Coping with Separation Anxiety: A Pediatrician’s View

Thoughts from Reach Out and Read’s National Medical Director Dr. Perri Klass

For many children and parents, the beginning of the school year is filled with excitement. Along with new clothes, supplies and activities comes the chance for a fresh start.

But, the new school year can also be accompanied by another emotion – separation anxiety. Around this time, it can start to creep up in children andparents. We’ve all seen a child clinging to a parent’s leg at school drop-off or crying before a dance lesson. It’s never easy, but there are coping strategies to help families through this time of heightened anxiety.

Recently, I posed some questions about separation anxiety to Dr. Perri Klass, professor of journalism and pediatrics at New York University, where she works in the clinic at Bellevue Hospital. Dr. Klass led Reach Out and Read from 1993 to 2006, and now serves as our National Medical Director. She writes frequently about children’s issues. Below is an edited version of our conversation.

Earl: What causes separation anxiety in children?

Dr. Klass: Separation anxiety is absolutely normal. It develops in babies as they come to terms with their social environment, identifying the importance of particular people in that environment and attaching to them. It’s a good thing. It’s part of the very particular attachments that a baby forms with caretakers and other important people in their lives. It shows you that the baby’s mind is working, and that their memory and feelings are developing.

The question is: in a room of 2-year-olds at a child care center, or later in a room full of kindergarteners, what is it about the one or two children that have a hard time understanding the daily routine? Why is it hard for them to understand that mommy or daddy will say goodbye in the morning, and of course, be back at the end of the day? Especially because they are spending time in a place they know and like? Why is it harder for one or two children out of the group to make that morning transition?

Earl: Are there certain signs parents can observe to anticipate if their child will have difficulty with separation? Are there signs you may see at a well-child visit that can let parents know this may be coming?

Dr. Klass: Usually parents know their children well, and they have some sense of, “Is this just what everybody else goes through or is my child always the one who is very upset at drop-off?”  Parents should consider, “Is the distress excessive?”

Separation anxiety usually starts before the first birthday – along with stranger anxiety, which is when a child does not want to be held by someone they are not familiar with. And that is totally normal. As you near age 2, children also develop a tremendous desire to explore the world and to assert autonomy and independence. Some 2-year-olds are out the door and down the hall if you don’t hold them. That desire for independence sometimes pushes back against the separation anxiety.

Yet, there are some children who are much clingier than others. These are the children, who in childhood, don’t want to go places that you as the parent think would be fun, but the children are too worried about the separation to enjoy the experience. They’re worried about going to a birthday party or a friend’s house and are constantly checking if their parents will be there.

Parents are usually aware of this. As children get older, separation anxiety can even become an issue during bedtime. There are older children who have anxiety that something is going to happen to them or to their parents at night while they are sleeping. This is an extra degree of clinginess.

Earl: What can parents of children with separation anxiety do to help make the transition to school smooth?

Dr. Klass: One of the things that really helps a lot of children is explaining the separation and planning for it by telling them what’s going to happen when they get to school, what room they’re going to be in, who else will be there, etc.

If you can meet one of the other children before school or visit the room in advance, that’s huge. Anything you can do to make the classroom a little more familiar, so it’s not everything new all at once, is really helpful.

Also, practicing is important. Make play dates so your child can spend time over at someone else’s house and you can practice whatever reassurances and routines the child needs, such as “I will be there to pick you up at 3 o’clock.” When you arrive to pick them up, say, “Look, it’s 3 o’clock and I am here. Tell me about all of the fun things you did.”

Earl: What role does routine play in helping a child feel more comfortable leaving the home?

Dr. Klass: As a child care parent, I noticed that the most consistently successful routine was the game that one of the teachers in my child’s child care center developed. It was basically a game to push mommy and daddy out of the door. It did not encourage weepiness and sentimentality. Instead, it encouraged a sense of power, making it clear that the child is in charge. This game never failed to have all of the toddlers laughing. For older children, a routine such as a kiss good-bye, a joke or a rhyme like “See you later, alligator!” can work well at the time of parting. Consistent routines help children feel safe.

Earl: I know you’ve written about homesickness in your column in The New York Times, and that parents also can suffer from separation anxiety. How can parents deal with their own feelings? What messages should they give to their children about the importance of time apart from loved ones? 

Dr. Klass: We have to remember that sometimes a child’s separation anxiety reflects what the parents are feeling, as well. Yes, maybe the child is upset because he’s never been away from the parent before, but sometimes there’s a reason for that – and it’s not all about the child.

As parents, we’ve got to be able to say to our children, “You’re going to have such a wonderful time here. I can’t wait to hear about everything you’re going to do. Maybe you’ll make something to bring home and we’ll hang it up on the refrigerator. I’m really excited that you’re so grown-up and are going to this great place today.”

You do not want to be the parent who is in tears. You do not want the child worrying about you. Your child should not be hearing that you are sad and you are missing him—that will be painful for him. This is a moment when you really need to be the grown-up!

The thing about this kind of separation is that it gets easier as you do it more. The reason it gets easier for children is that they will have fun in school, they are going to make friends, they will really go home at the end of the day, and their parents and their house will really be there! They are going to talk about what they did all day and they are going to feel proud of themselves. This is the kind of lesson that you learn as you do it.

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