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Medical Author:

Bettina E Bernstein, DO

Medical Editor:

David Perlstein, MD, MBA, FAAP

David Perlstein, MD, MBA, FAAP

Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

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Separation anxiety is a developmentally normal characteristic in infants and toddlers younger than 4 years of age upon separation from their primary attachment figure. Mild distress and clinging behavior are anticipated for short periods of time when young children are separated from their primary caregivers (attachment figures) in situations such as day care or initial exposure to school. Short-term developmental fears such as fear of the dark are expected in young children and are generally not severe enough to interfere with daily functioning or result in long-term difficulty.

Research studies indicate that some children who are overly fearful early in life may eventually develop anxiety disorders that result in substantial impairment. Significant symptoms of anxiety may emerge when a child enters school for the first time and is expected to adjust to daily separation from a parent or caregiver. In some cases, initial separation anxiety resolves over the first few weeks of school, while less commonly, the anxiety does not resolve spontaneously and worsens over time. Children who persist with significant anxiety disorders may have difficulty adjusting to the classroom leading to compromised academic performance.

Researchers have hypothesized that children who develop separation anxiety disorders may have altered sensitivity to endocrine influences such as maternal cortisol, and the way in which they process emotionally intense experiences of separation. It is well known that certain parts of the brain (such as the amygdala) are involved in modulating the processing of emotional experiences.

Bullying and experiences of recurrent social rejection may contribute to the development of separation anxiety in vulnerable children and adolescents.

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