Separation anxiety: what’s normal and when to be concerned

By Dr. Poonam Khanna, D.O./Child and Adolescent Psychiatrist

Just about every parent has experienced separation anxiety. Perhaps your child cries for you when you drop him or her off at daycare, or they cling to you when a new babysitter arrives for the evening. These behaviors are not only quite common, they’re also perfectly normal, depending on your child’s age and developmental level. If your elementary-age child exhibits school refusal, it might be a sign of an underlying, clinically significant separation anxiety disorder.

It is possible to treat school refusal and improve your child’s chances of performing well in school. However, it’s important to treat early and effectively.

School refusal: the facts

• School refusal occurs in 75 percent of children who have separation anxiety disorder.
• Separation anxiety is defined as an anxiety disorder that affects children 18 and younger and lasts for at least four weeks.
• If you experience school refusal or separation anxiety from your child, you should also get him or her screened for selective mutism, which is the inability to speak in certain settings and often considered a type of social phobia. In some cases, school refusal can be a sign of selective mutism.

What’s normal?

In fact, separation anxiety is part of normal child development. Separation anxiety in infants and toddlers is normal until age 4. Mild stress, emotional reactions and clinging to caregivers are all symptoms of normal separation anxiety.

Should I be concerned?

If extreme anxiety surrounds your child’s school refusal, he or she might have clinically significant separation anxiety. Consider whether your child exhibits these symptoms:

• Unrealistic or persistent worrying that something bad will happen to a loved one. This symptom might be especially apparent when the child is faced with the possibility of separation from the primary caregiver.
• Severe emotional or physical distress
• The inability to perform basic functions because of the severity of the anxiety. This includes resisting sleep unless the caregiver is near, temper tantrums and nightmares about separation.
• A strong desire to contact or return to the caregiver when separated
• Physical symptoms such as stomachaches, heart palpitations, dizziness, nausea, cramps, vomiting and muscle aches

What does it mean?

If your child’s anxiety progresses to school refusal, he or she might be at risk for decreased academic and social achievement later in life. Studies show that first-graders whose anxiety significantly affects their academic performance have lower performance in math and reading five years later. Additionally, children with separation anxiety might suffer depression years later or abuse substances.