Short answer: separation anxiety is normal in toddlers. When a school-age child has intense, lasting fear of being apart from a parent, with nightmares, physical complaints or refusal to go to school or sleep alone, it may be separation anxiety disorder, which responds well to CBT and parent coaching.
Signs of separation anxiety disorder
- Extreme distress at drop-off that does not settle after a few minutes
- Persistent worry that something bad will happen to a parent
- Refusing to sleep alone, or frequent nightmares about separation
- Stomach aches or headaches when separation is expected
- Avoiding sleepovers, camps or activities without a parent
What can trigger it
A move, new school, divorce, illness or death in the family, or a frightening event can spark separation fears. Some children are simply more anxious by temperament, and anxiety often runs in families.
How treatment helps
- CBT with gradual practice: short, planned separations that grow longer as confidence builds.
- Parent coaching: brief, warm goodbyes; avoiding sneaking away; praising brave behavior.
- Coordination with school: a consistent greeter or morning job can ease transitions.
- Medication: occasionally considered for severe or persistent cases alongside therapy.
What parents can do today
- Keep goodbyes short and predictable
- Talk about when you will return in terms the child understands (“after lunch”)
- Avoid letting the child stay home to avoid separation
- Model calm confidence, even if you feel anxious too
Bedtime and sleep
Separation anxiety often peaks at night. A gradual plan works best: a consistent bedtime routine, a parent sitting near the door, then moving farther away over successive nights. Brief check-ins at predictable intervals can reassure the child without reinforcing fears. Avoid letting the child move into your bed permanently, which usually makes independent sleep harder.
When a parent is anxious too
Anxiety often runs in families, and parents who are anxious may unintentionally signal danger during separations. That is not a failing; it is common. Parent coaching helps adults manage their own worry and respond in ways that build the child’s confidence.
Separation anxiety in older children and teens
Although most common in young children, separation anxiety can appear in older children and teens, especially after a frightening event, illness or family change. Teens may avoid trips, overnight activities or college visits. The same treatment principles apply, adapted to their age.
Frequently asked questions
Will my child grow out of it?
Many children improve, but untreated anxiety can shift into other anxiety problems. Early help makes a difference.
What age does Psych Boston see?
Our child and adolescent psychiatry team sees children, teens and families.
Read about school refusal and anxiety or request an appointment with Psych Boston in Lexington or by telehealth.
Related reading: Tics and Tourette Syndrome in Children: What Parents Should Know · Perfectionism, Anxiety and Burnout in High Achievers
This article is general information, not medical advice. If you are in crisis, call or text 988 or call 911. Psych Boston is an outpatient psychiatry practice at 35 Bedford St #17, Lexington, MA781-218-9550).