anxiety

Separation Anxiety Tips (from CDS with notes for other schools)

Family happy mother send children kid son boy kindergarten to school

Separation anxiety is fairly common in the toddler and preschool years. It is most likely to happen in response to the start of a new school year as it is a change in caregivers, setting, peer activity and schedule all at once.

Goodbye rituals can be helpful. When my girls were little we had two high-fives and a hug as our goodbye. A ritual lets the child relax until that happens and then clearly signals the separation. Keep the actual goodbye short and sweet. The guideline is – Don’t say it until you mean it, then say it, mean it and go.

Goodbyes are important and moving through them helps to build a sense of trust in the system. This also means to avoid being the parent who sneaks out. If you wait until your child is busy and then sneak out without the goodbye, they are more likely to cling longer the next time.

It is most helpful to keep an upbeat attitude and expression through the separation. Your words, tone and look should all reassure your child that school is a great and fun place and you are entirely confident leaving them here.

It can be helpful to send your child with a small, soft toy or other object from home (not their most loved/bedtime lovey please). Teachers may let them have this as they need for the first few weeks. Gradually, they may encourage the child to have the toy stay in the bag, and eventually to stay in the car or at home.

At Country Day School, we strongly encourage all families to drop-off and pick-up in our carpool system. This can help ease separation anxiety by keeping goodbyes short and by having the child arrive to the same activity each day. At CDS this activity is gathering on the porch. Arriving to the same activity each day helps because the child knows what to expect as they get out of the car. If you are at a school that drop-off happens at the classroom, the hope is they are doing about the same things in the same ways each day during the drop-off window. To have this added benefit, children also have to arrive on time.

If your child is experiencing separation anxiety, it can be helpful to be one of the last to arrive and one of the first to pick up. Let’s say your drop-off is 8:30 – 8:40am and your pick-up is 11:30 – 11:40am, it’s helpful to drop-off closer to 8:40am and pick-up closer to 11:30am. At drop-off and pick-up, this means less time sitting and waiting on the porch. Also at pick-up, it can be upsetting to wait longer and watch other children go home first. If you are at a school that drop-off happens in the classroom, teachers may encourage you to be one of the first to arrive so your child is coming in to a quieter classroom and the teacher may be more available to help with the transition. Either way, good to ask and follow the teachers suggestions about times.

At home, it can be helpful to look at class pictures online and talk about their teachers, friends, classrooms and activities. It may also be helpful to have playdates with classmates often. The more they feel connected to others in the class, the less separation is an issue. It may be helpful to drive by the school, wave and talk about how fun school is or, if allowed, play on their playground on your days off.

Many schools are happy to briefly email or call to let you know how things are going. If a child is experiencing separation anxiety, they can also let you know what improvements they see over the first few weeks of school.

It may be helpful to read upbeat books about separation and starting school including:

Separation Anxiety
• The Kissing Hand by Penn
• When I Miss You by Spelman and Parkinson
• Llama, Llama Misses Mama by Dewdney
• Will You Come Back for Me? By Tompert
• Owl Babies by Waddell
• The Invisible String by Karst
• I Love You All Day Long by Rusackas
• Oh My Baby, Little One by Appelt

Starting School
• DWs Guide to Preschool by Brown
• The Brand New Kid by Couric
• Wemberly Worried by Henkes
• Timothy Goes to School by Wells
• Do I Have to Go to School? A First Look at Starting School by Thomas and Harker
• What to Expect at Preschool by Murkoff
• Maisy Goes to Preschool by Cousins
• Going to School by Civardi
• Preschool Day, Hooray! By Strauss

What to Do When a Child is Scared of Going to Another Room in the House Alone

Upset problem child sitting on staircase

At least every other month a parent says to me, “this might be odd, but my child is scared of going to another room in the house by himself.” This is not odd. Between four and eight or nine years old, this is completely common. My older daughter spent a few years negotiating with me or her younger sister to have company while roaming the house. As common as it is, it can also be frustrating for all involved. Here are several ideas that may be helpful:

