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Children's Health

Separation Anxiety or Something More?



My only child is 3 years, 4 months old now. When she was 8 months old, her doctor said she had low muscle tone tone and we received visits from a physical therapist in an early intervention program. Although these helped her reach her physical milestones- she started crawling at 12 months, and then walking at 20 months, we had to discontinue the program about 6 months after we were into it because she would cry intensely throughout the hour-long session that the therapist was home. Both of us parents were there too but somehow it was very hard to calm her down and at that time we put it down to an extreme case of "stranger anxiety". 

We have been taking her fairly regularly to playgroups, parks, shopping, etc since then but her crying carried on till she was 2 and 1/2 years old. At this point we rejoined the early intervention program (called birth-to-3) and this time started seeing an improvement in her handling of new people. Infact she developed quite a fondness for the occupational therapist (whom we needed in addition to a speech therapist as an evaluation showed her to be behind in motor and speech) and would even stay with her for a period of time when we`d visit the parent centre at the local school. 

When she turned 3, the preschool basically picked from where Birth-to-3 left and she`s now been attending 3 days a week for the last 3 months. I stayed with her almost the entire time for the first 2 and 1/2 months and although the transition was tough she appeared to like and enjoy some of the activities there like music time, climbing and sliding, looking at books, etc. 

But for the last few weeks, as per a plan agreed on by her teacher, assistants and us parents, I`ve been leaving her at the start of class only to return 2 and1/2 hours later at home-time. I don`t actually leave- I stay and watch from an observation booth and it seems like her intense crying from the days of stranger anxiety have returned. The staff find it very hard to console her. Although they assign a person to be with her all the time, each time they rotate the person she cries with that transition. She also no longer enjoys the activities she once did as she seems intent on just crying the whole time. 

This has been going on for the last 3 weeks and the teaching staff at school recommend that we see her doctor to address this concern. My husband seems to think that, being the stubborn little individual she`s always been, we just have to let her cry this out until she gets used to the idea of school. Could she be going through an extreme case of separation anxiety or could she have some case of chronic crying? Please advise.


Thank you for your question. I would recommend consulting your pediatrician as a first step given the ongoing nature of this problem and the level of impairment it has created for your daughter's educational success. It is also important that your pediatrician continue to evaluate your daughter's developmental progress (given her history of speech and motor delays) in conjunction with this ongoing separation problem. Your pediatrician may recommend a comprehensive developmental evaluation with a psychologist for diagnostic clarification purposes. Behavioral treatment with a child psychologist may also be recommended.

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Response by:

Michelle Spader, PsyD
Clinical Assistant Professor of Pediatrics
College of Medicine
The Ohio State University