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Mental Health Center of Denver on Separation Anxiety, Death & More

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The Mental Health Center of Denver is the behavioral health provider for the City and County of Denver and the largest in the state. Nationally recognized for its focus on recovery, the Mental Health Center of Denver is also one of the few mental health centers that offers a practice specifically focused on children from ages birth to 3 years. Shannon Bekman, PhD, a licensed clinical psychologist and the program manager for the Mental Health Center of Denver’s Right Start for Infant Mental Health program, recently shared answers to common questions facing many mothers.

Q: What is acceptable separation/stranger anxiety and what could possibly signal a more serious issue?

A: Stranger anxiety is a normal part of your child’s development and a helpful adaptive response based on evolution. To help ensure survival, children are innately programmed to protest when their primary caretakers leave. Although there is great variability from child to child, on average, stranger anxiety and fear of separation from caregivers emerges between 7 – 9 months, peaks from 12 – 18 months and declines for most children by 30 months of age. At these stages, stranger/separation anxiety is developmentally appropriate and a sign of healthy attachment. These anxieties and fears are transient and do not derail the child’s cognitive, social or emotional development.

Children older than 2.5 – 3 years who have intense separation anxiety that doesn’t seem to lessen as routines are established could be a cause for concern. Even at age 2 and older, children often will protest when being left with a sitter or at daycare, but typically, these outbursts will lessen in severity and length as routines are established. The classic example of this is when a preschooler is hysterical when being dropped off at school, but before the parent has even left the building, has happily settled right into her routine as the concerned parent walks away worrying.

Children with a true separation anxiety disorder will refuse to separate from their parent, and when separated experience excessive distress. They will often express fear that accidents or illness will befall their parents or themselves when separated. Sensitive parents understandably want to respond to distraught children but can unintentionally feed the disorder by lingering, showing anxiety themselves or even dis-enrolling their children from school. Sometimes, the anxiety is so bad that the child will be asked to leave the school, as it can be very disruptive to the other children.

Thankfully, separation anxiety is a very treatable disorder that can usually be easily addressed. As with most childhood issues, the earlier the intervention, the more likely the treatment will be successful. That’s why it’s important to seek professional help if you suspect your child might be experiencing this disorder. There are a variety of approaches to treating separation anxiety disorder. Some therapists may choose to treat the child and parent together as a dyad and focus on strengthening the relationship. This type of family therapy can help discern when parenting may be contributing to the separation anxiety. Another approach is called systematic desensitization which gradually introduces separations of increased duration and distance. Children are taught relaxation techniques, such as deep breathing, and self-soothing language to maintain relaxation while separated from caregivers.

If you have concerns about your child and separation anxiety, talk to their teacher or sitter as well as your primary care physician. You may want to set up an initial appointment with a licensed clinician to further evaluate if your child is experiencing separation anxiety disorder.

Q: What are some tips for helping young children cope and understand when there has been a death in the family?

A: Young children don’t have the cognitive sophistication to understand death. And while it may take them awhile to process a loss, parents can avoid common mistakes while trying to help them cope. Many parents will try to explain the death in simple terms and might say something like, “Grandma went to sleep and she didn’t wake up.” This can give children an unintentional fear of going to sleep. It is suggested to use physiological examples, such as “Grandma was very old and her heart stopped beating and her lungs quit working so she can’t be with us anymore.”

It’s also important for parents to take cues from children. They may seem satisfied with an answer but as time goes on and they master more skills they might want to revisit a tragedy to better understand it. This can be painful for a parent who is dealing with a loss, but it’s important to answer children’s questions. Also, don’t be alarmed if you see your young children acting out scenarios related to the death. It is very common for children to “play funeral” after experiencing one.

Certainly if the death in the family is of a parent or someone who is particularly close to the child, you may want to seek a therapist’s guidance to help them process and mourn a loss. Watch your child closely – are they really distressed, are they not able to concentrate at school, have they lost interest in play, are they listless, suffering from sleep issues or are they talking incessantly about the loss? These are signals that you might want to seek help.

Q: Is it normal for an upset child to say he wants to kill himself?

A: There’s not one answer to this question. Any threat should be seriously considered, and if you have imminent concerns that your child will hurt him/herself you should take him immediately to the emergency room. But you will also want to examine the situation surrounding the statement. Is your child they truly distressed or do you think they are just saying it as an expression of speech? Does your child seem sad, depressed or irritable? If so, a statement like this could be a sign that your child is experiencing depression.

Take the situation as an opportunity to have a heart-to-heart with your child. Probe to find out if there is something upsetting they are dealing with that you may have been unaware of, such as bullying at school.

You will also want to explain the seriousness of what they said. Some children – especially younger ones – may not realize the potential impact of such a statement.

If your evaluation of the statement leads you to believe your child is truly distressed, consult with your child’s physician to get a referral to a therapist.

Q: What’s the difference between the normal “post baby blues” and true post-partum depression?

A: It is normal for moms to feel overwhelmed and sad after the birth of a child. In fact, 50-70% of women experience the “baby blues” after the birth of a child. The baby blues lasts approximately 2-3 weeks and involve feeling overwhelmed, anxious, irritable, sad, tired and weepy. You may find yourself crying over things that normally wouldn’t bother you. The good news is that the baby blues aren’t an illness, and these feelings will go away on their own. No mental health treatment is necessary other than support from family and friends, and rest.

If these feelings continue to persist for more than 2-3 weeks after childbirth it could signal a post partum mood disorder. Though many symptoms of the baby blue and post partum depression are similar, symptoms of PPD last longer and are more intense. Are you feeling hopeless or having thoughts of hurting yourself or your child? If so, you need to let your physician know right away as there are many ways to treat post-partum depression and most have very positive results.

Social support is one of the best ways to get through the baby blues. Seeking extra support from your partner, finding a group of similar moms and finding time for individual “alone” time are important for new moms. In cases of post partum depression, antidepressant medication can also be helpful to relieve symptoms of depression. Combination of talk therapy and medication is often beneficial. If you are depressed, your depression can affect your baby. Getting treatment is important for both you and your baby. If you are concerned you may be suffering from PPD, please talk to your doctor, your baby’s pediatrician or midwife to get referrals for professional support.

Guest blogger Shannon K. Bekman, PhD is the Program Manager for Right Start for Infant Mental Health and Infant/Early Childhood Mental Health Consultation. For additional information, go to the Mental Health Center of Denver at mhcd.org. Photo

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