Scott Webb (Host): Separation anxiety in our kids is common and understandable. And pediatrician at Stanford Medicine Children's Health Town and Country, Dr. Gianna Frazee, is here today to help us understand separation anxiety and how we as parents can best help our kids.

Host: This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Doctor, thanks so much for your time today. I do have a couple of kids myself, and I think I have a sense of what separation anxiety is, but it's great to have your expertise. So, let's just start here and just a little foundation, what is separation anxiety?

Dr. Gianna Frazee: Well, separation anxiety is when a baby or child becomes anxious or scared when a parent leaves the child. It can be as simple as leaving a room or leaving them with a babysitter, or even just handing them off to a grandparent, which used to be fine. It is actually a very normal part of childhood development. Once your baby starts to learn object permanence, which is the recognition that a person or object exists, even when it's not there or out of sight, separation anxiety can develop and will often resolve once object permanence is fully developed.

Host: I see what you mean, and that sort of checks out in my own experiences. So, is there an age range or can we set a starting point for something like this on average? In other words, when does separation anxiety usually develop?

Dr. Gianna Frazee: Well, it really varies. It can start as early as seven months, but commonly develops around nine to 10 months of age about the time babies start crawling. Once they realize they can leave you, they start to feel more upset when you leave. It usually will peak around 10 to 18 months of age, but can go on until around age three to four. It might often reoccur too when kids are heading off to daycare or preschool for the first time. I often find kids with a slow to warm temperament to have more separation anxiety also. And parents may actually develop separation anxiety as their kids head off to college, but that's another topic for another time perhaps.

Host: Yes. I have a 20-year-old who's in college. And both mom and dad, we have a little bit of a separation anxiety ourselves. He was home last weekend, so that was good for both of us. What are the signs, at least in kids, what are the signs of separation anxiety?

Dr. Gianna Frazee: Classic signs are the baby or child will cry as soon as you leave the room or become more clingy and crying in new situations. Babies might also start crying or waking up more in the middle of the night or even refusing to sleep without a parent nearby. You can usually tell this is the cause of sleep disturbances. You walk into their room and they immediately or shortly thereafter stop crying. And then, as soon as you leave, they start crying again. It can definitely be a frustrating time for parents.

Host: Yeah, it can. I had one good sleeper and one, you know, who just preferred to have us in the room and nearby at all times. And it definitely was challenging and he was our first, so of course everything was just more heightened and we were more worried about, you know, everything that went on. What's the best way to handle separation anxiety? Because I know it's just not always practical to be around, to be together. So, what do we do?

Dr. Gianna Frazee: Well, the best way to handle separation anxiety is, first of all, to really know that it's perfectly normal. It's important to make children feel secure when you're around. Comfort them when they're sad or scared and give them lots of cuddles. I think it's also important for kids' emotional health for them to understand feelings. And so, I often encourage parents as babies get older to start teaching them the words for their emotions or reading books about feelings, having young children even identify where in the body they feel the feelings can help them learn more emotional awareness.

I find it really helpful when babies are going through this phase for the parents to practice leaving. You can start small by leaving the room for just a few minutes and tell them you'll be back. Let them crawl out of your sight briefly so they can learn confidence. It is also really important when you do need to leave to make the goodbyes brief. Parents often make the mistake of feeling bad and prolonging the farewell, which tends to just reinforce the child's fears. Parents may want to try to remove their child's distress, but it's more important to remain calm, confident and reassuring, saying goodbye, and then really leaving. Most babies or kids will be fine within a few minutes. And as always, you just want to make sure your baby has a solid routine for meals and sleep. A hungry or tired baby is definitely more likely to feel anxious or scared.

Host: Yeah, I could definitely identify with that one. I would drop my son off at school. You know, my instincts were to prolong the hugs and kisses and goodbyes, and I just felt like it made it worse. And it seemed to go better and smoother when I just kind of did my thing, said goodbye and moved on out, right?

Dr. Gianna Frazee: Definitely. And the other thing is, you know, letting the daycare provider or babysitter know that your child might be going through this and them offering some distractions such as starting to read a book or play with them so that they can move on as well.

Host: Yeah, those distractions definitely help. And it was nice that they were professionals too, and they had been through this maybe many hundreds and thousands of times. Wondering, you know, we all have had our own experiences with COVID-19, good, bad, or otherwise, and, you know, both of my kids were at home instead of being at school. And so, we weren't so much, the four of us anyway, weren't suffering separation anxiety. It was more the opposite of that maybe, that we were just around each other so much and sort of getting on each other's nerves. But I do know that my kids were suffering a lot from separation anxiety from their friends and from their routine and all of that. So, did you find an uptick in this and just separation anxiety in general?

Dr. Gianna Frazee: Definitely. I mean, I think the pandemic caused a lot more anxiety in general in both kids and parents. And then, parents were working from home and many kids were also staying home for school. So, the natural and normal everyday separation was not happening. And then, sometimes parents even had to quarantine away from their child, which can be very scary, especially if the child really doesn't understand why. So, I do feel like we saw more kids with separation anxiety disorders or SAD is the acronym for that.

Host: Yeah, let's talk about that. I was going to ask you, the last question I had for you today was just about the actual disorder. So, we've sort of been touching on the temporary or the typical things that happen, you know, for many parents and children. But when it becomes sad, if you will, the actual disorder, separation anxiety disorder, tell us more about that.

Dr. Gianna Frazee: Sure. This is actually more common in older kids, often ages seven to nine. It's more likely to occur when there is a family history of anxiety or following a traumatic event such as COVID. In order to really make the diagnosis, the symptoms should have gone on for at least four weeks. Common symptoms are the child is very clingy and they have excessive worry about being away from their parent. They may even have lots of nightmares. The child may have excessive fears about getting lost or that something bad might happen to a parent or family member when they're not there. They may refuse to go to school or not want to go to bed without a parent being close by. And it can also present with physical symptoms like frequent stomach aches or headaches.

If you suspect this is going on with your child, please talk to your pediatrician. Often family or cognitive behavioral therapy can be helpful. I do also think that, as parents, we need to take care of ourselves and acknowledge our feelings. And if you as a parent feel like you're having more anxiety, please speak to a therapist. Kids are like sponges and often do feel what their parents feel.

Host: Yeah, they absolutely are. And this has been really helpful today. And I always love doing these for Stanford Medicine Children's Health because I get the pediatricians on, the experts on, and it allows me to sort of reminisce a little bit, you know, back to my time when my kids were younger. And I don't know that I had separation anxiety per se, but it was difficult for me. You know, when I had to drop my kids off at school, you know, I would often sort of have a tear in my eye. I would go to the car because I knew I had to go to work and I was going to miss them. And all of that probably is normal and natural, right?

Dr. Gianna Frazee: Definitely.

Host: Yeah. Maybe as we finish up here, doctor, just, you know, reassure parents that most of this stuff, things like separation anxiety will get better, will pass. There is help available, as you say, through our own providers and mental health professionals. But in case they're worried that this is going to go on forever, maybe you can reassure them.

Dr. Gianna Frazee: It definitely usually gets better with time and just being calm and reassuring when you're with them. And like I said, just try and make the goodbyes as brief as possible and have confidence that it will all be okay.

Host: Doctor, this has been so helpful today. I really appreciate getting to speak with you, getting to know you a little bit. And I'm sure that parents out there really appreciate it as well. So, thanks so much and you stay well.

Dr. Gianna Frazee: Thank you. My pleasure.

Host: And for more information, go to stanfordchildrens.org.

And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.