Separation anxiety: a common disorder in children

At the age of 7-8 months of life children start to be able to keep an object in their mind when it is not present, for example, the image of their parents. Therefore, at this age the first fears of strangers, of new situations or when they are separated from people close or familiar to them, such as their mother, appear.

These fears of strangers and anxiety about being separated from their parents peak at around 18 months, after which they tend to be less intense or appear more occasionally, such as at the start of kindergarten, school or in stressful situations.

Later, between 3 and 5 years of age, the fears that appear respond to the presence of animals, darkness and imaginary situations. From 6 to 11 years of age, more realistic fears will be more frequent: of losing parents, falling ill, making a fool of oneself or being punished; it is an age in which children have to learn to face and manage their difficulties.

When entering adolescence, from 12 to 18 years old, the opinion of the group of friends or peers gains importance, comparisons regarding the body, clothes…, appearing the fear to make a fool of oneself or to be different from others. Anxiety will manifest itself in a similar way as in adults, although physical symptoms are quite common in children.

Most of these fears are overcome spontaneously as they grow up, but if the child has a disproportionate fear that interferes with daily life, it may indicate that the child has a separation anxiety disorder.

What is anxiety?

Anxiety is a normal and adaptive emotional reaction to a situation, real or imaginary, that poses a danger or threat to the child. When this anxiety is caused by specific stimuli, it is called fear.

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Therefore, anxiety and fear are innate defensive reactions that constitute an alarm system to alert the child of possible dangers, having a protective role. Infants, for example, between six and eight months begin to develop fear of strangers, and fear becomes a protective agent. Most children experience many mild and transient fears, which are spontaneously overcome with age.

Separation anxiety in children

Separation anxiety disorder is very common within the Anxiety Disorders in children. Symptoms are more frequent the first time the child goes to school, as well as when starting in a new center or when moving from kindergarten to primary school.

As the weeks progress in September and October, children become more accustomed to school and show fewer and fewer symptoms of anxiety when leaving school. However, some will still have intense fear and great difficulty staying at school. These children may have separation anxiety disorder and should be evaluated by their physician.

This anxiety disorder usually begins before the age of 6 years and tends to decrease after the age of 12. The most common symptom is intense anxiety in the child when he/she has to be separated from caregivers, especially parents. The child experiences separation as a threat, because he/she thinks that during his/her absence something bad will happen to the parents or to him/herself, and he/she will not see them again, so he/she avoids it by all means. Younger children tend to experience anxiety in the actual absence of parents, while older children begin to suffer more in anticipation of separation (for example, when parents begin to plan a trip).

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How to detect separation anxiety disorder

Mainly, the child will show that he/she does not want to go to school or will cry a lot when separated from his/her parents, will not want to go to bed alone, will refuse to go to sleep at a relative’s or friend’s house, to go on a trip or camping without his/her parents. In these situations the child may also present anger, tantrums, even physical complaints, such as abdominal discomfort, vomiting and dizziness, which make the parents take the child to the pediatrician, but no physical cause is found for all these symptoms. These symptoms appear more frequently in the morning before going to school or on Sunday evenings, and are not present on weekends or during vacations, long weekends, etc.

Separation anxiety disorder is more frequent in parents who have an overprotective attitude towards their children. If the child does not lose the fear of school, he/she should be evaluated by a specialist in Psychiatry to rule out a separation anxiety problem.

Treatment of separation anxiety in children

The treatment is simple and effective, consisting of a repeated and gradual exposure to the stimulus that creates anxiety (in this case going to school). The first few days the mother or father can stay at school with the child for a while, gradually reducing this time.

The farewell has to be quick, because prolonging it will not reduce the anxiety. At the moment of saying goodbye, the child should be assured that everything will go well and that we will be waiting for him/her after school; it is important to do this and not be late to pick him/her up and keep him/her waiting. Sometimes it is necessary for the child to see or call the mother at recess for the first few days, but it is important for the child to know that he/she has to go to school.

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If gradual exposure is not enough, it is necessary to use medication for a few weeks. Finally, add that there is always a good prognosis.

5 tips for a child with separation anxiety

When a child says he is afraid, how can parents act to help him?

  • Recognize that the child is having a hard time, ask him what he is afraid of and try to understand him.
  • Do not ignore or minimize their fear, do not tell them: “Don’t be silly, you are grown up, children do not cry, how can you be afraid, etc.”.
  • Do not force him to face his fear all at once, for example, if he is afraid of the dark, it is better to leave a light on in the hallway until he falls asleep.
  • Do not be overprotective or teach him to be afraid of things. By being overprotective, the child thinks that something bad might happen.
  • Prepare the child to live new experiences; before facing them, tell him/her how it is going to be with as much detail as possible. You can also read a book with the child about the situation that is causing the fear.