Separation anxiety disorder in children: signs, causes and how it is treated

Almost every young child feels upset about being left at some point. NHS inform describes anxiety in children as an understandable reaction to change or a stressful event, with starting school or nursery or moving to a new area as common triggers. Separation anxiety is the form in which a child worries about not being with their parent or caregiver.

It becomes a disorder, or an anxiety problem needing help, when it stops being passing and starts to take over. The NHS puts the threshold in practical terms: when anxiety affects behaviour and thoughts every day and interferes with school, home and social life, professional help may be needed. The key question is not whether the child is ever upset when apart from you, but whether the worry is constant, out of proportion and limiting what they can do.

NHS inform lists separation anxiety among several types of anxiety seen in children and young people, alongside specific fears or phobias, social anxiety, school-based anxiety, generalised anxiety, post-traumatic stress disorder and obsessive compulsive disorder. A child can have more than one kind.

Children often cannot put their feelings into words, and NHS inform notes that a child may not be old enough to recognise why they are feeling this way. Signs therefore show up in behaviour and in the body as much as in what a child says.

• Being clingy, especially in young children.

• Constant worrying or negative thoughts, including about being apart from you.

• Not sleeping, or waking in the night with bad dreams.

• Tummy aches, headaches and feeling unwell.

• Crying a lot, or getting angry and irritable quickly.

• Finding it hard to concentrate.

• Not wanting to go to school or be away from parents or carers, which YoungMinds says is sometimes called separation anxiety.

• Becoming withdrawn or not wanting to do things they used to enjoy.

There is rarely one cause. NHS inform says some children are more nervous and less able to cope with stress than others, and that having a close family member with anxiety may make a child more likely to have it too. Children can also pick up anxious behaviour from being around anxious people.

Stressful events can trigger or worsen anxiety. NHS sources list moving house or school often, parents who fight or argue, the death of a close relative or friend, becoming ill or injured, a family member who is unwell or needs extra support, school pressures such as exams or bullying, and abuse or neglect. NHS inform adds that several difficult events together, or one traumatic event, may be too much for a child to cope with. The NHS also says children with ADHD and autistic spectrum disorders are more likely to have problems with anxiety.

The NHS advises seeking professional help or reassurance if your child is constantly anxious and it is not getting better, is getting worse, self-help is not working, or it is affecting school, family life or friendships. NHS inform adds reasons to speak to a GP practice or school health professional: anxiety that is slowing development, badly affecting confidence, happening often or all the time, or often making a child feel sick or have constant headaches.

A GP is a good first contact, and can be seen with or without the child present. If the GP thinks there may be an anxiety disorder they may refer the child to local children and young people's mental health services (CAMHS), where psychologists, psychiatrists, nurses and other specially trained staff work. School nurses, educational psychologists and school counselling services can also help, and some young people can use a youth counselling service directly.

The NHS says the type of treatment depends on the child's age and the cause of the anxiety. Counselling can help a child understand what is making them anxious and work through it. Cognitive behavioural therapy, or CBT, is a talking therapy that helps a child manage anxiety by changing how they think, feel and react, and it can be delivered in person or as online self-help. The therapist works with the child to understand what is causing the anxiety and to develop strategies for coping in situations that make them anxious.

Medicines for anxiety may be considered if anxiety is severe or does not get better with talking therapies, and the NHS says they are usually prescribed only by doctors who specialise in children and young people's mental health. NHS inform notes they can take time to work.

The NHS stresses that, above all, it helps to talk to your child about their anxiety or worries. YoungMinds suggests asking calmly what the anxiety feels like in mind and body, letting the child know their feelings are understandable, and resisting the urge to dismiss or fix worries, because feeling listened to helps a child relax. It also describes breathing and grounding techniques and sitting calmly with a child to offer reassurance that the anxiety will pass.

Keeping the school informed is useful, since the NHS suggests talking to the school about the anxiety and any support needed. Avoid pressure to do everything at once: YoungMinds encourages choosing one or two strategies to try rather than five at the same time.

The NHS says many children have anxieties that go away after a while, with reassurance. NHS inform notes that long-term anxiety can interfere with a child's personal development, family life and schooling, and that anxiety disorders starting in childhood sometimes carry on into adulthood, which is a reason to seek help early rather than waiting for it to pass.

NHS routes include the GP, the school nurse and CAMHS, and NHS inform also lists school counselling services and community-based mental health support. Waiting times for specialist assessment vary by area.

Some families choose a private child psychologist or therapist, mainly to be seen sooner or to access a particular type of therapy. If you do, check the professional's qualifications and registration, ask how they will work with the school, and keep the GP informed so that the child's care stays coordinated.