|
Separation anxiety:
Separation anxiety is crying when a parent leaves the room. It is normal starting at about 8 mo, peaks in intensity between 10 and 18 mo, and generally resolves by 24 mo. It should be distinguished from separation anxiety disorder (see Mental Disorders in Children and Adolescents: Separation Anxiety Disorder), which occurs later, at an age when such reaction is developmentally inappropriate; school (or preschool) refusal is a common manifestation.
Separation anxiety occurs at a time when infants start to become emotionally attached to their parents. Because they have no object permanence (incomplete memory and no sense of time), children fear that the departure of their parents is permanent. Separation anxiety resolves as the child develops a sense of memory and keeps an image of the parents in mind when they are gone and recalls that in the past the parents returned.
Parents should be advised not to limit or forego separations in response to separation anxiety; this could compromise the child's maturation and development. When parents leave the home (or leave the child at a childcare center), they should encourage the person with whom they are leaving the child to create distractions. The parent should then leave without responding at length to a child's crying. Parents should remain calm and reassuring and establish routines around separations to ease the child's anxiety. 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 gradually teaches the child that parents are still present even though the child cannot see them. Separation anxiety may be worse when a child is hungry or tired, so feeding the child and letting him nap before leaving may also help.
Separation anxiety at the normal age causes no long-term harm to the child. Separation anxiety that lasts beyond age 2 may or may not be a problem depending on the extent to which it interferes with the child's development. It is normal for children to feel some fear upon leaving for preschool or kindergarten. This feeling should diminish with time. Rarely, excessive fear of separations inhibits a child from attending childcare or preschool or keeps him from playing normally with peers. This anxiety is probably abnormal (separation anxiety disorder—see Mental Disorders in Children and Adolescents: Separation Anxiety Disorder). In this case, the parents should seek medical attention for the child.
Stranger
anxiety:
Stranger anxiety is manifested by crying when an unfamiliar person approaches. It is normal starting at about 8 to 9 mo and usually abates by age 2 yr. Stranger anxiety is linked with the infant's developmental task of distinguishing the familiar from the unfamiliar. Both the duration and intensity of the anxiety vary greatly among children.
Some infants and young children show a strong preference for one parent over another at a given age, and grandparents may suddenly be viewed as strangers. Anticipating these occurrences during well child visits helps prevent misinterpretation of the infant's behavior. Comforting the child and avoiding overreaction to the behavior are usually the only therapy needed.
Common sense should dictate management. If a new sitter is coming, having that person spend some time with the family before the actual day makes sense. When the event arrives, having parents spend some time with the child and sitter before leaving is prudent. If grandparents are coming to watch the child for a few days while parents go away, they should arrive a day or two early. Similar techniques can be used in anticipation of hospitalization.
Stranger anxiety of pronounced intensity or extended duration may be a sign of more generalized anxiety and should prompt evaluation of the family situation, parenting techniques, and the child's overall emotional state.
Last full review/revision November 2005
Content last modified November 2005
| 
