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Expert Q&A

	By Jenny Lewis, M.D. Pediatrician

I've been taking care of twin boys, age 1 year, for about three months now. One is easygoing; the other is very difficult. The biggest problem for him seems to be whenever he's left alone he starts crying and screaming ? mostly screaming. He sleeps with his twin at night at home. At my home, he sleeps in his own bed, and I just moved him to another room too, away from his brother. Whenever his brother leaves him to eat, go to bed or any separation, he screams and cries. Whenever anyone leaves him alone to do anything out of his eyesight, he screams and cries. He can keep this behavior up for a very long time ? the whole length of a normal nap which is approximately two hours.?

It sounds as if this little boy has separation anxiety, which is a normal developmental stage in most children starting around 9 months. The severity depends on many factors including the baby's temperament. It can last well beyond the first birthday as appears to be happening here.

It is clearly being exaggerated by his attachment to his twin who no doubt has been a constant presence in his world since birth. Twins are often ?inseparable÷ so it is not surprising that losing sight of his brother is as anxiety producing as losing sight of his caretaker.

Although it may lead to some difficult behaviors, the closeness of the twin relationship offers many benefits. I see no particular advantage in putting the babies in separate rooms for sleep, especially if that is not happening at home, and it causes distress. Separate cribs from which they can see each other, however, may help them learn ways of getting themselves to sleep which do not need each other?s body contact. At this age I would still be trying to keep them on the same schedule of sleeping/waking/eating if possible.

As with any baby with separation anxiety I would suggest not leaving the room abruptly; rather, use a reassuring voice which he can continue to hear even when he cannot see you or simply take him with you. When babies start to become more independently mobile ? crawling or walking ? they often get less distressed being left for a few minutes, as they have the potential to follow you. My guess is that this distress on separation will gradually lessen over the next few months, and meanwhile, avoiding situations which cause extreme, prolonged distress would be best.

Dr. Jennifer Lewis
Pediatrician

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