How to Handle Separation Anxiety

Research may help to make separations less painful for both children and their parents

Aug 25, 2022

Source: Jordan Whitt/Unsplash

My first baby had terrible separation anxiety starting around 6 months. She would cry so hard and so persistently that even the most experienced babysitters would call us and beg us to just come home. As she got older and became a toddler, it only seemed to get worse. I was planning for her to start school at 24 months and I was really worried about what drop-off would be like. So I dug into the research and did everything in my power to improve her separation anxiety. Around 22 months, we finally reached a real breakthrough. As I was leaving her one day, she asked me “Come back?” and I realized that she just wanted to know that I would come back for her. After this breakthrough, it became our ritual that every time we left she would say “Come back?” and we would answer “Mommy/Daddy always come back.” It’s so hard as a parent (even as a parent with a PhD in child psychology) to remember that our children do not understand some basic aspects of separation that seem so obvious to us. This story also helps to illustrate that being okay with separation sometimes requires children to develop the understanding that you will always come back or that their caregivers will help to meet their need while you are away. Developing this understanding simply requires time and a lot of practice. Although the time period that my child had separation anxiety was difficult and heart-breaking, she is now a 7-year-old who runs into school without looking back and would prefer to be with her friends over me. So, remember even in the worst cases of separation anxiety, this will not always be your reality!

Now Let’s Dive into the Research…

Separation anxiety, or difficulty being away from a parent or caregiver, is a normal developmental stage that tends to be most common around 8 to 24 months. However, children can experience anxiety or distress related to separation from a parent or caregiver at any point throughout childhood (and even into adulthood).

First, it is important to remember that separation anxiety is typically a sign of healthy brain development and a strong bond with caregivers. However, it is also important to mention that there are some children who have very strong bonds with their caregivers and show no signs of separation anxiety, while there are some children with very weak bonds with their caregivers who show intense separation anxiety. Research also suggests that separation anxiety may be more likely in children who have a more inhibited temperament. Temperament is an inborn way of responding to the world that is relatively stable over time and children with a more inhibited temperament may appear fearful or shy and less likely to approach unfamiliar adults or peers. Yet, even knowing that separation anxiety is normal and may even signal that your child has a healthy bond with you, most parents would like to find a way to make separations less painful for their children and for themselves.

Research-Backed Tips for Preventing and Addressing Separation Anxiety

Help your child to label and accept their fears about separation. For example, “You feel sad when daddy has to leave for work. It’s okay to feel sad about that” or “You are feeling nervous that mommy might leave you. I understand why you might feel that way.” Research suggests that this type of emotion coaching helps to reduce children’s anxiety. Parents are often worried about labeling and validating separation fears because they may feel like this practice would encourage or reinforce the distress around separation. However, by putting a name to the emotion and validating it, you are helping to improve your child’s emotional regulation abilities and thus ultimately helping them to manage their anxiety around separation.
Regularly practice separations and build up to harder and longer separations. Many parents of children with separation anxiety start to avoid any type of separations because they know their child will become distressed. However, avoiding separations will likely only make your child’s anxiety worse. Instead, regularly practice separations, starting with separations that are easiest for your child (such as shorter separations or separations where they are left with familiar people or in a familiar place) and very gradually build up to more difficult situations. This gradual approach is likely to be less distressing than the “rip the bandaid” type of approach, in which the first separation is long or difficult so that the child can “get over it.” Research finds that interventions that advise parents to use this type of gradual exposure to the feared situation may be effective in reducing children’s anxiety.
Praise children when they successfully face a difficult separation. Interventions for separation anxiety also advise parents to praise children when they successfully face a difficult separation. For example, “I know you were nervous about walking away from mommy’s side at the playground but you walked away to play with your friends anyway. That was really a brave thing to do and it looks like you had so much fun”.
Say a quick goodbye. Research finds that when parents linger when saying goodbye, their children tend to show more distress and anxiety. Children of parents who linger may also be more hesitant to engage in play once the parent leaves. If you linger during the goodbye or leave and then return to calm your child, it can be very confusing to your child. You may also inadvertently be teaching your child that crying makes you stay longer or come back and they will start crying more as a result. Research also suggests that it is particularly confusing when you continue to talk with caregiver after you have said goodbye and that this will likely lead to more distress and crying. Although it might seem cruel in the moment, the kindest thing you can for your child is to leave immediately after you say goodbye, even if they cry or protest your departure.
Have a goodbye ritual. A goodbye ritual is something that you do every time you separate from your child. This can involve a special handshake or hug, a song that you sing together, hugging and kissing in a particular order, or something that you always say to them. Rituals and routines like this can be soothing and may also help your child to know what is coming. Research finds that goodbye rituals can help to reduce distress and anxiety in children .
Do not sneak out. Many parents think that separation will be easier if they sneak out while the child is distracted. However, research finds that this practice is actually associated with more distress and anxiety in infants when they realize that their parents have left. Also, make sure that you ask caregivers to not immediately distract your child but to provide empathy and comfort instead. Research finds that distracting children may temporarily reduce crying but lead to more crying in the long-run. Research also suggests that parents should initiate the goodbye rather than the caregiver, which is not possible when you sneak out.
Stay calm, neutral, and confident during the separation. Even if you are also nervous or sad about the separation, make sure to maintain a neutral facial expression and project confidence. Research suggests that children will mirror your emotions and behavior during times of separation. Often when a child experiences separation anxiety, parents become nervous about their reaction and then the parent’s anxiety may feed into the child’s anxiety. Try to avoid this vicious cycle by using “self-talk” to control your own anxiety. For example, you may remind yourself that your child is safe and that learning how to separate from parents is an important skill for children to learn.
Know that it will get better with time. It is heart-breaking to see your child crying when you separate from them and it is so tempting to just change your plans and stay with your child. However, it is important to remember that the crying and protests will improve over time for nearly every child. Research finds that infants seem to show the most crying and fussing on the first day of separation and that crying and fussing decreases on subsequent days.

