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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

A Parent's Life A Parent's Life

Say Goodbye to Separation Anxiety

November 14, 2013

By Claire McCarthy M.D.

Boston Children's Hospital

We've all seen separation anxiety, or worse yet, lived it: The little child clinging to his mother's leg for dear life, crying, "Don't go, Mommy, don't go!" It's normal for children to have some trouble separating from caretakers. It's a sign of bonding and of the strong relationship that is important for nurturing.

Separation anxiety begins in the second half of baby's first year. That's when babies begin to understand that those they love exist even when they can't see them. It's also when they start to be uncomfortable with people they don't know well. It peaks at 18 to 24 months of age, but continues through age six or so as children venture out into the world of new experiences — and then back to the comfort of home.

Each child is different. You can see this at any school or daycare center. Some children run in with hardly a glance backward when they are dropped off. Some are being pried tearfully off their parents by staff members. Sometimes children separate well one day and then won't the next, depending on their mood and the circumstances. It's an emotional tug of war between the need for security and the desire for independence.

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Help Nurture Independence

If your child will be separating from you to go to daycare, school, or an activity, here are some ideas to make the transition go more smoothly:

  • Prepare your child. Talk about the place or program they will be going to, what's great about it, who will take them and pick them up, and what will happen there.
  • Use rituals. A goodbye phrase, a special hug, something that is the same every day, can help some children. In the book The Kissing Hand (by Audrey Penn), the mommy raccoon kisses her baby’s hand, and when he's away from her he can hold his hand to his cheek to feel her kiss.
  • Get there early. That way you can settle your child in. Transitions are harder when you are rushed.
  • Work with staff. They've seen it all, most likely. They may have good ideas as to how to ease the transition, whether it's a snuggle or leading the child to something fun or interesting.
  • Always say goodbye. Resist the temptation to sneak out when your child is distracted; it breaks down your child's trust in you and can make separations harder.
  • Pack notes, stickers, other "I love you" tokens in lunches or backpacks. These let your child know you are thinking about them and loving them even when you’re not around.
  • Be positive and calm. Kids pick up on the emotions of their caretakers; if they see that you are upset, it will upset them more.
  • Set limits. If screaming got you want you wanted, you'd be silly not to scream. As hard as it can be to walk away from a screaming child, that may be exactly what you need to do if you want it to stop sooner. If you do walk away from a very upset child, call in 20 to 30 minutes to see how they are doing. It's not uncommon to find out that they stopped crying shortly after you left. That's not manipulation, that's normal separation — and usually all crying stops within a week or so.

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Looking Out for Trouble Signs

If after a week or so the crying hasn't stopped when you call and staff tell you that your child is miserable for a large portion of the day or program if not all of it, reevaluate the situation.

The place or activity may not be a good fit for your child. Make a surprise visit; watch interactions between staff and children, watch how the interactions between children are managed and get a sense of the activities and routines. Every child has different needs when it comes to interactions, activities, structure, etc. If anything doesn’t seem right, or if the fit is wrong, look for a different program.

Your child may not be ready to be away from you, especially if your child is young — younger than 4 years — or if there has been a major life change such as divorce or a new sibling. Keeping him at home for a few months (or until the next school year) and trying shorter separations (swim class, movement class, etc) may be your best bets if they are realistic options.

But if work demands or your child's age necessitates that he be in school, then talk to your doctor and the daycare or school staff about ways to make the transition and experience better. (Often more emphatic variations of the above tips, for a bit longer, will do the trick.)

Sometimes separation anxiety can be serious and interfere with the child's life and health. This may be happening if your child:

  • Is anxious or worried even when not separating
  • Has drawn-out tantrums and an absolute refusal to separate
  • Has trouble sleeping, nightmares, poor appetite
  • Is sad and doesn't want to do normal activities
  • Shows regression — lapses in toileting, acting more baby-like
  • Has physical complaints at separation time, such as headache or stomachache

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If any of these are occurring, call your doctor. Together you can figure out the best way to help your child. Sometimes advice from or visits with a mental health professional are necessary.

Usually, though, with love and patience children learn to separate successfully and enter the exciting world outside the home, with all its adventures and possibilities.

Claire McCarthy, M.D., is an assistant professor in pediatrics at Harvard Medical School, an attending physician at Children's Hospital of Boston, and medical director of the Martha Eliot Health Center, a neighborhood health service of Children's Hospital. She is a senior medical editor for Harvard Health Publications.

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