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Separation anxiety in preschooler: Is this normal?

I'm a stay-at-home mom with children ages 2, 4 and 10 years old. My middle child has always been very attached to me. But recently he has been showing excessive separation anxiety. If I leave the room, he runs after me asking, "Mom, where are you?" We occasionally have a sitter. But I rarely am not with him. Recently he started preschool and is doing well there. But he has begun attaching to his teacher. How can I help him overcome his anxiety? I want him to feel secure, but I also need some breathing room.

- Suzanne / Missouri

Mayo Clinic pediatrician Jay Hoecker, M.D., and colleagues answer select questions from readers.

Answer

Some degree of separation anxiety is normal and even healthy for a 4-year-old. But excessive, persistent separation anxiety can be a concern.

There are several possible explanations for your child's separation anxiety. Your 4-year-old middle child is too young to share many activities with your 10-year-old and too old to share many activities with your 2-year-old. Plus, your 2-year-old still requires a great deal of your time and attention, which takes time away from your 4-year-old. As a result, your middle child may feel left out and not really sure of his place in the order of things (not uncommon in middle children). Also, your 4-year-old's separation anxiety may be compounded by the fact that he recently started preschool, which marks his first real time away from you.

Your middle child wants to know that he is important to you. You can help ease some of his insecurities and build his self-esteem by setting aside 20 to 40 minutes each day to devote exclusively to him. You can do this by enlisting help from another adult or by scheduling time when your 10-year-old is at school and your 2-year-old is napping.

During this time, don't answer the phone and don't check your e-mail. Do something your 4-year-old wants to do. If you have someone to watch the other kids, leave the house during this time if you feel like you can't be free of distractions.

Each day, remind your 4-year-old when this special time will occur, and keep your word. Praise your middle child for the things he does well. Look for things that make your middle child special and different from your other children, and encourage him in those areas.

Your 4-year-old will learn that although his mom has many other people in her life, he is certainly one of them. He will also learn that when his mom says she will save special time for him that she keeps her word and can be trusted. In addition, you may look for age-appropriate playmates for your son so that he can count on those playtimes as well.

Try these suggestions for four to six weeks. If during that time, your middle child's fears or anxieties don't improve or they get worse, consult his doctor for an evaluation.

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Dec 1, 2008