EARLY
CHILDHOOD
SEPARATIONS
John H. Kennell, M.D., and Mary E. Bergen, M.S.W.
Departments of Pediatrics and Psychiatry, Western Reserve University School of Medicine,
Cleveland, Ohio
(Submitted May 5; revision accepted for publication October 20, 1965.)
From the Child Rearing Study at Western Reserve University Medical School, Cleveland, Ohio.
Dr. Benjamin Spock is the Director of this study, which is supported by the Grant Foundation. ADDRESS: (J.H.K.) Babies
&
Childrens Hospital, University Circle, Cleveland, Ohio 44106.PEDIATRICS, VOL. 37, No. 2, FEBRUAIIY 1966
T
HERE have been a number ofarticles115 in the pediatric literature in the past 60 years on the traumatic effect of prolonged separations, particularly those connected with hospital care. As early as
1908 Chapin6 recognized the disastrous effects on infants and children of confinement in an institution. In 1936 Bev-erly commented that it was common knowledge to pediatricians that babies do poorly in a hospital even with the best of
care and that these same babies thrive at home with the mother even though the care is relatively poor.
Ainsworth6 and Bowlby’7 have reviewed the extensive literature on maternal depri-vation and separation anxiety. The cases of severe “hospitalism,” described by Spitz18 in 1945, led that author to conclude that the most destitute of homes offers more mental stimulation than the usual hospital ward. Robertson’s film, A
Two-Year-Old
Goes
to
the Hospital, demonstrates that even in
more satisfactory institutional surroundings the loss of the mother creates strong anxiety for the young child.
The literature has paid less attention to the frequent but shorter and less complete separations that occur in ordinary family life. Bowlby suggests that any separation from the mother is important to the child. He considers separation from the mother to be the primary fear of human beings. He states:2#{176} “Substantial evidence has come from many sources that separation from the mother, or mother-substitute, during the
early years, may have a serious effect on the
development of a child’s personality.” Yet, he points out that many children have the
capacity to cope \vitll the experience of separation under traumatic circumstances. “There are, on the other hand, some chil-dren who appear to overcome these experi-ences and to develop fairly normally. Differences in outcome are probably due to the many variables operating. These in-dude age of separation, length of separa-tion, nature of mother-child relationship be-fore and after separation, nature of substi-tute mothering during separation.”
Perhaps the young child’s deepest fear, as Bowlby suggests, is the dread of abandon-ment by his mother. The infant’s survival depends on a mother who is willing to feed
him. As he grows older and more indepen-dent he needs to find his way back to her from time to time for protection and reas-surance. The mother nurtures the
intellec-tual and emotional capacities which make
tile child progressively better able to han-dle his own problems. Although growth
continues under many adverse
circum-stances, a sensitive mother is best able to bring balance into many of the child’s expe-riences. She does not allow him to go too long with hunger-tension or without the so-lace of her presence, but she knows the im-portance of his learning to bear a tolerable degree of discomfort.
upset the equilibrium which the mother and child usually maintain. Mahler2’ and Sander,22 in two separate studies of child development, have commented on the emo-tional significance of anxieties which arise from separations from the mother in the course of normal growth.
This paper will present the reactions of a group of young children to the usual sepa-rations of family life during various stages of their development.
CHILD-REARING STUDY
In a long-term study of child rearing the authors have had an opportunity to observe the reactions of young children to ordinary separations in 21 families. Eleven of these families entered a child-rearing study at Western Reserve University 6 years ago. Another group of 10 families joined the fol-lowing year. With siblings born subse-quently there are now 39 children in the study. The separations in these families oc-curred mainly because of vacations, hospi-talizations of the parents, and employment of the mother.
These families were all referred to this study by their private obstetricians. The majority had some college education. The father’s occupations ranged from skilled labor to the professions. The extremes of income and social position were not repre-sented in this group. The primary care of the children came from their own mothers. One family came close to the pattern of multiple care because of the employment of both parents. However, a grandmother was a fairly constant maternal figure in this fam-ily.
The mother in each of these families has met with a counselor-either a psychiatrist, a child psychotherapist, or a pediatrician-on the average for an hour every 2 weeks, starting in the last months of the mother’s pregnancy with her first child. The mothers’
accounts of the behavior of their children
and direct observations of the babies by the counselors are discussed in weekly staff meetings. The verbatim transcriptions of
these meetings have been reviewed as a basis for this report. A special nursery school session on Saturday mornings for the children in the study has provided addition-a! observations.
