pediatrics
Separation Anxiety and Stranger Anxiety
Separation anxiety
Separation anxiety is fussing and crying when a parent leaves the room. Some children scream and have tantrums, refuse to leave their parents' side, and/or have nighttime awakenings. Separation anxiety is a normal stage of development and typically begins at about 8 months, peaks in intensity between 10 and 18 months, and generally resolves by 24 months. It should be distinguished from Separation Anxiety Disorder , which occurs at an older age, when such a reaction is developmentally inappropriate; refusal to go to school (or preschool) is a common manifestation of separation anxiety disorder. Separation anxiety occurs when infants begin to understand that they are a separate person from their primary caregiver but still have not mastered the concept of object permanence—the idea that something still exists when it is not seen or heard. Thus, when infants are separated from their primary caregiver, they do not understand that the caregiver will return. Because infants do not have a concept of time, they fear that the departure of their parents is permanent. Separation anxiety resolves as children develop a sense of memory. They can keep an image of their parents in mind when the parents are gone and can recall that in the past, the parents returned. Parents should be advised not to limit or forego separations in response to separation anxiety; this response could compromise the child’s maturation and development. When parents leave the home (or leave the child at a child care center), they can try the following strategies: Encouraging the person caring for the child to create distractions Leaving without responding at length to a child’s crying Remaining calm and reassuring Establishing routines at separations to ease the child’s anxiety Feeding the child and letting the child nap before parents leave (because separation anxiety may be worse when a child is hungry or tired) If the parents must momentarily go to another room in the home, they should call to the child while in the other room to reassure the child. This strategy gradually teaches the child that parents are still present even though the child cannot see them. Separation anxiety causes no long-term harm to children if it resolves by age 2 years. If it persists beyond age 2, separation anxiety may or may not be a problem depending how much it interferes with the child’s development. For children, feeling some fear when they leave for preschool or kindergarten is normal. This feeling should diminish with time. Rarely, excessive fear of separations inhibits children from attending child care or preschool or keeps them from playing normally with peers. This anxiety is probably abnormal ( Separation Anxiety Disorder ). In such cases, children require medical attention. 