What about Separation Anxiety at Night?

If your child sleeps separately from you, nighttime may be a very difficult separation for them. Although it is often hard for us as parents to understand this, it is important to see from their perspective that nighttime is potentially the longest separation of the day and that bedtime occurs at a time that they may have little emotional regulation reserves left to manage their anxiety. Research finds that separation anxiety often co-occurs with sleep issues and bedtime resistance. So what should you do if you think your child’s sleep issues may be related to separation anxiety?

A recent study examined which sleep training methods are most effective for infants and toddlers with separation anxiety and sleep problems. Researchers randomly assigned parents to use a sleep training approach referred to as “Checking In” or an approach referred to as “Camping Out” (see here for research on these two methods). The “Checking In” approach includes the following steps: 1) Put the infant in the crib awake, 2) Parents leave the room promptly with minimal interaction with the child, 3) If the child cries or protests, parents should check on the child every few minutes to provide verbal, replace a sleep aid (such as a pacifier), or help the child to get into a comfortable sleeping positon. The parents were told to continue until the child fell asleep and use the same procedure for nighttime awakenings. Parents gradually increase the time between checking in every few days. The “Camping Out” method is similar to the “Checking In” method, except parents remain present throughout the night. The idea behind this approach is that parental presence may be less distressing for some infants. In this approach, parents spend the night sleeping next to the crib in a separate bed or mattress. Parents provide brief verbal reassurance, replacing the child’s sleep aids (such as a pacifier), and helping the child get into a comfortable position every few minutes if the child cries or protests. The parent then returns to their own bed. After seven days of “camping out” the parents gradually remove their presence from the room, first during the nighttime awakenings and then at bedtime.

Researchers found that infants with low levels of separation anxiety seemed to benefit from both interventions, showing longer sleep periods following both the “Camping Out” and “Checking In” methods. However, for infants with higher levels of separation anxiety, only the “Camping Out” method seemed to improve their sleep. In other words, for children with higher levels of separation anxiety, the “Camping Out” method seemed to be more effective. However, it is important to note that choosing a sleep training method really depends on what feels right to you as a parent based on the individual needs of your child and family so, regardless of the research, choose whichever method is best for you!

What about sleep issues related to separation in older children? Research has found that one effective approach for preschool children may be “Huggy Puppy” intervention. In this intervention, parents ask their child to take care of a puppy stuffed animal. Children are told that he is sad and scared since he is away from home and needs some comforting. Children are asked to hug him and care for him throughout the night. The researchers believe that the puppy helps to increase children’s self-esteem as it makes them see themselves as a caregiver and helps to take their attention away from their own anxiety. This intervention was found to reduce nighttime fear AND its associated sleep problems Further research indicates that this approach also works when the puppy is presented as the one who will protect the child throughout the night. So try both approaches and see which works best with your child!

When to Seek Help from a Mental Health Professional?

Although separation anxiety is a completely normal experience for young children, the anxiety around separation is so intense and persistent for some children that it significantly disrupts their life (for example, they refuse going to school or can’t be in a room by themselves). If this is the case, then you may want to have your child evaluated for separation anxiety disorder. Separation anxiety disorder is characterized by intense distress when anticipating or experiencing separation from an attachment figure, intense worry about harm to the attachment figure or something happening that will cause separation, and refusal to be away from the attachment figure or be alone. These symptoms must last for more than 4 weeks in children. However, it is important to note that separation anxiety disorder is rarely diagnosed in infants and toddlers since distress upon separation is developmentally normal at these ages. Separation anxiety disorder is relatively common in children and is diagnosed is about 4% of children.

Parents should also seek help for their own separation anxiety if necessary. Although It is difficult for many parents to separate from their children, there are some parents who experience unusually intense distress and worry around separations. These parents should also be evaluated for separation anxiety disorder. The symptoms in adults may be similar to those in children and may include avoiding separations from their child unless necessary, intense worry about something happening to their child, and even experiencing physical symptoms (such as stomachaches) when separated from their child. It is important to treat your own symptoms of separation anxiety not only to improve your own experience of distress and the negative impact it might have on your life but also to help your child. Mothers with greater separation anxiety tend to have children with greater separation anxiety.

Research finds that therapy and medication are very effective in treating separation anxiety disorder. In particular, cognitive behavioral therapy (CBT) and exposure therapy are effective forms of therapy for separation anxiety disorder. For children with separation anxiety disorder, parent training in addition to CBT may be the most effective approach.

Peer Review

This week’s newsletter was reviewed by Dr. Jenna Elgin, Ph.D. Dr. Elgin is a licensed psychologist, mom of 3, and co-founder of Helping Families Thrive (HFT). The mission at HFT is to bring parenting science to the everyday parent. Dr. Elgin shares evidence-based parenting information and strategies on instagram and the HFT blog. She has also co-created several other resources for parents to decrease challenging behaviors and improve child and family well-being. These resources include two free guides–one on cooperation and another on children’s emotion regulation–as well as a comprehensive parenting e-course.

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