In Educating Parents on Separation Anxiety Disorder: Part I, the warning signs and common causes of child separation anxiety disorder (SAD) were highlighted. In this second part of our two-part series on helping your child with SAD, we will review the four common causes of SAD, highlight 10 tips on how to help your child with SAD, discuss tips for anxiety-provoking transitions into daycare or school, and how to know when you should seek help from your child’s pediatrician or counselor. 

It is important to note that while these causes have been shown to be the most substantial stressors among children with SAD, your child’s SAD diagnosis could be caused by numerous other scenarios. It is important to consult with your child’s pediatrician or a licensed child counselor before treating your child for SAD. 

Common Causes of Separation Anxiety Disorder

1. Insecure attachment to adults. Believe it or not, parents are more affected by being separated from their infant than vice versa between their infant’s age of 0-6 months. Between 0-6 months, your child can adjust well to other caretakers without disruption. Studies show that only once your infant starts to test and understand the concept of object permanence sometime between 4-7 months do they worry about you not coming back once you are out of sight. As far as your child is concerned, if you are out of sight, you simply no longer exist. This is why the game of peek-a-boo is such a thrill to young children. 

If your child doesn’t grow up with a regular, predictable routine and find stability in caregivers and in the home, they can develop separation anxiety disorder. This insecure attachment style often occurs with neglect or with the unpredictable presence of one or more caregivers. However, it is normal for children to experience some level of separation anxiety between 7-18 months, and last between 2-5 months. If your child is experiencing intense distress for a longer duration, there is likely reason for concern. For more information about attachment styles, click here.

2. Overly accommodating or protective parents. Parents or caregivers that provide little independence for their children at home and in playtime to grow and make mistakes separately from their caregivers can have an especially tough time when it comes to separation. Infants that are held by caregivers every time they cry (such as when being put down in their crib to nap), may never learn effective self-soothing skills. This can lead to severe distress when children have to leave their caregiver for the first time, such as for daycare or school. 

3. Life stressors involving loss. One of the most common causes of severe anxiety disorder is a sudden loss in a child’s life during key developmental stages, such as a death in the immediate family (including a beloved pet), a divorce, or losing their home due to natural disasters or financial struggles. Any loss of a loved one, drastic change to family dynamics, or considerable loss of possessions, like a home, can cause SAD.

4. A drastic change in their environment. Similarly to experiencing a dramatic loss, drastic or constant changes in environment can make children feel intensely anxious about separation from their primary caregiver(s). A traumatic natural disaster unexpectedly taking away their home, moving houses and schools frequently for parents’ jobs, or being passed from caregiver to caregiver in the foster care system all have the potential to cause children to develop SAD.

How to Help Your Child with Separation Anxiety

1. Practice common separation scenarios. Consider what times of day and in which situations you will be separating from your child, then practice these when you don’t actually have to leave for a prolonged period of time. For example, if you will be leaving your child with a nanny around 8:30 A.M. when you leave for work, ask your nanny to come for a few hours around that time before you actually go back to work. This will allow your child to get comfortable with their nanny, you can observe how they react from a distance without really needing to be anywhere in a rush, and your child can get used to this new schedule. You could go run errands for an hour or two, or even sneak back into your home office to get some work done while being able to hear the progress your child is making with their secondary caregiver.

2. Practice separation times after your child eats or takes a nap. Separation distress can be heightened if your child is either hungry or tired, or both. If you leave after your child has a full tummy, or after putting them down for their nap, it’s likely that they will experience less intense emotions during and after the separation, or not have a chance to fear the separation at all in the case of already being asleep during a nap.

3. Make saying goodbye quick, calm and uneventful. The goal with separation anxiety is to diminish the amount of stress your child feels when you need to be apart, which won’t happen if goodbye’s are drawn out and emotionally charged. The best thing you can do is practice being calm while explaining that you will always come back to them, and to leave as quickly as possible. In fact, if your child is happily playing with their secondary caregiver, it may be best to sneak out the door without saying goodbye so as not to disrupt your child’s playtime at all!

4. Have a consistent secondary caregiver and set up practice playdates with them. One of the most effective ways to decrease your child’s fear when it comes to being separated from you is to help them feel comfortable and familiar with their nanny or teacher, as well as the environment they will be in while you are away. If your child is going to have a nanny, you can set up “working interviews” or practice playdates where you stay home, but out of sight, while your child and nanny can become comfortable with one another and build a relationship. 

If your child is going to be at a daycare or school, be sure to have your child tour their new environment to become familiar with their surroundings, teacher, and classmates. You can even ask to volunteer in the daycare or classroom while your child becomes comfortable with their new routine. The teachers will likely appreciate the help, and you probably aren’t the first parent to request to help their child ease into their new environment!

5. Remain consistent with boundaries and routines. One of the root causes of separation anxiety disorder is a lack of consistency or predictability in daily routines and environments. Keeping a calendar on a wall or bulletin board of your home with your child’s schedule can be an effective visual to ease anxiety. Even if your child can’t read, you can color code activities so that they can visualize what each day will look like during their week. Actively pointing out and reviewing their activities at the start of each day can help them to know what to expect and when to expect them.

6. Offer your child small options throughout their day for a sense of control. Separation anxiety causes children to be fearful due to the unpredictability of when they will see their caregiver next, with their ultimate fear being that they will never see their caregiver again. One way you can ease their anxieties throughout the day is to give them control over little things. For example, you can ask them what they would like to do during the time that you do spend together, such as going to either the library or the park. Or, would they like to come with you to pick up their sibling from a sports practice, or would they like to stay home with their older sibling? Providing your child with small, frequent choices can help them feel in control of their schedule.

