Welcome to Play On Pediatric Therapy
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By: Jacqueline Agnew, OT Reg. (Ont.)
Infants: Separation anxiety develops once they realize the parent is really gone (a term called “object permanence”), which can make them feel uneasy. Although some babies display object permanence and separation anxiety as early as 4 to 5 months of age, most develop separation anxiety around 9 months of age. It can feel worse if your baby is hungry, tired, teething, or not feeling well.
Toddlers: Toddlers can go through spurts of separation anxiety but it typically presents itself at 15-18 months of age, and can peak at 3 years of age. Again, separation is more challenging when your child is feeling hungry, ill, tired, and teething. Toddlers are learning to become more independent and may insist on doing many things themselves, but are very aware of separation. Their behaviours at times of separation can be very loud, tearful, and difficult to stop.
Preschoolers: As mentioned above, separation anxiety often peaks at 3 years of age, and then tends to decrease until the child reaches 4 years old. There can be another period of anxiety when the child starts kindergarten, as this is a major change in their routine. Separation anxiety has peaks and valleys, so your independent preschooler/kindergartener may experience times of being just fine without your presence, and other times when they want you close by – especially during times of illness or fatigue.
School-aged children: Separation anxiety can continue through peaks and valleys into the school-age years, with particular onset during times of transition, such as attending a new school, entry into middle or high school.
Teenagers: Roughly 8% of teens age 13+ experience separation anxiety, with the cause being more outward-focused, such as violence, accidents, severe illness, etc. that may take their parent away from them permanently.
→Fussier than usual, will only sleep if held.
→Cries at nap or bedtime when being laid down or when you leave the room (when YOU initiate the separation)
→Becomes upset when someone other than preferred caregiver holds them.
→Taking short naps or refusing to nap without parent’s presence.
→Waking in the middle of the night and calling out for a parent (and this wasn’t an issue previously).
→Pushing boundaries, for example fighting or drawing out bedtime. This is how the child figures out your responses to their behaviour.
→Prolonged, excessive, and/or intense crying at times of separation, such as daycare or kindergarten drop-offs.
→Hesitant around strangers or people they don’t know.
→Daycare or school refusal.
→Fear of the dark.
→Nightmares and night terrors.
→Refusing to be alone in a room.
→Physical feelings such as stomach aches, headaches, etc.
→More frequent tantrums.
→School refusal
→“What if” thoughts such as, “what if I get lost?”, “What if grandma doesn’t pick me up after school?” Etc.
→Avoiding participation in new activities or going somewhere without a parent (e.g. a birthday party where parent drops child off and leaves).
→Refusal to attend play dates without their parent/caregiver.
→Fewer friendships with peers because of a preference for spending their time with parents.
→Refusal to sleep alone
→Nightmares
→Physical symptoms such as stomach aches, headaches, dizziness, racing heart, shortness of breath.
→School refusal
→Avoiding participation in new activities
→Decline invitations to spend time with peers in order to stay home
→Refusal to go on overnight trips (e.g. school-related or summer camps)
→Constant worry that something bad will happen to their parent/caregiver
→Frequent checking in on parent/caregiver through texts, calls, etc. to learn where they are and be reassured that parent is available.
→Lack of independence
→Physical symptoms such as stomach aches, headaches, dizziness, racing heart, shortness of breath.
Toddlers, preschoolers and younger school-aged children may present with more physical responses to separation anxiety, such as stomach aches, crying, clinging, and tantrums. These physical signs are more common on Sunday nights and Monday mornings with the anticipation of returning to daycare or school, as well as following other periods of time away from daycare or school.
For older school-aged children and teenagers, separation anxiety can be situational, such as when it occurs after a stressful event such as a divorce, severe illness, loss of a loved one, or a transition to a new school. Their symptoms may be less obvious to spot and can appear similar to general anxiety.
Even if it’s just 10-15 minutes, this 1 on 1 time provides extra attention and connection time, which can help your child adjust to transitions. Call it ‘Special Time’ and make it a regular part of your daily routine, that the child can expect and they lead. No distractions, no siblings.
For example, play peek-a-boo with your baby, or hide and seek with your young child. These games reinforce that you come back and are a fun way to practice object permanence. It can help to talk to you toddler at first while you are hidden to ensure them that you are close by. When you are ready, do a practice run and have a friend or relative watch your child while you go out for an hour. You can also practice this with older children as well, for example, at the grocery store you could ask your school-aged child to go get an item for you that is further up the aisle, graduating to the next aisle over where they can’t see you (ensure you stay in the same spot so they can return to you with the item from the grocery list). This can foster a sense of growing independence and pride in separating from you briefly while helping with grocery shopping.
Read books about separation to your little one, an example is “The Kissing Hand” by Audrey Penn, or “Mommy always comes back to you” by Christine Yeung and Anna Liang.
The amount of time needed depends on how long the separation will be. Longer periods of separation will require a longer amount of time to prepare your child and have them get used to the idea.
Talk about the positive things that the child will be able to do at their new daycare or school.
If the child is older, involve them in the decision-making, planning and organization of the new routine. This will help them feel they have more control over the situation.
✅Create a simple goodbye ritual with your child.
✅Emphasize that you WILL return to pick them up and when they can expect you to come back (if a toddler, you can state a general time, such as after nap time, or before dinner).
✅Ensure transition is brief – do not prolong the goodbye. “Quick goodbyes lead to dry eyes”
✅Be consistent.
✅For younger children, a transition object such as a favourite stuffed animal or lovey could help offer a sense of security.
👍Build trust through consistency
👍Don’t sneak away while your child is distracted – this can create feelings of mistrust. Let them see you leave so that they can process this fact.
👍If you say you will be gone for 2 hours, ensure you are home in 2 hours (to the best of your ability).
🙂Let your child express their worries or cry for a few minutes – let them feel seen and heard.
🙂Repeat what they say (e.g. if they say they miss you and want you to stay, repeat, “I hear you. You are going to miss me. I know this is hard, and you want me to stay. I have to go. I love you, and I’ll be here to pick you up when school ends.”)
🙂Re-direct to positive and confident statements (e.g. “I’ve packed your favourite food for lunch!” or “You can do this because you are brave!”)
🙂Perhaps include a little note in their lunch bag that lets them know you are thinking of them. For teens, you could send them a quick text during the day.
👏Typically as your child becomes used to the new daycare or school routine, the separation becomes easier.
👏As mentioned above, be consistent.
👏Be kind to your child and yourself, knowing that sometimes things take longer than we want them to take.
Ask for your child’s teachers to get on board with helping your child to feel comfortable. For example, “show and tell” can be popular as the child can bring something from home (or talk about something they like to do at home with their caregiver) and share about it at daycare or school. Ask other loved and trusted adults to help with times of separation if that makes it easier.
Sometimes a child’s anxiety can go beyond what is typical in child development and cause significant disruptions in daily life for you and your child. If you are needing professional help, the following services may be of assistance:
1. Your family doctor or pediatrician
2. Crossroads Children’s Mental Health: Free of charge for children 12 years of age and younger.
3. Youth Services Bureau: Free of charge for children older than 12 years.
4. Occupational Therapy: Occupational Therapists like the ones here at Play On Pediatric Therapy in Ottawa can work with you and your child using meaningful and motivating strategies as well as tools that can help ease separation anxiety. Reach out to learn more today
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