Throughout the study it was apparent that the majority of the mothers found it difficult to discuss or even take cognizance of their own or the child’s reactions to sepa-rations. This contrasted with the ease with which they brought up other problems such as feeding or sleeping difficulties, or thumb sucking.
Individuals who are responsible for the
care of children, as Bowlby2#{176} has pointed out, “have to build defenses against recog-nizing the degree of distress in young chil-dren passing through their care because they cannot bear to feel the full impact of each child’s disturbance.” This distress is much greater, of course, when mother and child are separated for long periods of time or under traumatic circumstances. But even in daily living the mother must find ways to tolerate the anxiety which her departure arouses in the young child. She often ac-complishes this, apparently, by ignoring her feelings and the strength of the baby’s reac-tions. The pediatrician may, therefore, not hear about these problems.
At the beginning of this study members of the staff had expected to find more in-tense reactions to separation in the children who experienced the most frequent or pro-longed separations. They also expected the anxious, over-protective mother to have more problems than the secure mother in allowing her child to separate. And, since mothers in general are more likely to be anxious about the first child, they expected to find a greater frequency of anxiety in first children.
GENERAL PATTERN OR RESPONSE TO
SEPARATION
ARTICLES
of life there was no clear-cut evidence of reaction to the mother’s departure; but, in the second half of the first year the babies sllO\ved stranger anxiety and definite reac-tions to separation. Separation anxiety
be-came unmistakable, in some cases by 9 months, in the form of whimpering, cling-ing, prolonged crying, the intensified use of a comforting object, and, in one child who was hospitalized, depression. (The grief and depression that other observers have de-scribed, from the age of 5 or 6 months on-wards, in infants separated from their moth-ers for long periods in institutions, show
that the sense of loss may become acute
con-siderably earlier than 9 months, at least if the trauma is severe.)
These responses, which usually remained the same for each child, rose in a crescendo of intensity and frequency up to 18 months, or sometimes beyond. The reactions
ap-peared earliest in the first year with those
children who were experiencing significant
separations from their mothers, but were
evident in all by the age of 1 year.
Stranger anxiety-a reaction in which the infant becomes quiet, clouds over, or cries agitatedly at the approach of an unfamiliar person or even at the sound of a new voice
-was seen as early as 6 months and was
usual by a year. After the age of 1% years
most of the children appeared to be less overwhelmed by separation, but they con-tinued to react vigorously to it up to 2% years. The protests, however, seemed to be increasingly merged with annoyance and with the wish to control the mother after the age of 18 months. Most of the 2-year-olds protested strongly even when tile mother’s attention was diverted while
she talked on the telephone or to another
person.
Toward the end of the third year, ac-cording to the mothers’ reports, all these children were able to accept separations under ordinary circumstances. By age 34 months all but one were able to enter nur-sery school without difficulty. (These obser-vations, therefore, confirm the correctness
of the usual practice of not starting
chil-(Iren in nursery schools before 3 years of
age.)
CHARACTERISTIC REACTIONS TO SEPARATION (FIRST CHILDREN)
Eleven of the 21 mothers reported that clinging on separation was a major prob-1cm. It is noteworthy that 10 of these 11 first-born children, and 1 other, had had the most frequent, the most prolonged, or the most upsetting separations. There were other reactions shown by the 22 children. Three children reacted every time with
sad-ness. One mother who had considerable
difficulty in controlling her son described his behavior as “perfect” for a week or more after each prolonged absence. Nine children reacted with anger as well as clinging or sorrow and showed temper tantrums and screaming. On the return of the mother, the children’s most common reaction (12 out of 22) was to ignore her for a period of time.
The first ignoring reactions occurred at an age (9-12 months) when failure to remem-ber the mother might conceivably be a fac-tor, but these children continued to show the same reaction at later ages when they pointedly ignored the mother but recog-nized the father who had also been absent.
UNIVERSALITY OF SEPARATION
REACTION
mother, even in a herd, never fail to keep close to her, come to her for sustenance. The separation reaction in human beings is most evident at the time when an infant be-comes mobile and able to leave his mother, which would be biologically appropriate, especially in primitive societies in forest or jungle.
SEPARATION REACTIONS IN THE
SECOND CHILD
The clinging reaction of the second child was distinctly more intense than that of the first child in 8 out of the 11 families which had siblings old enough to be evaluated. (It is worthy of note that in 2 of the 3 families where the reaction differed the oldest child was distinctly exceptional in his behavior and less able intellectually than the second child.) The increased clinging in the second child was a surprising observation to the staff since they had expected the greater protectiveness and closer relationship with the mother, which is more characteristic of the rearing of a first child, to result in a more dependent, clinging reaction to sepa-rations. They were also aware of the com-mon assumption in child psychiatry, at least in regard to the older child, that the indi-vidual’s difficulty in separating is apt to be proportional to the mother’s anxiety in han-dling him. The experience with the families in this study suggests that the clinging and separation reaction of the child is more in-tense when the mother is less apprehensive about the child’s closeness to her.
