parkhurst shares what parents should know about dealing with separation and anxiety in kids.

What is separation anxiety? 

Separation anxiety includes a child’s feelings of fear when they face a new person or environment or when their parent leaves. These emotions typically happen during early developmental stages in a child’s life. Nearly every young child experiences some anxiousness when separated from a caregiver, and it’s a completely developmentally appropriate emotion, Dr. Parkhurst says.

Separation Anxiety in Babies

Separation anxiety often begins during a baby’s first years, as early as 8 months. Babies know their parents and primary caregivers by this age and feel safe around them. “A strong attachment to the parent can lead to hesitation to engage with new adults or unknown others,” Dr. Parkhurst says.

Separation Anxiety in Toddlers

You may see separation anxiety begin to ease as your baby reaches 15 to 18 months. “Kids, especially under age 2, look to their parents to provide assurance, nurturing and safety,” Dr. Parkhurst says. But some toddlers may remain or become fearful around new people and places at this age. In new places, they often look to their caregivers for guidance on how to feel or for reassurance. 

Separation Anxiety in Preschoolers

Children may continue to feel anxious when separating from a parent, especially at bedtime or in a new place, as they get older. This is also an age when kids are aware of how parents react to their anxious feelings or crying. Kids may express emotions, perhaps becoming tearful, to delay bedtime or keep you from leaving.

Signs of Separation Anxiety

Separation anxiety often goes away over time. But separation anxiety may interfere with (impair) your child’s activities and development as they get older if they continue to:  

• Appear to be shy or slow to warm to new people 
• Bury their face against you
• Cry or get teary-eyed
• Refuse to engage with new people or take part in new situations
• Stand behind you or cling to you

Separation anxiety behaviors occur on a spectrum and are unique to your child, Dr. Parkhurst says. “Parents should expect that there might be some stress in new situations,” he says. “But remember, your child is looking to you as they assess the situation. How you respond to a new person or place, or to separating from your child, is going to help drive their response.”

How to Deal With Separation Anxiety

It’s hard to walk away when your child is crying or upset. It can also be tough to know what to do when your child doesn’t want to engage with people you know.

What should you do? Stay calm and behave as you typically would, says Dr. Parkhurst. “With young kids, it’s not our words that matter as much as how we respond and how we act,” he says. “If we’re confident and relaxed in a situation, that sends a signal to our child.”

Establishing behaviors is also important so your child knows what to expect. Routines and rituals can help, he says.

Create expectations

Use age-appropriate words or visual reminders like pictures or charts to help your child know what to expect during their day. You might also talk about how much fun your child will have with teachers or friends. You can also remind them that you or another favorite caregiver will pick them up when the day is over.

Keep a consistent routine

Having a routine can help when daycare drop-off or separating at bedtime causes distress in your child. It may be a hug, kiss on the cheek or something reassuring that tells your child it’s time for you to go. “Once you’ve done your routine, you’ve got to go,” Dr. Parkhurst says. “If you linger, it’s going to make it harder for your child and for them to know what to expect next time.”

Set an example

Don’t hide in a corner if your child is acting shy at a family party. Mingle and talk to guests as you typically would, but don’t pressure your child, Dr. Parkhurst says. They may warm up with some encouragement or they may need more time. But the more comfortable you are, the stronger the signal to your child that all is well, he says.

Stay strong

It’s important to stick to the expectations and routines that you create. Don’t change your plan because of your child’s anxiety or be overly attentive to their emotions. “We're trying to raise brave kids, and we have to be brave too,” Dr. Parkhurst says. “Our ability to separate and show them it’s OK, even when they’re anxious — or when we are — allows them to grow their independence and confidence.”

Manage how you show your own feelings 

Dr. Parkhurst says parents often don’t get empathy for their own complicated feelings about separating from their child. But it’s important to show your child that separating is a routine part of the day. “It’s really hard to leave your child when they’re upset,” he says. “When you maintain your composure in that moment, you teach your child that they’re going to be OK. We can model braveness for our kids, especially when they struggle with transitions.”     

What is separation anxiety disorder?

Mild separation anxiety typically resolves by the time children are between 5 and 7 years old. You may still notice some occasional anxiety in new situations, Dr. Parkhurst says. For example, it’s typical for older kids to be anxious at the start of a new school year or with a new teacher. 

“It’s not uncommon for even the first month of a new school year to be tough,” he says. “Sunday nights can be hard as kids get back into a school routine and realize they won’t be seeing mom or dad for the day.”

But when anxiety symptoms continue beyond a month or so or become very intense, talk to your pediatrician. These could be signs of separation anxiety disorder.

Separation Anxiety Disorder Symptoms

Separation anxiety disorder occurs when age-appropriate, expected separation anxiety lasts longer than it should. Separation anxiety disorder often includes larger emotional reactions than are typically expected with a transition away from a caregiver. These emotional reactions may interfere with a child’s ability to attend school, interact with extended family and build friendships. 

Healthcare providers consider certain questions to distinguish healthy, appropriate separation anxiety from a possible separation anxiety disorder, Dr. Parkhurst says. These include questions about the duration, frequency and intensity of a child’s anxiety, such as:

• How many days in a row was separation challenging?
• Was the child able to separate from their caregiver to go to school or daycare or participate in an activity?
• How intense is the child’s anxiety? Are they asking for the parent often or seeking reassurance constantly?

“If a parent isn’t staying too long at drop-off or giving in and not leaving the child, separation should get easier in about a month,” Dr. Parkhurst says. “Your child’s emotional response will typically lessen over time. If it doesn’t, bring it to your pediatrician’s attention.”

When Separation Anxiety Doesn’t Go Away

Kids who have trouble separating during the later elementary and tween years could be experiencing other anxiety disorders. These include generalized anxiety disorder and social anxiety disorder, Dr. Parkhurst says. Anxieties about separation in older kids may include worries about something bad happening to a parent or caregiver while they’re apart. 

Practicing separation — known as exposure — may help. For example, you might have your child stay with one parent while the other takes out the trash or walks the dog. Small steps like these can help kids learn to manage their feelings about separating from a parent or caregiver.

“Showing kids they’re safe and can feel and manage their distress is powerful,” Dr. Parkhurst says. “Planned exposure to the separation helps them realize the situation isn’t as bad as what their mind makes it out to be.”

When to Seek Treatment

Dr. Parkhurst says parents may sometimes misunderstand the difference between normal anxiety and anxiety that prevents coping with everyday stressors. “All people experience anxiety,” he says. But when separation anxiety disorder keeps your child from participating in school or activities, treatment may help. 

Treatment for separation anxiety disorder may include:

• Cognitive behavioral therapy (CBT): Providers use CBT to help kids and parents learn strategies to talk about and manage anxious feelings about being apart from someone they care about. CBT is goal oriented and often includes practice between sessions to address anxiety. 
• Medications: Pediatricians and other medical providers may prescribe medications called selective serotonin reuptake inhibitors (SSRIs) to help kids manage impairing anxiety. Kids may use these medications along with cognitive behavioral therapy.

Most separation anxiety is developmentally expected, and treatment often isn’t necessary, Dr. Parkhurst says. Your child’s pediatrician can help identify separation anxiety symptoms that are causing too much distress and help develop a treatment plan with you or refer your child to a specialist when appropriate.

Learn more about pediatric psychiatry and psychology at Lurie Children’s. 

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