  • Start with empathy often – When your child is scared, it’s often helpful to start with empathy. Empathy would be saying, “I know you are worried about going up to your room. You don’t like being alone,” which lets the child know you are listening and you understand. It keeps the communication open. So many parents start with logic, “you were just alone in your room this morning,” which is something for the child to argue with. Other parents start with denial, “you shouldn’t be scared, we are all right here,” which just tells the child you don’t understand. Logic and denial tend to close down the communication.
  • Next move to problem solving – Once you’ve given empathy, it may be helpful to brainstorm solutions or ask the child to think of things he can do to help themselves. You might also remind them of other solutions given below.
  • Encourage practice being alone in small doses – While you are playing together, you might make small trips to check on something in the kitchen. You can start with stepping out for very short periods of time and work your way up.
  • Then encourage your child to go alone in small doses – You might ask your child to get something from the hallway that is in plain view and gradually request things farther away. You might leave a favorite thing in another room, so they are motivated to make the trip.
  • Offer to go part way – We have two landings on our way upstairs. For about one month, I offered to go to the top landing and watch her go the rest of the way to her room. The next month, I offered to go to the lower landing. For a few days in-between, I may have negotiated to a step or two in between.
  • Agree to talk the whole time – (Thanks to a mom on facebook for this idea!) You might agree to have a conversation with your child the whole time they are going back and forth. This mom said she and her child would “beep” back and forth to each other or play “Marco, Polo.” This way the child knew their mom could at least hear them.
  • Promote the buddy system – In our house it was a younger sibling. The family dog or a stuffed animal might also be sufficient company.
  • Give a bravery cape or medal of courage – Small tokens can go a long way. A bravery cape can be taken from a super hero costume, or can be made out of a towel. A medal can be bought at the party store or made from yarn and construction paper.
  • Appeal to being a big kid – Without putting pressure, you might highlight an older cousin or friend who easily goes to other rooms. You might remind them of other things they are able to do as a big kid.
  • Leave music playing in other rooms – Your child may not feel so lonely if there is familiar music playing.
  • Draw maps of the house and make a plan – You might make errands to other rooms more of a game by making a simple map (a few squares with doors marked by lines) of the house. You or your child can then draw an X to mark the spot and lines about how to get there and back.
  • Descriptive praise when they do go alone – Remember this is a small accomplishment. Good to note, “you were brave! You went by yourself to get that,” when it goes well.

 

Resources for Children’s Anxiety, Worry and Perfectionism

Child psychologist with a little girl

Children’s storybooks

  • Sometimes I Worry too Much but Now I Know How to Stop by Huebner
  • David and the Worry Beast: Helping Kids Cope with Anxiety by Guanci
  • Nobody’s Perfect: A Story for Children about Perfectionism by Burns
  • Wilma Jean the Worry Machine by Cook
  • Slip, Slide Skate by Herman (perfectionism)
  • The Girl Who Never Made Mistakes by Pett
  • Is a Worry Worrying You by Wolff
  • A Boy and a Bear: A Children’s Relaxation Book by Lite
  • DW’s Guide to Preschool by Brown (separation)
  • The Kissing Hand by Penn (separation)
  • Oh My Baby, Little One by Appelt (separation)

Children’s workbooks

  • When My Worries Get Too Big: A Relaxation Book by Buron
  • What to Do When Your Worry Too Much by Huebner
  • What to Do When Good Enough Isn’t Good Enough by Greenspon
  • What to Do When Your Brain Gets Stuck by Huebner
  • What to Do When You are Scared and Worried by Crist
  • The Relaxation and Stress Reduction Workbook by Shapiro

Parenting books

  • Freeing Your Child from Negative Thinking by Chansky
  • Freeing Your Child from Anxiety by Chansky
  • Helping Your Anxious Child: A Step by Step Guide by Rapee, Wignall, Spence, Cobham
  • The Optomistic Child by Seligman
  • Freeing Our Families from Perfectionism by Greenspon
  • Letting Go of Perfect by Wilson
  • Building Resilience in Children and Teens by Ginsburg
  • The No Cry Separation Anxiety Solution by Pantley

Join me for a workshop on Separation Anxiety, Worries, Fears and Perfectionism, July 23rd, 7:00-9:00pm in Reston, VA.  For more information and to register, please visit http://www.eventbrite.com/o/parenting-by-dr-rene-parenting-playgroups-283710166?s=1328924.

Addressing Childhood Fears

fear

Developing fears is a normal part of the preschool and early elementary school years.  Their awareness of the world and their imaginations are growing faster than their ability to use logic and reason. This is also a stage where the time they spend away from their families is increasing, and they are learning to function more independently. Typical fears include being afraid of the dark, being leary of strangers, being afraid of dogs, thunder or water. While fears are normal, it is the level of the fear that can be disruptive.

When you realize there is a fear, encourage your child to talk about it. Practice listening to all they say, validating that they have concerns, labeling and helping them to express their emotions. It can also go a long way to offer reassurance that they are safe.

