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Preschoolers Who Refuse to Be Examined: Fearful or Spoiled?

Preschoolers Who Refuse to Be Examined: Fearful or Spoiled? Abstract • Twenty-two children (aged 2 to 5 years) who cried excessively or resisted physical examination during routine office visits initially seemed to be afraid of physicians, but eight were afraid of medical procedures, five had prolonged separation anxiety, six were manipulative, and three were afraid of men because of previous physical abuse by their fathers. Management plans were initiated for each etiological subtype. Five of eight parents whose children were afraid of medical procedures and five of six parents whose children were manipulative returned for counseling. In these cases, 100% (8/8) and 80% (4/5) of the children, respectively, made major improvement. Abused children required referral to mental health centers. Most parents of children with prolonged separation anxiety (three of five) did not consider the overdependent behavior to be a problem and therefore did not comply with treatment recommendations. (AJDC 1984;138:443-446) References 1. Tennes K, Lampl E: Stranger and separation anxiety in infancy . J Nerv Ment Dis 1964;139:247-254.Crossref 2. Wright GZ, Starkey PE, Gardner DE: Managing Children's Behavior in the Dental Office . St Louis, CV Mosby Co, 1983. 3. Munby M, Johnston D: Agoraphobia: The long-term follow-up of behavioral treatment . Br J Psychiatry 1980;137:418-427.Crossref 4. Schmitt BD: School phobia—the great imitator: A pediatrician's viewpoint . Pediatrics 1971;48:433-441. 5. Sheehan DV, Sheehan KE, Minichiello WE: Age of onset of phobic disorders: A reevaluation . Compr Psychiatry 1981;22:544-553.Crossref 6. Buchanan A, Oliver JE: Abuse and neglect as a cause of mental retardation . Child Abuse Neglect 1979;3:467-471.Crossref 7. Klein DM: Central nervous system injuries , in Ellerstein NS (ed): Child Abuse and Neglect: A Medical Reference . New York, John Wiley & Sons Inc, 1981, pp 73-93. 8. Martin HP: The consequences of being abused and neglected: How the child fares , in Kempe CH, Helfer RE (eds): The Battered Child , ed 3. Chicago, University of Chicago Press, 1980, pp 347-365. 9. Green AH: Self-destructive behavior in battered children . Am J Psychiatry 1978;135: 579-582. 10. Lewis DO, Shanok SS, Pincus JH, et al: Violent juvenile delinquents: Psychiatric, neurological, psychological and abuse factors . J Am Acad Child Psychiatry 1979;18:307-320.Crossref 11. Hunter RS, Kilstrom N, Kraybill EN, et al: Antecedents of child abuse and neglect in premature infants: A prospective study in a newborn intensive care unit . Pediatrics 1978;61: 629-635. 12. Schmitt BD: Pediatric developmental-behavioral counseling , in Levine MD, Carey WB, Crocker AC, et al (eds): Developmental-Behavioral Pediatrics . Philadelphia, WB Saunders Co, 1983, pp 1043-1057. 13. Beezley P, Martin HP, Kempe R: Psychotherapy , in Martin HP (ed): The Abused Child: A Multidisciplinary Approach to Developmental Issues and Treatment . Cambridge, Mass, Ballinger Publishing Co, 1976, pp 201-213. 14. Frankl SN, Shiere FR, Fogels HR: Should the parent remain with the child in the dental operatory? ASDC J Dent Child 1962;29:150-161. 15. Poole SR: The 'overanxious' parent . Clin Pediatr 1980:19:557-562.Crossref 16. Green M, Solnit AJ; Reactions to the threatened loss of a child: A vulnerable child syndrome . Pediatrics 1964;34:58-66. 17. Levy JC: Vulnerable children: Parents' perspectives and the use of medical care . Pediatrics 1980;65:956-963. 18. Prugh DG, Staub EM, Sands HH, et al: A study of the emotional reactions of children and families to hospitalization and illness . Am J Orthopsychiatry 1953;23:70-106.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Preschoolers Who Refuse to Be Examined: Fearful or Spoiled?

