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Separtion Anxiety


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Describes meaning of separation anxiety, its expressions, the need for parent child bonding, development and factors that contribute to separation anxiety, how to support a child with separation anxiety, warning signs and role of parents and teachers to prevent it.

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Separtion Anxiety

  1. 1. Nirmala Roberts Paediatric Nursing
  2. 2. Parent- Child Bonding <ul><li>The bond between mother and child - One of the strongest in nature </li></ul><ul><li>The first attachment (of umbilical cord) provides everything we need to thrive inside the womb </li></ul><ul><li>With the cutting of the umbilical cord – </li></ul><ul><ul><li>Physical attachment to mother ends and, </li></ul></ul><ul><ul><li>Emotional and psychological attachment begins </li></ul></ul><ul><li>Countless studies show - maternal influence has an indelible, far-reaching impact on a child's development </li></ul><ul><li>Even as adults, we are generally happier and more secure in life when we continue to maintain a strong bond with our mothers. </li></ul><ul><li>This second attachment provides the psychological foundation and even the social and physical buffer we need to thrive in the world. </li></ul>
  3. 3. Parent- Child Bonding <ul><li>Early bonding between infant and mother/ caregiver is critical for healthy brain development. </li></ul><ul><li>Breaks in early attachment (adoption, illness of mother or baby, return to work, frequent change of nannies) can have lifelong effects on relationships and mental health. </li></ul><ul><li>Thus, while an infant can be soothed by almost any caring adult, more subtle difficulties in attachment can actually be seen on brain scans. </li></ul>
  4. 4. What is separation anxiety? <ul><li>Separation anxiety is a normal developmental stage experienced by a child when separated from the primary caregiver. </li></ul><ul><li>It typically manifests itself as crying and distress when a child is away from a parent or from home. </li></ul>
  5. 5. As time goes by….. <ul><li>Child develops ‘Object permanence’ </li></ul><ul><li>Anxiety of separation fades </li></ul><ul><li>Child learns that parent/ caregiver will return after an absence. </li></ul>
  6. 6. Expressions of separation anxiety <ul><li>Shyness </li></ul><ul><li>Crying or whining </li></ul><ul><li>Silence (instead of constant talking or babble) </li></ul><ul><li>Clinginess (holding hand or leg, wanting to be held, hiding behind parent) </li></ul><ul><li>Unwillingness to interact with others, even if they are familiar (other parent, grandparent, friend) </li></ul><ul><li>Situations that trigger separation anxiety - </li></ul><ul><li>Moving to a new home </li></ul><ul><li>Change in caregiver </li></ul><ul><li>Birth of a new sibling </li></ul><ul><li>Change of place (hospitalization) </li></ul>
  7. 7. Sequence of child development and parent/child attachment <ul><li>First few months: </li></ul><ul><ul><li>No differentiation among caregivers </li></ul></ul><ul><ul><li>Fearful response to loud noise or sudden loss of physical support </li></ul></ul><ul><ul><li>Can be calmed by any loving person, regardless of relationship </li></ul></ul><ul><ul><li>This is why new parents often get more emotional the first time they leave an infant with a babysitter or at day care than the baby does! </li></ul></ul><ul><li>7-14 months: </li></ul><ul><ul><li>They begin to differentiate between their own and others </li></ul></ul><ul><ul><li>But no sense of time/ place (lacks object permanence) </li></ul></ul><ul><ul><li>This leads to ‘Separation anxiety’ ( r eluctance to be separated from one's caregiver) </li></ul></ul><ul><ul><li>A normal, healthy response and indicates the development of healthy attachment </li></ul></ul><ul><li>Toddler/preschool years: </li></ul><ul><ul><li>Is anxious/ emotional when a parent or primary caregiver leaves </li></ul></ul><ul><ul><li>But, can be distracted by activities with the caregiver or other children. </li></ul></ul><ul><li>Age 5 – </li></ul><ul><ul><li>Most children are secure enough to be left with a babysitter or dropped off at school without distress. </li></ul></ul>
  8. 8. Factors that may contribute to separation anxiety <ul><li>Tiredness </li></ul><ul><li>Minor or major illness </li></ul><ul><li>Changes in the household routine </li></ul><ul><li>Family changes such as birth of a sibling, divorce, death or illness. </li></ul><ul><li>Change in caregiver or routine at day care center. </li></ul><ul><li>Parents usually are not the cause of the separation anxiety, but they can make things worse or better. </li></ul>