Next encourage children to find solutions. Brainstorm with them things that would help them feel better. Talk about which ideas are helpful and possible. If you are part of the solution, be sure you are doing things with your child rather than for your child. The goal of this is to help children learn to face and conquer their fears. It is moving away from their thinking, “this is bad,” to, “I can handle this.” This works by helping them feel confident to move through it and be okay on the other side, rather than avoiding the thing. This doesn’t mean forcing a screaming child through, it means providing time, space and reassurance to help them move though in a comfortable way.

Helpful parenting books include

Freeing Your Child from Negative Thinking or Freeing Your Child from Anxiety both by Chansky

Helping Your Anxious Child: A Step by Step Guide for Parents by Rapee, Spence, Wignall and Cobham

Helpful children’s books include

Sometimes I Worry Too Much but Now I Know How to Stop by Huebner

Wemberly Worried by Henkes

Wilma Jean the Worry Machine by Cook

What To Do When Your Child Pulls Their Own Hair

Pulling their own hair can be mild and transient in some children. This is often related to self-soothing, and seen as being similar to head banging, thumb sucking, hair twirling or body rocking. When it is this, parents may look for patterns such as pulling when they are bored, lonely, excited or when they are falling asleep. If this is the case, it may be best to help them learn new ways to sooth or cope. It may help for parents to rub their child’s back at bedtime or run fingers through their child’s hair. If it’s particularly problematic at bedtime, it may be helpful for a child to wear mittens to bed. When it is self soothing in infants and toddlers, it may stop within a few months with little intervention. When it is mild, parents may ignore the behavior or address with very little emotion and with positive directions and gentle reminders such as “hands down.” Parents may also give incompatible behaviors in the moment such as small stickers, crayons and paper or things to carry. Parents may also make it less pleasurable by keeping a child’s hair very short or under a hat.

When this behavior is longer lasting or seen in older children, it can be related to obsessive-compulsive disorder or anxiety. This may be in the category of behaviors called trichotillomania, and is similar to skin picking. If that is the case, parents may pursue cognitive-behavioral therapy with the goal of helping the child to gain control of their pattern. It may be helpful to teach the child stress management tools in general or attend therapy focused on habit reversal. Others suggest the use of medicines to treat OCD or depression and others suggest a professionally developed behavior modification plan. Some mixture of these interventions is likely helpful to lessen the behavior.

For more information, please visit www.trich.org.

Please Read:

  • Stay Out of My Hair! Parenting a Child with Trichotillomania by Mouton-Odum and Golomb (for parents)
  • What to Do When Bad Habits Take Hold by Huebner (for kids)
  • The  Hair Pulling Habit and You: How to Solve the Trichotillomania Puzzle by Golomb and Vavrichek (for parents and teens)
  • The Hair Pulling Problem: A Complete Guide to Trichotillomania by Penzel (for parents)
  • Help for Hair Pullers: Understanding and Coping with Trichotillomania by Keuthen, Stein & Christenson (for parents)

Helping Children Learn to Make Decisions

Hi Dr. Rene,
I have a third grader who, at times, seems to be paralyzed by indecision. Here is a typical situation: each week his teacher sends home a homework packet that requires two reading and writing activities. He is given ten activities to choose two from (e.g., write a letter to the librarian telling her why she should get this book). Although he reads for at least 30 minutes a night, he has difficulty choosing what book to base an activity on and then choosing an activity. He asks us for help, and we will suggest a book he has just read  and a potential activity or two, but that never seems to help. He will spend a half hour to an hour fretting about what to do and sometimes ends up in tears. What is the best way for us to support him in this situation? He is a good reader and grasps what he is reading, but this particular activity is very draining for him.
Thank you for your advice,
Cindy

Hi Cindy,
I would focus first on teaching him decision making separate from homework time. Start small, each day give him choices like apples or oranges for snack, or playing monopoly or clue with you. Continually offer very small choices. When you are in the car, a book on tape or music, tucking in this story or that. When he is able to make small choices, occasionally comment, “you decided that by yourself,” “I saw you think about it and decide on this story,” or ask, “how did you make that decision so easily? What helped you decide?” Talk with him through his decision making process.

When a choice is too difficult, focus on helping him weigh his options. Remind him of the high and low points of each choice, remind him how or what he chose last time or how it worked out. If he really can’t decide whether you choose for him or not, I would ask him to let you know one thing he liked about each of the options and why he might have chosen each one later. This is still teaching him to look at the details.

