Separation Anxiety
Separation anxiety is distress that the child feels when all of a sudden he or she realizes, “These are my parents and these are strangers, and I don't want to be next to strangers. I want to be next to my parents.” It's a very normal part of development which starts at about 8 months to about a year and a half. It's about the time that a child begins to walk. When a child begins to walk, they typically explore, and then all of a sudden they realize that there's a stranger there, and so they will run back to their parents. So it's really adaptive behavior.

Don’t Sneak Out
Routines are really important for children, because routines make them feel safe. They know what to expect, and so it's wonderful for them. If a parent sneaks out, they are playing into a child's worst fear -- mom or dad disappearing. Now, if you go through a routine and it's a gentle, loving, quick good-bye, and then you just leave and you say, “I'm going to be back at this time, and I'll see you then” and the parent comes back and really meets his or her promise, then the child begins to learn there's an expectation here that gets met. When the parent sneaks out and disappears, however, there's no expectation to be met except a horrible one -- mom and dad just suddenly disappearing.

Don’t Be Anxious Yourself
It's also important to realize that children, especially very young children, get their cues from how the parents are feeling. They really are very good at sensing your feelings. If you are anxious, they know you're anxious. Then they know there's something not right here. So check your own anxiety level before leaving your child in someone else’s care.

Divorce
Divorce is a huge issue for children to deal with because in divorce, the worst fear of the child, which is mom or dad are going to leave, happens. So my advice to parents is, if at all possible, hang in there until the child is at least 18 months old. Do not separate between 8 and 18 months. Because that's really a very tough age to experience that. Also, plan not to have a child also during that time or during when the time when a child starts schools. Because all of those are points when a child will feel more distress, because they're already adapting to another situation. It makes it more complicated.

Validate Your Child’s Feelings
It’s important to prepare the child for what's going to happen, and what the child can expect when they are left in someone else’s care. But it’s also important to take your child’s feelings seriously and validate those feelings, and help your child to process them. When you take the time to make a book and say, "I know you're sad” or when the mother says, "I know you're sad and sometimes you cry," you are taking the child's feelings seriously and validating them, but also helping the child process it: “It's fine to feel sad. It's fine to cry. I understand it. I know it's not a good feeling, but it's human.”

Will a Child Outgrow It?
Children generally do outgrow it. Once the setting becomes familiar, and once they're out of that critical stage, then they're more comfortable being with strangers, but it also depends on the temperament of the child. Children who are more shy will always have more difficulty with a new stranger. But in school, in a preschool setting, they have their buddies that they are familiar with. So even if it's a new teacher or a new classroom, the classmates then become the support system.

Provide a Physical Reminder the Parent Will Return
Something that I tell my patients when they have a younger child – about a year old – I tell the parent to start wearing a watch that is not expensive at all, and then when you leave, give the child the watch, or a scarf or something. Then say, “Hold it for me until I come back.” Because then the child thinks, “OK, I'm connected to her. There's something that she's going to come back for.” Not that the mother wouldn't come back for the child, but in a child's mind, the watch becomes more important than they are.

When I drop my son off at day care, my son usually experiences some separation anxiety. Sometimes he is fine when I leave. I give him a kiss and tell him that I will see him later. Then, I leave. I try to keep it short and not drag it out. Sometimes, he cries, and he will put his arms out. He will say “Mommy! Mommy!” The teachers help me distract him. They will take him away to look out the window or play with a toy or to the playground. When we get home after I pick him up from day care, he just wants to be held and close to me. He will tell me to “Sit. Sit.” He likes me to sit with him when he is eating. He is more “Mommy. Mommy.” He wants me to be closer to him, like have him in my lap. Even if I am in the room, he wants me to sit with him. This happens until he goes to bed.

I encourage parents to give a kiss goodbye and hand the child to me. I also encourage the child to do the same, give her Mommy a kiss. This helps to establish a routine. I reassure the child that mommy will be back. I hold her and talk with her. I reassure her again that mommy will be back. I tell her that mommy is going to work. I take her to the bathroom to dry her tears. I will sometimes call mom later in the day to reassure her that they kids are okay. You don’t want the parent leaving and feeling that my child is upset all day long. You don’t want them to have that on their mind.

I help the kids in my care cope with separation anxiety by letting them know that their Mommy or Daddy is going to work, but they will return for them. I reassure them. Also, I take pictures of the parents. I let the kids look at them. “That is Mommy.” I remind them that Mommy is going to pick them up later. I always let them bring something from home. If they bring something from home (such as a blanket, favorite cup, or stuffed animal) it reassures them that they will be going home. Their biggest concern is not ever getting picked up. They worry that they will stay here forever.