  9. 9. Factors that may reduce the chances of developing separation anxiety <ul><li>By 6 months of age - Start using a babysitter occasionally – </li></ul><ul><ul><li>Helps child tolerate short periods away from the parent </li></ul></ul><ul><ul><li>Encourages child to build trust in other adults. </li></ul></ul><ul><li>Start contact with peers by 12 months – by 3 yrs of age, child should be experiencing play groups. </li></ul><ul><li>By age 3 or 4 –Give preschool experience </li></ul>
  10. 10. Supporting a child through periods of separation anxiety <ul><li>Positive experiences with caregivers, short times at first. </li></ul><ul><li>Help child become familiar with new surroundings and people before actually leaving the child there. </li></ul><ul><li>Rituals (bedtime and morning) </li></ul><ul><li>&quot;Lovie&quot; or &quot;Cuddly&quot; represents closeness to parents. If possible, allow the child to take the &quot;Lovie&quot; along. </li></ul><ul><li>Do not give in. Let the child know that he or she will be all right. </li></ul><ul><li>Remind the child of previous brave things he or she has done. Talk about how a fictional character might handle it. </li></ul><ul><li>Let child know, in words he or she can understand that you appreciate how distressing it must be to be separated from loved ones. Understanding and acceptance, but not excessive sympathy. </li></ul><ul><li>Never make fun of a child's separation distress. Do not scold child. </li></ul><ul><li>Do not bribe child to mask the distress. Be unconditional in approach. </li></ul><ul><li>Focus on positive things that happened in daycare. Don't let them dwell on fears or imagination of what might happen. </li></ul><ul><li>Minimize fears by limiting scary TV shows </li></ul>
  11. 11. <ul><li>If an older child, introduce to ‘would be’ class mates. </li></ul><ul><li>Prepare by reading books about preschool/ voyages or quests. </li></ul><ul><li>Make shopping for school supplies a special event just for that child. </li></ul><ul><li>Expect the child to be more tired and possibly more irritable than usual when he or she starts Kindergarten or First grade for the first few weeks. </li></ul><ul><li>When leaving, give a quick kiss and hug and cheerfully say goodbye. </li></ul><ul><li>Don't prolong the departure or come back several times. </li></ul><ul><li>If the child does stay home, do not make it an extra fun, gratifying day. </li></ul>
  12. 12. Easing a child’s separation anxiety ( For babies and toddlers) <ul><li>Have babysitters come before the child develops stranger anxiety </li></ul><ul><li>Schedule separations after naps or feedings </li></ul><ul><li>Have a consistent primary caregiver </li></ul><ul><li>Practice separation for brief periods </li></ul><ul><li>Keep the child in familiar surroundings when possible </li></ul><ul><li>Make new surroundings familiar </li></ul><ul><li>Develop a “goodbye” ritual </li></ul><ul><li>Have a calm, positive attitude .   </li></ul><ul><li>Tell your child when you go that you are leaving and that you will return, then go ( Do not sneak away) </li></ul><ul><li>Listen to your child’s feelings </li></ul><ul><li>Read stories, role-play, and remind your child of successes </li></ul><ul><li>Honor all commitments to your child, especially time commitments </li></ul><ul><li>Plan and talk about enjoyable activities in advance. </li></ul>
  13. 13. Role of nurses/ teachers to relieve anxiety of parents… <ul><li>Introduce self to child and invite the child to play with toys or have a snack. </li></ul><ul><li>Offer to have the parent stay a while, leave the child alone briefly with the teacher and then return. </li></ul><ul><li>Suggest to the parent that he or she try role playing with the child to rehearse the separation. </li></ul><ul><li>Have a ritual for the parent leaving the child. </li></ul><ul><li>If the child in absolute panic, ask parent to stay until the child is quieter. Ask parent to comfort child in a firm, loving voice. </li></ul><ul><li>Never criticize child for feeling sad or anxious. </li></ul>
  14. 14. <ul><li>&quot;Some kids just need to know that parents are there and accessible. Most often, they need love and reassurance.&quot; </li></ul>
  15. 15. Warning signals <ul><li>Child is inconsolable for more than 2 weeks. </li></ul><ul><li>Repeated physical complaints in the morning before preschool. </li></ul><ul><li>Separation anxiety continuing into elementary school years and interfering with activities that other children do at that particular age. </li></ul><ul><li>No separation anxiety at any other time. </li></ul><ul><li>School refusal in an older child or adolescent is often a more serious problem. In such a case, the parent should seek professional help early </li></ul>
  16. 16. Thanx