As infants develop, they experience various emotions, usually in a relatively predictable sequence. Before 8 months, infants are so new to the world that they have little knowledge of what is ordinary and what may be dangerous, so new situations or experiences seem usual, not frightening.

In normal development, this early period involves the establishment of familiarity with the home environment, and a feeling of safety and comfort when parents or other known caretakers are present. After this time, lack of familiarity often produces fear because the infant recognizes that something unusual is going on.

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 parents, particularly when away from home, they feel threatened and unsafe.

Separation anxiety is a normal development stage. It helped keep our ancestors alive and helps children learn how to master their environment. It usually ends around 2 years old, when toddlers begin to understand that parents may be out of sight now, but will return later. At this age, there is also a normal desire to test their autonomy.

Resolution of separation anxiety depends on an adequate sense of safety and trust in people other than parents, trust and safety in their home environment, and trust in their parent's return.

Even after children have successfully mastered this developmental stage, separation anxiety may return during periods of stress. Most children will experience some degree of separation anxiety when in unfamiliar situations, especially when separated from parents.

When children are in situations (such as hospitals) and are experiencing stress (such as illness or pain), they seek the safety, comfort, and protection of their parents. When parents cannot be with their children in these situations, the child experiences distress.

This is why it is important to stay with your child as much as is possible during any medical procedures. Your presence can actually reduce the amount of pain the child experiences, as anxiety of any kind makes pain worse.

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

There are no tests for this condition, as it is normal. If severe separation anxiety persists past age 2, a psychiatric evaluation may be needed to determine if an anxiety disorder or other condition is present. This evaluation consists of having the child talk with a psychiatrist and providing the history of the symptoms and any family history of mental illness.

No treatment is necessary for ordinary separation anxiety.

If medical procedures are needed while a child is in this stage, it is helpful for a parent to accompany the child whenever possible. When a parent cannot accompany the child, prior exposure to the situation is helpful, for example, visiting the doctor's office in advance of a test. When this is not possible, the child may display severe anxiety by crying, resisting treatment, begging, and screaming.

Some hospitals provide Child Life specialists who specialize in explaining procedures and medical conditions to children of all ages. If your child is particularly anxious and needs significant medical care, it may help to ask your health care provider about such services.

When separation from parents is necessary, but prior exposure is not possible (such as for surgical treatment), many physicians will recommend the child take mild sedating or tranquilizing medications to help reduce the trauma.

Explain the situation and experience to the child and assure him or her that a parent is waiting, and specifically, explain WHERE the parent is waiting.

For older children who have not outgrown separation anxiety within the normal developmental timetable or who have regressed to it under stress, effective treatments may include counseling for the parents and child, changes in parenting techniques, and anti-anxiety medications.

Treatment for severe cases may include individual psychotherapy, family education, and family therapy.

Young children with symptoms that improve after age 2 are normal, even if there is some later return of anxiety during stress. When separation anxiety occurs in adolescence, the prognosis is less clear and it may signal the development of an anxiety disorder.