When to refer a child with possible Separation Anxiety Disorder

A worried clinging child is common — your job at the frontline is to spot when ordinary worry has tipped into something that needs a specialist's eye.

In short

Refer when separation distress is persistent (lasting several weeks or more), developmentally out of step, and causing real impairment — the child is missing school, not sleeping, complaining of headaches or tummy aches with no medical cause, or the family routine has stalled. Brief clinginess at a new playgroup or after a move is normal and usually settles. A pattern that does not ease, or that is escalating, is your referral signal.

When to refer — the decision points

Refer a child with possible Separation Anxiety Disorder (ICD-11 6B05) to a specialist when you see:

• Duration — fear or distress about separation lasting roughly 4 weeks or more in a child, well beyond settling-in.
• Function — school refusal or repeated absence, refusing to sleep alone, unable to be left with a familiar carer.
• Body signs — recurrent headaches, nausea or stomach aches at the point of separation, with no medical cause found.
• Intensity — panic, inconsolable crying, or excessive worry that harm will come to a parent.
• Red flags for urgent review — self-harm talk, complete refusal to eat, or a sudden change after a frightening event.

If in doubt, refer for assessment rather than wait — early help is gentler and shorter.

The science, briefly

Separation anxiety is a normal developmental stage peaking in toddlers. It becomes a disorder only when it is excessive for age, persistent and impairing — the distinction WHO draws in ICD-11. Identified early, most children respond well to family-based behavioural support, so timely referral changes the trajectory.

The Pinnacle way

Developmental measurement supports care planning; diagnosis requires an appropriately qualified healthcare professional., under qualified clinician care — never from a form or a single visit. Our clinicians review your referral against the child's own developmental baseline and plan child-and-family behavioural therapy where needed. As a frontline worker, your early note is invaluable.

Trusted sources

WHO ICD-11 (6B05); American Academy of Pediatrics guidance on childhood anxiety; NICE guidance on anxiety in children and young people.

Next step — Don't wait for it to pass on its own. Book a developmental assessment so a clinician can guide the family.

This is general information, not a diagnosis — individual assessment and diagnosis require an appropriately qualified healthcare professional.