This too affords a parallel with observa-tions of imprinting in other species; Hess23 found that the greater the effort which a duckling had to make to follow a decoy mother over varying distances and hurdles, the stronger the following response and the imprinting became. The experience with
tile families in this study suggests that clinging and the separation reaction are more intense as the casualness or elusive-ness of the mother increases. Despite the sharper reactions of the second child, his
clinging did not persist longer. The second children in this study mastered their anxi-ety at about the same age as the first.
MOTHERS’ REACTIONS
Early Infancy
An unexpected finding was tile early age at which all the mothers in the study re-vealed in one way or another an impatient wish to separate temporarily from their ba-bies. This wish first occurred in most cases when the baby was about 3 months old, al-though two mothers reacted at 6 weeks.
The isolation of mother and baby in the weeks after childbirth is in marked contrast to a woman’s many activities and social contacts previous to her confinement. Tra-ditional practices in other cultures recog-nize the temporary nature of the exclusive mother-child relationship. In Turkey, for example, the mother traditionally remained at home with the baby for 40 days.24 She could then return by degrees to her normal life. It would seem that for many American mothers the isolation fosters a closeness which she welcomes at first, but eventually finds too intense, exclusive and restrictive. The staff had the impression that the mothers who breast-fed their first babies were particularly likely to feel oppressed. Several breast-feeding mothers surprised the staff with the abruptness and impulsiveness with which they decided to wean their ba-bies.
A conscientious mother who had ex-pected to nurse for at least 6 months sud-denly made plans to wean the baby at 4 months in order to be able to go to a dis-tant city for a shopping expedition. After a discussion with her counselor she decided to cancel the trip. A few weeks later she an-nounced with the same urgency that she would need to wean her baby so she could attend an out-of-town athletic event.
quite unaware. She had been happy in her professional career up to the time of the birth of her first baby, but did not seem to miss her former activities or her colleagues. She breast-fed successfully. When tile baby was 5 months old she told her counselor that she did not want to leave him at all because she had heard how quickly babies forget their mothers during an absence; but, for her, this would remain a hypotheti-cal problem because she never dreamed of leaving her child. Just 2 weeks later she started part-time employment and shortly afterward returned to full-time work.
A majority of the mothers expressed spontaneous opinions at one time or an-other about the right of parents to lead a life of their own. Though intellectually they agreed with their counselors that children should become used to changes gradually, the counselors were impressed with the abrupt way many of them left their chil-dren and how deaf they seemed to the counselors’ suggestions of caution.
Responses to the One-Year-Old
A second period of strain for the mothers occurred around 1 year of age, when the child began to show stronger reactions to separations. The majority of the mothers regarded the clinging and crying as “spoiled” behavior. They reacted with an-noyance to these demands and tried to withdraw from the clinging. One mother, complaining that her son was hitting her, crying, and clinging, said, “I don’t want him to he a mama’s boy.” (Even during the prenatal period this mother had been deter-mined not to have a spoiled child.) Soon after this she announced that she and her husband were going away for 2 weeks and she showed little interest in discussing witil
the counselor tile arrangements she had
made for her SOIl’S care. When she returned
from the vacation she complained that her son “did not kllow her.” For the next year she reported: “terrible problem, spoiled, won’t let me out of his sight, fusses all day,
afraid of new people.” All this was attrib-uted to some inexplicable attitude in the child, not to the effects of separation.
One mother expressed repeatedly her dis-gust and disappointment and spanked her daughter because she cried and held her mother’s legs whenever the latter tried to
leave. She was embarrassed al)out the poor
impression which she thought her daughter made and was concerned that this would frighten away baby sitters.
The liklihood of “following” responses and of the child’s reactions to separation
were not well known to these mothers in advance and they did not seem to under-stand their significance at all. Tile counsel-ors attempted to explain and to reassure as the reactions appeared. But they could not,
at the time, allay the mothers’ fears that their children had become spoiled. In retro-spect the mothers agreed that they might
have been less anxious had they been able
to discuss and anticipate the reactions of the child before lie entered this phase of his development.
COMMENT
It should help conscientious parents to know that they cannot prevent separation reactions. This should lessen the feeling of failure-that the child is not enlarging or even maintaining his independence-which
causes some mothers to withdraw further from the child, a reaction which only aggra-‘ates the problem. At the same time, a mother, particularly a too casual one, should be helped to realize that the effects of separation cannot be ignored.
