A 5-year-old boy is brought to the office by his mother for a checkup. He is healthy and about to start kindergarten. His mother is concerned about his recent reaction to her brother's death. "Although I told him that Uncle John died and can't be with us anymore, he insists that he is coming for his birthday and will take him to a ballgame. He died over 3 months ago, but my son repeatedly asks me when he is coming back. When I try to explain, he starts crying that his stomach hurts." Physical examination is normal. During the examination he tells the physician, "I try to clean up my toys before bedtime so mommy won't cry." Which of the following is the most likely explanation for the patient's behavior?

Question

A 5-year-old boy is brought to the office by his mother for a checkup.  He is healthy and about to start kindergarten.  His mother is concerned about his recent reaction to her brother's death.  "Although I told him that Uncle John died and can't be with us anymore, he insists that he is coming for his birthday and will take him to a ballgame.  He died over 3 months ago, but my son repeatedly asks me when he is coming back.  When I try to explain, he starts crying that his stomach hurts."  Physical examination is normal.  During the examination he tells the physician, "I try to clean up my toys before bedtime so mommy won't cry."  Which of the following is the most likely explanation for the patient's behavior?

Quizplus · Accepted Answer

Bereavement reactions in children depend on the child's age. Preschool children (age <6) may not understand the finality of death and can exhibit magical thinking in which they fully expect that a dead person can come back to life. Younger children may also attribute events or other's reactions to something they did wrong due to an egocentric thought process (eg, this child believing that he causes his mother's crying). Death should be explained to them in concrete terms, and they should be reassured that other people's grief is not their fault. (Choice B) This child's reactions are age-appropriate. Complicated grief (also known as persistent complex bereavement disorder) is characterized by prolonged grief, excessive yearning for the deceased, and inability to move on with life. (Choice C) This boy's behavior (not understanding death) is appropriate for a 5-year-old; in contrast, children age ≥7 are typically aware that death is final. (Choice D) Post-traumatic stress disorder requires exposure to a life-threatening event that continues to be reexperienced in the form of flashbacks and nightmares. In preschool children this can be manifested by repetitive play about the event, frightening nightmares, and mood or behavioral changes (eg, temper tantrums, separation anxiety). (Choice E) Regression refers to returning to a former, less developed stage of development. It is often seen in response to traumatic or anxiety-provoking situations (eg, if this child started wetting the bed following a stressful event after having achieved continence previously). (Choice F) Children commonly develop somatic symptoms as a nonverbal expression of psychological distress. This child is not excessively focused on his stomachaches to the extent of impairment, as would be seen in somatic symptom disorder. Educational objective: Preschool children have not developed an understanding of the finality of death, which typically occurs around age 7. They may have magical thoughts that death is temporary or reversible and believe that other people's grief is their fault. __________ References: Exploring children's understanding of death: through drawings and the Death Concept Questionnaire. (http://www.ncbi.nlm.nih.gov/pubmed/24600720) Predictors of children's understandings of death: age, cognitive ability, death experience and maternal communicative competence. (http://www.ncbi.nlm.nih.gov/pubmed/18680887) Sources of children's knowledge about death and dying. (http://www.ncbi.nlm.nih.gov/pubmed/30012734)

A 5-Year-Old Boy Is Brought to the Office by His