1. SEPARATION ANXIETY A GUIDE FOR CHILDCARE PROVIDERS Child Care Health Consultation Program Missouri Department of Health and Senior Services In partnership with your Local Public Health Agency

2. Separation Anxiety—What It IS Crying, clinginess, tantrums—normal reactions to separation in young children Can begin before a child’s first birthday, and reoccur or last until a child is about 4 years old Can affect some older children Should fade as the child gets older but can vary from child to child

3. Separation Anxiety—What it is NOT If it continues or recurs beyond the early elementary years Is excessive enough to interfere with school and other family activities/friends Doesn’t go away

4. Normal Separation Anxiety by Age INFANTSTODDLERSPRE-SCHOOL What Separation Anxiety looks like at this age Usually shows up around 9 months of age, but can start as early as 4 or 5 months. Can be worse if child is hungry, tired, etc As their independence develops, so increases their resistance to separation. They are louder, more tearful, and more difficult to stop. At this age, children clearly understand they can affect us by how they act. They will be persistent to get the parent to change (take longer to leave, or come back if they hear crying) What parents can do to ease their anxiety Keep transitions short and as routine as possible Keep good-byes short, be consistent, be loving and affectionate, and KEEP PROMISES on when you’ll be back Don’t cancel plans; be consistent with transitions, and be loving but firm. Be on time for when you’ve promised to be back.

5. Normal Separation Anxiety -- Tips STRATEGYDESCRIPTION Practice separationChildren who are new to child care should start with being left for brief periods and short distances at first. Schedule separations after naps or feedings Babies are more susceptible to separation anxiety when they’re tired or hungry. Develop a “goodbye ritual”Rituals are reassuring and can be as simple as a special wave through the window or a goodbye kiss. Keep familiar surroundings when possible and make new surroundings familiar When the child is away from home, let him or her bring a familiar object. Have a consistent primary caregiver Consistency is extremely important. If your center is large, keeping the child with familiar staff will help. Leave without fanfare & don’t give in Parents need to tell the child they are leaving and that they will return, then go —don’t stall. Reassure them they will be fine, but set limits. Minimize scary TVChildren are less likely to be anxious if they don’t watch frightening shows.

6. Separation Anxiety Disorder NOT a normal stage of development Serious emotional problem where child shows extreme stress when separated from parent Fears are more intense and keep child from normal activities (school, play dates, friends, etc) May become agitated just at the thought of being away from parent

7. Separation Anxiety Disorder SYMPTOMS WORRIES AND FEARS (can be overwhelming) Fear that something terrible will happen to a loved one Worry that an unpredicted event will permanently separate them from their loved one Nightmares about being separated from their loved ones REFUSALS AND SICKNESS Unreasonable fear of school; will do almost anything to stay home Refusal to go to sleep; either fear of being alone or because of the nightmares Often complain of vague illness like headache or stomach ache just before they know separation is coming CLING TO CAREGIVER Follows parent around the house (won’t let them out of their sight) and clings to arms or legs if they try to step out

8. Separation Anxiety Disorder--Causes Child feels unsafe in some way, for some reason Change in environment—new house, new school, new daycare can trigger Stress—like loss of loved one or pet, move to new city or school Over-protective parent—children feel their parents’ stress; if parent is anxious about separation, child may also become anxious

9. Separation Anxiety Disorder –Causes con’t Finally, the anxiety could be the result of trauma in the child’s life. Symptoms for Separation Anxiety Disorder and Trauma may be similar, but the treatment is very different. If you suspect that trauma may be the cause, it is important that the parents get professional help.

10. When Help May Be Needed –Red Flags Age-inappropriate clinginess or tantrums Constant complaints of physical sickness Withdrawal from friends, family, or peers Refusing to go to school for weeks Preoccupation with intense fear or guilt Excessive fear of leaving the house

11. Provider Tips Become informed—the more you know the more you can help Listen to and respect the child’s feelings—just having someone ‘hear’ them can help Let the child talk about their feelings Reinforce when they make positive progress Be ready for the transition points that may trigger the anxiety

12. Helping Children Feel Secure Keep daily patterns consistent—children need predictability; if their routine is going to change, they need to know in advance Set limits—their feelings must be respected, but they need to know the parents set the rules and they must follow them Offer choices—parents can give the child control of something in the daily routine so that they feel more comfortable

13. Encouraging Healthy Separation and Independence Keep calm—during transition times, keep calm and reassuring Be encouraging—support the child in participating in healthy social and physical activities Return to normal activities—if a child has been absent, help them get back into their normal routine as quickly as possible, even if shorter separations are needed at first Offer praise—recognize the child’s accomplishments no matter how small

14. Be Supportive of Parents Child development is influenced by the emotional health of the family New moms may feel they are not being good moms by putting their children in child care Families’ feelings about the mom working can affect the child’s adjustment/anxiety Reassure parents that children who are loved and well cared for will thrive regardless of whether or not the mom works outside the home

15. Resources for Parents If Separation Anxiety Disorder or trauma is suspected, refer to a pediatrician or child development specialist for further diagnosis A good resource for trauma information: http://www.helpguide.org/articles/ptsd- trauma/emotional-and-psychological-trauma.htm Also, as a provider you can take a trauma awareness course. http://ctf4kids.org/2013/04/ctf-conference- presentations/carter-pp-trauma/ http://ctf4kids.org/2013/04/ctf-conference- presentations/carter-pp-trauma/

16. Sources Harvard Health www.healthguide.orgwww.healthguide.org www.healthychildren.org “Preparing Your Child for Child Care” www.healthychildren.org http://ctf4kids.org/2013/04/ctf-conference- presentations/carter-pp-trauma/ http://ctf4kids.org/2013/04/ctf-conference- presentations/carter-pp-trauma/