A SUGGESTED PLAN
Two general principles seem most impor-tant in talking to mothers about separation -gradualness and anticipation.
Give the Mother the Right to Control
Closeness to Her Baby
In the prenatal discussion with a mother-to-be, or in the neonatal period, the pedia-trician can advise the mother, especially the one expecting to breast-feed, to plan to go out with her husband by the time the baby is a month old, and to get the baby into his own room from the start. Attention to this is particularly worthwhile after an illness or in a child with a definite or suspected medi-cal problem.
At the 9-month visit mothers can be
pre-pared for the changes in behavior that are coming: that the baby will probably cry at subsequent visits, especially the baby who has had frequent or prolonged separations or painful experiences. The pediatrician can predict that the child will scream and cling to the mother during a routine examination but will stop as soon as he is returned to her. (This will be unlike his behavior in the early months when crying was usually only in response to a painful injection.) The phy-sician can emphasize that the separation reaction will not be limited to the doctor’s office but will probably show up whenever the baby is separated from the mother in the next year.
The pediatrician may explain how he will now conduct the examination with the in-fant on the mother’s lap, usually starting with the back of the baby’s chest and then gradually moving to the front. He may sug-gest that the mother can reassure the child during the examination by keeping her face close to his.
The mother can be assured that the criti-cal period is relatively short and that the child will learn to master separation fears in the next couple of years. The mother can help. Teaching an infant to wave “bye-bye” is one of the first steps and an important
one because it gives the child a feeling of participation and mastery. “Peek-a-boo” is another game that reassures a child because he can make his mother appear and disap-pear at will. Gradually he learns that he can rely on his mother to return even when she leaves the room or goes out the door with her hat on.
The lack of verbal communication, par-ticularly in the first 18 months, makes prep-aration for an absence of more than 2 days almost impossible. The protests of the baby to separation may seem much more drama-tic from 1% to 2% years; but observation of the children in this study, and in pediatric and psychiatric practice generally, suggest that separation has a more disintegrative effect on the child under 18 months, who is apt to react with a severe anxiety or quiet despair. So it is frequently recommended that a vacation trip of more than a day or two or full-time employment of the mother should be avoided, if at all possible, until the baby is at least 1% years old, preferably 2%. The trauma will be reduced, of course, to the degree that there is a familiar rela-tive to stay with the child. On the other hand, separations for a morning or after-noon will prepare a child for longer ab-sences later on.
Separation for Confinement
Separation for the mother’s confinement can be particularly hard for a child. His anxiety about her absence will be coupled with the need to adjust to the loss of her full attention when she returns home. A mother approaching her second con-finement should be particularly encour-aged to accustom her child to increasing absences, perhaps including one for over-night.
The Problem of Vacations
Young parents are often exposed to a lot of persuasion from relatives, friends, and sometimes doctors, to get away from a
young child for “a real vacation.” The
prin-ciple of the importance of relief is sound, but an understanding of the vulnerability of the child should help parents to substi-tute small tolerable absences for the cus-tomary 1- or 2-week vacation.
It is not realistic to think that unduly long separations can always be eliminated. The impact will be softened if the young-ster remains in his own home.
Often a mother is hurt by the child who ignores her after a separation and is tempted to retaliate in kind or to show
anger. These reactions intensify the child’s
fear of loss. The mothers in the study were relieved to hear how common and natural this reaction of ignoral in children is. An-other frequent response in children is an outburst of anger. A mother is almost cer-tam to think-and to be told-that her child is spoiled. She may feel the impulse to meet such challenges with a tightening up of her discipline. In most cases this would be a
mistake, intensifying the child’s sense of
loss. On the other hand, if a mother is feel-ing guilty about her absence and allows the child to be abusive or controlling, a new and chronic problem may be created. A middle-of-the-road course, with daily rou-tines back to normal, is best.
SUMMARY
Every child in this long-term study of child rearing showed significant reactions to ordinary separations by about 1 year of age.
The similar pattern of response in this group of children suggests a biologically determined cause. The clinging reaction appeared when the child became mobile and able to move away from his mother, regardless of the frequency or duration of his separations.
The majority of the mothers did not
un-derstand this natural phenomenon and re-garded the clinging and crying of the 1-year-old as evidence of spoiled or
re-gressed behavior.
The pediatrician can be helpful to a mother by anticipating and explaining sep-aration responses, by indicating their
uni-versality, and by giving specific
recom-mendations for gradual changes to modify these reactions.
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