Up Close With Dr. E

Tips ease separation anxiety disorder


Emma, a 2-year-old toddler, sits face-to-face on her mother’s lap. Mother makes eye contact and smiles. Emma smiles back. Next, mother holds a kitchen towel, using it as a barrier between herself and Emma. All Emma can see is the towel. Mother’s face is now hidden. Emma stops smiling. “Where did Mommy go?” she thinks. Every second that ticks by is torture for Emma. As her anxiety builds, she asks herself, over and over: “Where is Mommy?” Emma is near tears. Suddenly, mommy drops the towel and says, “Peek-a-boo!” Flooded with relief, Emma rejoices and thinks, “Hurrah, Mommy is back.”

Peek-a-boo is neither a silly game nor child’s play. It is serious developmental work where Emma is challenged to learn basic skills in soothing her fears and worries. How so you ask? The answer lies in child development.

Separation anxiety begins at the same time the infant is attaching to their primary caregiver, birth to 10. Because children, under the age of about 3, do not have the mental ability to hold “visual photos” in their mind, all it takes to trigger anxiety is for the mother to separate and leave the child’s sight. Peek-a-boo, as seen from the child’s perspective, goes like this ... out of sight equals gone forever equals panic. When the kitchen towel separated Emma from her mother, Emma believed that “mommy was gone.” For a few seconds, this was exciting. When will she come back? Too much time elapsed and Emma’s “mommy is gone” triggered a fear reaction.

Child psychologists call the ability to hold “photos” in a child’s mind — object permanence. As Emma gets older, separation anxiety lessens because she can now hold an image of her mother’s face in her mind (object permanence has been achieved) and, since Emma’s mother always returns, the child can trust this relationship. This allows Emma to develop emotional security. What would you predict would happen if mother did not always return to Emma’s side? Consider these catastrophic events:

1. A young child is removed from her mother’s care due to abuse and neglect. Multiple caregivers occur in the child’s first 10 years of life.

2. The mother is diagnosed with cancer, is hospitalized, and is unable to raise her child.

3. The mother dies before the child is 10.

Disruptions of this magnitude always lead to anxiety in the child.

As fall approaches, many children will struggle with crying, emotional upset and intense anxiety, when they separate from caregivers and leave for school. This is called separation anxiety disorder. The purpose of this article is to give you — the primary caregivers — practical ways to help your child to overcome these fears. Even children who have had no disruptions in their life, can struggle with separation anxiety. New research on anxiety in children has found this: Genetic factors run in certain families and make children vulnerable to anxiety.

Recommendations for handling separation anxiety in children/adolescents:

1. Your child must go to school. Even though your child pleads, “Mom, I’m worried you will die if I go to school” or “I’m too scared to ride the bus” or “My stomach hurts, I can’t go to school” or “I’m afraid I will throw up in school,” your child’s anxiety will go up 500% if they find ways to avoid school. If your child has strong fears about riding the bus, it is ok to drive them to school for the first one to two weeks.

2. Call your child’s principal and teacher and ask for help. You may want to have school staff meet you outside of the school building and escort your child inside to their class.

3. As a general rule, parents are not advised to go with their child into their classroom — this usually increases their anxiety. However, each child is unique, and for some, escorting them to their class is helpful.

4. Give your child a photo of you — explain to the teacher what you are doing and why.

5. Do not discuss with your child, the night before school, your child’s fears. This only fans the fire of their fear. Re-assure your child with, “we can talk about school in the morning.”

6. Separation anxiety disorder usually passes with time. If it does not, call a professional for help.

Try to keep this in mind: As children, we all experienced fears. Tell your child a story about your own struggles and how you overcame your fears. Did it make you stronger? The content of this article is for educational purposes only and should not be used as a substitute for treatment by a professional. The characters in this story are not real. Names and details have been changed to protect confidentiality.


Dr. Richard Elghammer contributes his column each week to the Journal Review.


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