7. Provide your child with the language to express how they’re feeling. Your child’s natural reaction may be to cry or scream uncontrollably when it is time for you to leave them, which is a natural response for young children that don’t yet know how to regulate their emotions, or speak well enough to communicate their complex feelings. 

8. Listen to and show respect for your child’s feelings. One way to help them understand their big feelings is to ask them questions about how they are feeling and to communicate how you are feeling, too. You can ask them a question like, “How are you feeling right now?” If you have previously encouraged them to discuss feelings with you, they will likely respond with “sad,” “mad” or “scared.” Make sure to get down to their eye level and make it clear that you are intently listening to them. You can follow this up by saying something like, “It makes me feel sad/mad/scared too when I need to leave for work and don’t get to spend the day with you, but I will always come back to you! And it makes me even happier when I get to see you and read with you at the end of the day!” 

An effective tactic to ease anxieties is to distract them with something positive, such as asking “What are you most excited for at daycare/school today?” Try to positively pass their attention off to a friend, activity, or teacher so that you can leave without any attention being drawn to you.

9. Support your child’s anticipation of separation. Ignoring your child’s anxieties won’t help them go away overnight; in fact, ignoring your child’s anticipation of separation can make it worse. Just like talking to a therapist helps kids and adults work through complex thoughts and emotions, talking about mental health and anxiety openly in your household can help your child feel more “normal” and less alone when they’re feeling anxiety. Talk to your child openly about how they feel when they are apart from you when their emotions are in a neutral state and there is no threat of being separated, such as when reading books together in the evening. Tell them you understand how they feel and reassure them that their worst fears would not happen and how you know this.

10. Praise your child’s efforts. Using positive reinforcement is the most effective way to change your child’s behavior. If your child does well with daycare drop-off one day, make sure to give them praise when you pick them up later and tell them how proud of them you are. If they don’t do well with drop-off the following day, don’t draw attention to their setback. Have patience with their progression and keep using positive reinforcement, and their behavior will gradually change.

Tips for Anxiety at Daycare or at School

1. Communicate with your child’s daycare or school. Let caregivers and teachers know that your child is experiencing separation anxiety so that they can be your teammate in helping your child ease into their new environment. They are there to help your child grow and are relative experts in helping children transition more smoothly into their day away from their parents and fostering independence. These can also be great people to come to if you, yourself are feeling emotional about leaving your child or have any concerns about separation. You won’t be the first parent they have met with these concerns, and you likely won’t be the last! They will also understand if you show up late to drop-off in the beginning while your child gets used to the transition.

2. Help your child ease back into daycare/school as quickly as possible after being absent. If your family goes on vacation, your child is sick, or they need a legitimate mental health break from daycare/school, be sure to help them get back to their regular routine as quickly as possible. The longer you allow them to stay home, the more they will regress into their separation anxiety disorder, and the harder it will be for them to leave you and go back to daycare/school.

3. Let your child know that they can contact you when necessary. Establish a plan with your child that allows them to contact you under certain circumstances and walk them through how they would go about contacting you. Teach your child your phone number and let their caregiver or teacher know this plan. For example, if your child is having an intense panic attack, you may want to first teach them how to breathe to calm themselves and to educate them on the power of their thoughts. There is no real, immediate threat to them, their bodies, or their surroundings when they experience a panic attack, and they can seek out help from an adult when they are experiencing an attack. 

However, if their caregiver thinks the only way to subdue them would be for them to hear your voice, this would be a situation in which your child should contact you. The objective isn’t for your child to want to call you multiple times each day, but only when it is entirely necessary. Oftentimes, just knowing that your child has the option to contact you if they need to will help to control their anxiety.

When Should You Contact their Pediatrician for Help?

How do you know if your child is experiencing normal, developmental separation anxiety, or if they have separation anxiety disorder? The following behaviors may be signs that your child may need talk therapy, play therapy, in-school counseling, or medication. Regardless, you will want to consult you child’s pediatrician for a professional opinion if you notice your child doing the following for more than four weeks at a time:

1. Age-inappropriate clinginess or prolonged emotional outbursts during separation. Most children outgrow clinginess and separation tantrums around the age of 3 years old. If your child is between the ages of 4-6 years old and still experiences intense emotional distress when you leave, your child may have SAD.

2. Chosen isolation from family or friends. If you notice that your child is becoming isolated from family and friends, they may be trying to subconsciously “solve” their separation anxiety by gradually disconnecting from loved ones altogether. This can also be a sign of depression, which is closely tied to anxiety.

3. Constant complaints of irrational fears or physical sickness. If your child is frequently concerned with irrational fears such as never being able to come home again if they leave, concern that you will never come home again, or that things they love will disappear, this is a sign of SAD. Further, if your child complains of constant stomach aches, headaches, or other general physical sickness symptoms before situations of separation, they may also have SAD.

4. Refusal to leave the house or go to daycare/school for weeks. If a child is afraid to leave the house or afraid of having to go to daycare or school, it’s likely that this worry stems from the fear of never seeing their primary caregiver again. This might be one of the most obvious signs that a child has SAD, because this is a refusal to ever leave their caregiver’s side.

If you think your child has any of these symptoms of separation anxiety disorder, it is a good idea to contact their pediatrician for further guidance. For more information on separation anxiety, visit the American Academy of Pediatrics for other articles and academic journals.