Shayna Gavin, Splash Principal Physiotherapist
What is separation anxiety?
What is separation anxiety?
Separation anxiety is when a child feels upset when separated from their caregiver.
Some babies and children struggle when they are put down or the caregiver is nearby in the room. Others struggle when they are left a childcare, or put into bed by themselves.
Separation anxiety is a normal stage of development. It relates to:
their attachment to their caregiver, which starts in the first few months of life
their cognitive development, when they understand they are separate people to their caregiver, can recognise the difference between people, and can remember that a person still exists when they are not in sight (object permanence)
their increased mobility. Separation anxiety at this age has a survival reason, to prevent children from getting lost
them trying to hold on to what is safe in an uncertain environment.
Image description: two women embracing a baby, all smiling
What age do children experience separation anxiety?
Separation anxiety usually starts at 6-8 months of age. It usually peaks at around 18 months and then start to reduce as they become more confident, until around 2.5 - 4 years of age.
The timing can differ. Some babies experience it early, and others more at around 2 years of age. Others never go through a very difficult period. It can be triggered at different times by life changes.
It is sometimes prolonged or increased, for example:
when a child has had limited experience with another caregiver outside the family before
when a new baby joins the family
if the child has had any painful separations
if the child has had illnesses, painful medical procedures or hospitalisations
if the child has developmental delays
if the child has an intellectual disability
if the child is left with caregivers they are not familiar with or in a new environment
new caregivers or environments
tension at home, or issues with other caregiver arrangements, or in their peer group (eg bullying or abuse)
How do children learn to cope with separation from their caregiver?
When the caregiver repeatedly leaves for small separations and always returns, the child learns this pattern. They come to understand the world is a safe place, and can be happy when their caregiver is away.
At first these separations need to be very short. The child does not understand the caregiver will always come back. Practise separations can be used, for example, playing peek a boo, hide and seek, doing a chore at home in another room
Many babies and toddlers are upset when dropped off at childcare, however this is often short. Many children do well in safe child care environments, being relaxed and happy in between drop off and pick up times, as they learn to manage separating.
By kindergarten and school age they are usually more able to separate for longer times.
Children can become attached to more than one caregiver, and this is helpful for them to have more than one person they feel safe with.
What strategies can help learning to deal with separations?
Practising separations can help to prepare for separating
short separations at home, eg playing hide and seek or doing a chore in the next room
read or make up stories about separations
avoiding separations can increase separation anxiety
Strategies can help with separations, however they are of course not always possible and do not suit all families. Strategies could include:
caregivers are confident in leaving their child, knowing they will be safe and well cared for
caregivers stay for a while to help their child get to know their new caregivers and environment, showing that you trust and like the caregiver, being encouraging to your child
where possible time your departure for when they are comfortable, eg after naps or mealtimes, and ideally not when they are hungry, tired or restless.
bring special toys, dummies or blankets if this helps. This can be gradually phased out.
show you understand your child’s feelings eg. “I know you wish I could stay. I wish I could stay too”
consider letting the child mind something of yours while you are not there
help the child understand when you will return, eg. after lunch
use assistive communication aids where needed to help your child understand (eg visual schedule)
where possible leave your child with someone they know and trust
always say goodbye before you leave, but then try not to drag out your departure. This is helpful even for babies
be calm and consistent when you leave. Create an exit ritual, stay calm and show confience in your child.
keep a relaxed and happy look on your face when you are leaving. This is called ‘social referencing’. When children are uncertain they look to their caregiver/s to understand if the situation is safe or dangerous. If you look worried or upset they will be more likely to fear the situation, because you are non - verbally communicating that it is not safe
be reliable and come back when you say they will. Communicate to the carer if you will be late so they can tell your child what has happened.
having time together when you are reunited
give lots of positive attention about how brave they were when away from you, and highlighting the great things they did or enjoyed in that time
the step ladder approach can be helpful for some families https://raisingchildren.net.au/toddlers/health-daily-care/mental-health/anxiety-stepladder-approach
remember this is a normal developmental phase and it will pass
Always consider if general advice such as this article is right for your family or if you need support from a health professional.
When is separation anxiety not normal?
If your child’s separation is severe, lasts a long time or is interfering in their ability to participate in and enjoy their everyday life, you may life to seek additional support.
This can be called ‘separation anxiety disorder’. Around 4% of preschool and school aged children develop this.
Separation anxiety disorder is when:
anxiety interfere’s with your child’s life (and therefore the caregiver/s and family’s life)
your child has more anxiety than other children their age
anxiety continues for 4 weeks or longer
You could notice your child:
experiences panic symptoms when the caregiver leaves (eg nausea, vomiting, shortness of breath)
has nightmares about separation
is fearful of sleeping along (although this can be common in children without anxiety)
excessively worries about being lost, kidnapped, or going places without a parent
If you have concerns about this, notice when your child:
dislikes being separated from their caregiver/s
worries they or their caregiver might be hurt or have an accident
refuses to go to preschool, childcare or school
refuses to have sleep overs (with trusted caregivers) without you
says they feel sick or in pain when separated
What about a child who has not experienced separation anxiety?
There can be different reasons for this. For example:
they feel safe in the environment and with the new care giver
some children do not experience obvious separation anxiety
they have a developmental delay or intellectual disability which means they do not understand the change in caregiver
they have learnt that becoming upset does not bring the care giver back and they have given up
they have experienced trauma and difficulties with attachment.
If you have concerns please seek support
Who can support us with separation anxiety / separation anxiety disorder?
your GP or paediatrician
your local health centre or community health centre
a child psychologist http://www.psychology.org.au/findapsychologist/
a school counsellor
a specialist anxiety clinic
your early childhood therapy team (eg. physiotherapist, OT and speech pathologist) can support you with your child's whole development, and can work in collaboration with team members brought in to specifically assist with separation anxiety disorder
Shayna Gavin is a physiotherapist who is passionate about helping babies, children and young people learn functional skills so they can participate in life at home, school and in their community. Recognising that children do best in their own environments, she visits homes, schools, and leisure activities from football fields to ballet classes. She also has daily aquatic physiotherapy sessions available at two private swimming schools in Moonee Ponds and Greensborough, Melbourne. She combines principles of paediatric physiotherapy, Contemporary Neuro Developmental Treatment, motor learning, and swimming teaching to address the individual needs of each child and their family. She loves providing professional development to physiotherapists, allied health and education professionals, allied health assistants and swimming teachers.