Q. I know that separation anxiety is normal, but my two-year-old son’s behavior seems extreme. He wants to be in the same room with me at all times, and he throws a fit if he can’t see me. After spending some time as a stay-at-home mom, I plan to go back to work soon and I need to be able to leave him in day care. Can I ease him out of this phase, or does his behavior signal a bigger problem?

A. Infants can show signs of separation anxiety as early as six or seven months old, with most children “peaking” in their separation anxiety at ten to 18 months. Usually, the phase ends by age two, but sometimes lasts a little longer.

You can help your son to develop object permanence (that is, knowing that you still exist even when he doesn’t see you) with games such as peek-a-boo, hide and seek or going behind a door and then peeking back around. He will begin to understand that “now I see you, now I don’t; oh, you are still there.”

Gradual changes may ease your son out of this phase. Try leaving him with a person he knows for ten or 15 minutes and gradually work up to an hour or so. Or hire a neighborhood teen to play with him while you stay within eyesight, gradually moving the play area farther away from you and then eventually out of sight. In helping your son to adjust to day care, first take him to visit the facility while you stay with him and get him acquainted with the teacher, caregivers and other children. One of my favorite pediatricians and authors, T. Berry Brazelton, advocates using a “lovey”—a familiar stuffed animal, small toy or blanket—to help reduce separation anxiety. When you do leave him, give your son a casual, matter-of-fact goodbye that signals, “this is just part of our day, and we’ll both be fine.”

Sometimes, children do need professional help in overcoming separation anxiety. The Diagnostic and Statistical Manual of Mental Disorders—both the recent DSM V and its predecessor, DSM IV—describes a diagnosis of Separation Anxiety Disorder (SAD). For a child to be diagnosed with SAD, the symptoms have to persist over four weeks, be seen before 18 years of age and be a “persistent and excessive anxiety beyond that expected for the child’s developmental level,” and meet a number of specific criteria. In addition, according to the DSM V, the symptoms must cause “clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning and are not better explained by another mental disorder.”

Twenty-four months of age is too early to tell if your child will go on to have bigger problems such as SAD. Perhaps it will reassure you to know that only 4.1 percent of children develop SAD and of this number, only about one-third carry the disorder into adulthood if untreated. Also be aware that our culture values independence, but in some cultures, children are with at least one parent 24/7, and there is no concern about separating.

I feel certain you will do your best to help your child learn to accept being separated from you at appropriate times. I’ve given you the criteria for SAD so as your son gets older, if you notice he meets some of these criteria, you can have your child evaluated and, if necessary, treated by a child psychiatrist.

Betty Richardson, Ph.D., R.N.C., L.P.C., L.M.F.T., is an Austin-based psychotherapist who specializes in dealing with the problems of children, adolescents and parents.

Got a question for Betty Richardson? Email us here and you just might see the answer in an upcoming issue!

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