Gradually work your way up to bigger decisions such as who to invite over to play or which after school activity to sign-up for. Afterwards talk about how either decision would have it’s benefits. With homework specifically, maybe talk about what types of projects he’s enjoyed doing before or what types of projects tend to get the best grades. You might take a list of ten projects and whittle it down to the top three. If they truly are equal choices to him, or he wrestles with the decision among the top three for more than a few minutes, teach him how to make the arbitrary decisions like flipping a coin or assigning numbers and rolling a die, at this age even eeny-meeny-miney-mo works.

I would also try to find fun ways to practice like the Choose Your Own Adventures storybooks that were popular in the 80s and 90s. These are read aloud chapter books where every few pages children get to choose the direction of the plot. Encourage him to pick the ice cream flavor at the grocery store or the next family outing to take. Think of fun ways to practice choices often.

If it really is more narrowly related to academics and homework, it may be that he is perfectionistic or stressed about academic performance. If this seems to be the issue, I would learn more about perfectionistic tendencies and talk to his teacher about the academic worries. Ask if he struggles this way in the classroom as well.
Sincerely, Dr. Rene

Best New Learning Builds on Previous Knowledge

When your child is challenged by a new problem, the idea is to remind them of what they already know and build from there. This can help make the task seem more manageable and provide a familiar strategy.

Let’s say your child has mastered 25 piece puzzles, and they are starting on a 60 piece puzzle for the first time. If they get to a point of frustration, you might remind them of previous strategies such as, “I remember the last puzzle, you started by finding all the edge pieces.” This helps them to break the big task into smaller tasks, and puts them on a familiar path towards problem solving.

When your third grader is starting to learn her multiplication tables, you might start by showing her how multiplication is repeat addition. She’s already mastered addition, so multiplication may seem a more managable task this way.

Tips for Separation at the Start of the School Year

It is normal for young children to experience some level of separation anxiety at the start of a new school year. It often represents a change in caregiver, schedule, setting and classmates. As a parent, it makes sense to prepare yourself for some upset, and be pleasantly surprised if it is an easy transition.

  • Take Advantage of Previews – If your school offers a summertime classroom visit or an opportunity to meet their teacher, attend. Attend the back to school night with your child if that’s available. Play on their playground, and make playdates with their classmates as soon as you can. Any preview experience can be helpful.
  • Don’t Sneak Out, Say Goodbye –  As hard as it can be, sneaking out builds mistrust in the system. Children are more likely to cling harder the next day.
  • Goodbye Rituals Can Be Helpful – Children may be comforted by a sense of routine. In our house, this meant I would give two high-fives and a hug before I left them anywhere. This helped them to relax in new situations because they knew I wouldn’t leave unexpectedly.
  • Avoid Pushing Them Out – It can be helpful to give them time to hang back, to observe a bit before they dive into a new setting. In these moments, often the more you push them out, the more they resist. Avoid saying, “you should play legos,” while directing them there. It’s better to hang out with them and comment on the fun, or go with them to see the legos together.
  • Wait Until You Mean It, Then Say It and Go – Avoid saying goodbye several times only to stay longer. This builds more tension in the system as the children try new ways to keep you there, and they learn you don’t really mean it when you say it.
  • Ask for Regular Feedback from Teachers – The teachers want a smooth transition for your child as much as you do. It helps everyone to stay in regular communication. It is fine to ask them to call you at a given time, or ask them to track how it is going over the first few weeks.

Playdates and Stressed Kids

Dear Dr. Rene,

My son is almost three years old. He is very verbal and cognitive, but seems overwhelmed easily in playgroups. If we are at playgrounds and there are three or more kids nearby, he wants to leave. If an indoor group is loud, or children are misbehaving, he gets extremely upset. He manages better when play is with just one other child, but even that often ends in tears. He hates to leave the house, he says, “let’s just stay home,” even when it’s a place he loves to go. He dislikes other children or adults touching him. He is also an only child and takes after me. While I try not to show it, I don’t like crowds and don’t care for other children being rowdy. Do I continue to put him in these stressful situations?

Sincerely,

A Worried Mom

Dear Worried Mom,

I think there is a best answer in the middle. Yes, continue to leave the house and continue to schedule playdates. Leave the house for more low-key activities, think play at the park rather than busy gym class. Plan one-on-one playdates with kids that tend to play well rather than playdates with several children at the same time. One-on-one actually tends to be better for play skills, and there’s no real downside relative to bigger groups. Managing group play becomes more important as he is a bit older.

