Separation anxiety in children

As infants grow, their emotions and reactions to the world around them seem to occur in a predictable order. Before 8 months, infants are so new to the world that they lack a sense of what is normal and safe and what may be dangerous. As a result, new settings or people seem to not frighten them.

From 8 to 14 months, children often become frightened when they meet new people or visit new places. They recognize their parents as familiar and safe. When separated from their parents, they feel threatened and unsafe.

Separation anxiety is a normal stage as a child grows and develops. It helped keep our ancestors alive and helps children learn how to master the world around them.

It usually ends when the child is around 2 years old. At this age, toddlers begin to understand that parents may be out of sight now, but will return later. It's also normal for them to test their independence.

To get over separation anxiety, children need to:

• Feel safe in their home.
• Trust people other than their parents.
• Trust that their parents will return.

Even after children have mastered this stage, separation anxiety may return in times of stress. Most children will feel some degree of separation anxiety when in unfamiliar situations, most often when separated from their parents.

When children are in situations (such as hospitals) and are under stress (such as illness or pain), they seek the safety, comfort, and protection of their parents. Since anxiety can worsen pain, staying with a child as much as possible can reduce the pain.

A child with severe separation anxiety may have any of the following:

• Excessive distress when separated from their primary caregiver
• Nightmares
• Reluctance to go to school or other places because of fear of separation
• Reluctance to go to sleep without their primary caregiver nearby
• Repeated physical complaints
• Worry about losing, or harm coming to their primary caregiver

There are no tests for this condition, because it is normal.

If severe separation anxiety persists past age 2, a visit with your health care provider may help determine if your child has an anxiety disorder or other condition.

No treatment is needed for normal separation anxiety.

Parents can help their infant or toddler adjust to their absence by letting trusted caregivers babysit the child. This helps the child learn to trust and bond with other adults and understand that their parents will return.

During medical procedures, a parent should go with the child if possible. When a parent can't go with the child, exposing the child to the situation beforehand may be helpful, such as visiting the provider's office before a test.

Some hospitals have child life specialists who can explain procedures and medical conditions to children of all ages. If your child is very anxious and needs extended medical care, ask your provider about such services.

When it's not possible for parents to be with the child, such as for surgery, explain the experience to the child. Reassure the child that a parent is waiting, and where.

For older children who have not outgrown separation anxiety, treatments may include:

• Anti-anxiety medicines
• Changes in parenting techniques
• Counseling for the parents and child

Treatment for severe cases may include:

• Family education
• Family therapy
• Talk therapy

Young children with symptoms that improve after age 2 are normal, even if some anxiety comes back later during stress. When separation anxiety occurs in adolescence, it may signal the development of an anxiety disorder.

Contact your provider if your child has severe separation anxiety after age 2.

American Academy of Pediatrics website. How to ease your child's separation anxiety. www.healthychildren.org/English/ages-stages/toddler/Pages/Soothing-Your-Childs-Separation-Anxiety.aspx. Updated July 29, 2021. Accessed April 25, 2024.

Carter RG, Feigelman S. The second year. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 24.

Kim RK. Anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 38.

Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.