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References (21)

Publisher
American Medical Association
Copyright
Copyright © 1984 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1984.02140430021006
Publisher site
See Article on Publisher Site

Abstract

Abstract • Twenty-two children (aged 2 to 5 years) who cried excessively or resisted physical examination during routine office visits initially seemed to be afraid of physicians, but eight were afraid of medical procedures, five had prolonged separation anxiety, six were manipulative, and three were afraid of men because of previous physical abuse by their fathers. Management plans were initiated for each etiological subtype. Five of eight parents whose children were afraid of medical procedures and five of six parents whose children were manipulative returned for counseling. In these cases, 100% (8/8) and 80% (4/5) of the children, respectively, made major improvement. Abused children required referral to mental health centers. Most parents of children with prolonged separation anxiety (three of five) did not consider the overdependent behavior to be a problem and therefore did not comply with treatment recommendations. (AJDC 1984;138:443-446) References 1. Tennes K, Lampl E: Stranger and separation anxiety in infancy . J Nerv Ment Dis 1964;139:247-254.Crossref 2. Wright GZ, Starkey PE, Gardner DE: Managing Children's Behavior in the Dental Office . St Louis, CV Mosby Co, 1983. 3. Munby M, Johnston D: Agoraphobia: The long-term follow-up of behavioral treatment . Br J Psychiatry 1980;137:418-427.Crossref 4. Schmitt BD: School phobia—the great imitator: A pediatrician's viewpoint . Pediatrics 1971;48:433-441. 5. Sheehan DV, Sheehan KE, Minichiello WE: Age of onset of phobic disorders: A reevaluation . Compr Psychiatry 1981;22:544-553.Crossref 6. Buchanan A, Oliver JE: Abuse and neglect as a cause of mental retardation . Child Abuse Neglect 1979;3:467-471.Crossref 7. Klein DM: Central nervous system injuries , in Ellerstein NS (ed): Child Abuse and Neglect: A Medical Reference . New York, John Wiley & Sons Inc, 1981, pp 73-93. 8. Martin HP: The consequences of being abused and neglected: How the child fares , in Kempe CH, Helfer RE (eds): The Battered Child , ed 3. Chicago, University of Chicago Press, 1980, pp 347-365. 9. Green AH: Self-destructive behavior in battered children . Am J Psychiatry 1978;135: 579-582. 10. Lewis DO, Shanok SS, Pincus JH, et al: Violent juvenile delinquents: Psychiatric, neurological, psychological and abuse factors . J Am Acad Child Psychiatry 1979;18:307-320.Crossref 11. Hunter RS, Kilstrom N, Kraybill EN, et al: Antecedents of child abuse and neglect in premature infants: A prospective study in a newborn intensive care unit . Pediatrics 1978;61: 629-635. 12. Schmitt BD: Pediatric developmental-behavioral counseling , in Levine MD, Carey WB, Crocker AC, et al (eds): Developmental-Behavioral Pediatrics . Philadelphia, WB Saunders Co, 1983, pp 1043-1057. 13. Beezley P, Martin HP, Kempe R: Psychotherapy , in Martin HP (ed): The Abused Child: A Multidisciplinary Approach to Developmental Issues and Treatment . Cambridge, Mass, Ballinger Publishing Co, 1976, pp 201-213. 14. Frankl SN, Shiere FR, Fogels HR: Should the parent remain with the child in the dental operatory? ASDC J Dent Child 1962;29:150-161. 15. Poole SR: The 'overanxious' parent . Clin Pediatr 1980:19:557-562.Crossref 16. Green M, Solnit AJ; Reactions to the threatened loss of a child: A vulnerable child syndrome . Pediatrics 1964;34:58-66. 17. Levy JC: Vulnerable children: Parents' perspectives and the use of medical care . Pediatrics 1980;65:956-963. 18. Prugh DG, Staub EM, Sands HH, et al: A study of the emotional reactions of children and families to hospitalization and illness . Am J Orthopsychiatry 1953;23:70-106.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: May 1, 1984

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