When things get to busy or loud, give a lot of empathy and step out for a time. When others misbehave, if he is not directly involved, distract him away when you can. If there’s no distraction, talk him through it and let him see the resolution. If he is directly involved, think empathy and wait for the calm. Talk through on the quiet, calm side.

Pulling too far back means no playdates and you never leave the house. Both are important towards social development, but you want to aim for things that may be successful. Just diving in to big groups means he will struggle through and enjoy social less. Aim for the middle.

Sincerely,

Dr. Rene

Will Not Sit on Potty

Dear Dr. Rene,

My daughter will be four years old in January and will not pee or poop on the potty. She wears underwear all day long and very rarely has an accident. However, whenever she has to pee or poop, she asks for a pull-up. She puts on the pull-up herself, goes pee, takes the pull-up off, puts it in the trash and puts her underwear back on. If we are out, she only likes to change into a pull-up to go to the bathroom in the car. Sometimes I have to help her take her pants and shoes off, but she is self sufficient with the pull-ups. She is terribly afraid of the potty! We have two different potties, we’ve watched the movies and read the books, and she has a dollhouse with a potty to play. I don’t know how to physically make her pee where I want her to. A couple of times I have said that we have no more pull-ups for during the day, and both times she has held it all day until she is too uncomfortable to sit down – at which point I give her the pull-up. I don’t want to do this again unless I’m really going to stick to it. I just didn’t feel right having her in so much discomfort while trying to force her to pee on the potty. We also have a baby due in January, if that makes a difference.

Sincerely,

Erkia, mother of one and one on the way

Dear Erika,

There are two answers here. First, the potty training answer. Second, the answer about managing fears and anxieties. I would start with the low key way of addressing the first while you learn about the second.

You are already on the path of the potty training answer. A more common related concern would be the child who will pee but not poop in the potty then has an accident or needs a pull-up to poop. The overarching suggestion there is to stay calm emotionally and allow the child to change into a pull-up as needed and then clean them as you would if they were not yet potty training. All of this while expressing, you know they are potty trained for pee (not in your case) and you know they will poop on the potty when they are ready.

There are several additional potty training things you can do to move forward. I would encourage her to be in a bathroom for the process. At home, move the stack of pull-ups to the bathroom and talk about how that is the room where people go when they need to potty. Carry a pull-up in your bag and guide her to a bathroom when you are out. With a silly tone you can remind her, “the car is not a bathroom, silly. When people go potty they go to a bathroom.” A next step, once she is comfortably going in the bathroom, would be to have her sit down when she is in the pull-up, either on the edge of the tub or on the can be closed potty. This is getting her into the sitting position which can feel different, but it’s necessary for eventually going on the potty.

Give her choices about which bathroom and if you help her or not. When she does at least make it in the bathroom, give her a bit of descriptive praise, “you knew you had to go, and you got yourself into the bathroom!” I would also give her language of ownership. This means saying every few days, and not on the heels of a pull-up, “you so know when you need to go potty. Your body knows soon enough that you can even get yourself changed to a pull-up. I know when you are ready, you will sit on the potty.” This is meant to be encouragement without pressure. Continue to mix in the story books and the video tapes. Continue to play with the dollhouse bathroom set.

If all that doesn’t lead to progress, you might take a consultation with the WASH Clinic at Children’s National Medical Center. They are specialists in potty training issues and may have additional answers to encouraging the process when there are specific concerns.

Your description of her being “terribly afraid” of going on the potty and her complicated answer to avoid it of changing, even in the car to go to the bathroom suggests while she is able, she has unknowingly convinced herself that is a scary thing. The more you just push or “force” her to go on the potty, likely the more she will push back. When there is an anxiety, the underlying idea is the thinking causes the feelings which cause the behavior. To help the child move beyond the avoidance behavior, the trick is to figure out and address the thinking to change the feelings to change the behavior. There is a good book titled Helping Your Anxious Child: A Step by Step Guide for Parents by Rapee, Wignall, Spence, Lyneham and Cobham. It is an activity book for parents and children to work through together to help children help themselves to calm the anxious feelings and outcome behaviors. I would start reading this book yourself, and, if they potty training suggestions don’t move the system forward, you can go back and start working through these activities together. This is a long term effort to your concern, but a healthy way to go. There are also area specialists who can work through this with you if you prefer a person to a book.

Sincerely, Dr. Rene

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