context: Separation anxiety is normal in very young children (those between 8 and 14 months old). Kids often go through a phase when they are "clingy" and afraid of unfamiliar people and places. When this fear occurs in a child over age 6 years, is excessive, and lasts longer than four weeks, the child may have separation anxiety disorder. Separation anxiety disorder is a condition in which a child becomes fearful and nervous when away from home or separated from a loved one -- usually a parent or other caregiver -- to whom the child is attached. Some children also develop physical symptoms, such as headaches or stomachaches, at the thought of being separated. The fear of separation causes great distress to the child and may interfere with the child's normal activities, such as going to school or playing with other children. Following are some of the most common symptoms of separation anxiety disorder: An unrealistic and lasting worry that something bad will happen to the parent or caregiver if the child leaves An unrealistic and lasting worry that something bad will happen to the child if he or she leaves the caregiver Refusal to go to school in order to stay with the caregiver Refusal to go to sleep without the caregiver being nearby or to sleep away from home Fear of being alone Nightmares about being separated Bed wetting Complaints of physical symptoms, such as headaches and stomachaches, on school days Repeated temper tantrums or pleading Separation anxiety often develops after a significant stressful or traumatic event in the child's life, such as a stay in the hospital, the death of a loved one or pet, or a change in environment (such as moving to another house or a change of schools). Children whose parents are over-protective may be more prone to separation anxiety. In fact, it may not necessarily be a disease of the child but a manifestation of parental separation anxiety as well -- parent and child can feed the other's anxiety. In addition, the fact that children with separation anxiety often have family members with anxiety or other mental disorders suggests that a vulnerability to the disorder may be inherited. Separation anxiety affects approximately 4%-5% of children in the U. S. ages 7 to 11 years. It is less common in teenagers, affecting about 1.3% of American teens. It affects boys and girls equally. As with adults, mental illness in children is diagnosed based on signs and symptoms. If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical exam. Although there are no laboratory tests to specifically diagnose separation anxiety disorder, the doctor may use various tests -- such as blood tests and other laboratory measures -- to rule out physical illness or medication side effects as the cause of the symptoms. If no physical illness is found, the child may be referred to a child and adolescent psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illness in children and teens. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a child for a mental illness. The doctor bases his or her diagnosis on reports of the child's symptoms and his or her observation of the child's attitude and behavior. Most mild cases of separation anxiety disorder do not need medical treatment. In more severe cases, or when the child refuses to go to school, treatment may be needed. The goals of treatment include reducing anxiety in the child, developing a sense of security in the child and the caregivers, and educating the child and family/caregivers about the need for natural separations. Treatment options that may be used include: Psychotherapy: Psychotherapy (''talking'' therapy) is the main treatment approach for separation anxiety disorder. The focus of therapy is to help the child tolerate being separated from the caregiver without the separation causing distress or interfering with function. A type of therapy called cognitive-behavioral therapy works to reshape the child's thinking (cognition) so that the child's behavior becomes more appropriate. Family therapy also may help teach the family about the disorder and help family members better support the child during periods of anxiety. Medication: Antidepressant or other anti-anxiety medications may be used to treat severe cases of separation anxiety disorder. Most children with separation anxiety disorder get better, although their symptoms may recur for many years, particularly when stressful events or situations occur. When treatment is started early and involves the family as well as the child, the child's chance of recovery improves. There is no known way to prevent separation anxiety disorder, but recognizing and acting on symptoms when they appear can minimize distress and prevent problems associated with not going to school. In addition, reinforcing a child's independence and self-esteem through support and approval may help prevent future episodes of anxiety.