A 4-year-old child is brought to his pediatrician by his mother and father. They are worried that their baby-sitter may be hurting their child. They left the child with a baby-sitter for the first...

A 4-year-old child is brought to his pediatrician by his mother and father. They are worried that their baby-sitter may be hurting their child. They left the child with a baby-sitter for the first time 2 days ago. When the parents returned, the child was crying, and pleaded for them to “never leave again!” When the pediatrician questions the child alone, he denies any poor treatment by the baby-sitter or parents. He simply says, “mommy and daddy could get sick and die when they are gone.” The child’s babysitter, when questioned by phone, states that the child “won’t stop crying when his parents leave.” When asked how he feels while his parents are away, the child says, “it makes me feel sick when they are gone.” The child denies discomfort when he is with his parents. On physical examination the child has no stigmata of abuse, such as scars, bruises, burns, or genital lesions. His abdomen is soft, nontender, and nondistended. The child does not complain of bone pain. Which of the following is the most appropriate next step?

(A) Call child protective services


(B) Diagnose a likely separation anxiety disorder


(C) Diagnose the patient with a generalized anxiety disorder


(D) Image the child’s bones


(E) Recommend upper endoscopy



May 19, 2022
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