AIIMS Delhi NO- 2019: A 4-year-old child is hospitalized and refuses to eat, crying for parents. Which stage of separation anxiety…

AIIMS Delhi NO- 2019

Child Health Nursing (Pediatrics)

Medium

Appeared in: AIIMS Delhi NO- 2019

Explanation

the Protest stage.
This stage is characterized by active, overt, and often loud resistance to the separation from a parent or primary caregiver.
The child's behaviors in the scenario—crying specifically for parents and refusing to eat—are hallmark signs of the protest phase.
During this phase, the child's entire focus is on the absence of the parent and the need to bring them back, leading to inconsolable distress.

Option B: The Despair stage involves the child becoming quiet, withdrawn, and appearing hopeless. The child in the scenario is actively crying and protesting, not showing signs of despair or apathy.
Option C: The Detachment stage is marked by a superficial adjustment. The child appears happy, engages with others, and plays. This is the opposite of the distressed behavior described.
Option D: Regression is a return to earlier, less mature behaviors (e.g., thumb-sucking, bedwetting) as a coping mechanism for stress. While it can occur during separation anxiety, it is not one of the three distinct stages of the process.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Stages of separation anxiety in a hospitalized child as background academic context rather than a clinical decision trigger.
Recognizing the stages of separation anxiety is crucial for nurses to provide appropriate psychosocial support to pediatric patients.
Nursing interventions should be tailored to the child's stage. For a child in the protest stage, providing comfort, reassurance, and encouraging parental presence is key.
What if? If the 4-year-old child was initially protesting but is now quiet, not playing, and staring blankly, the nurse should recognize this as a progression to the Despair stage. This is not a sign of improvement but of increasing hopelessness, requiring immediate intervention to prevent further emotional withdrawal.

How to Approach the Question

First, read the clinical scenario carefully, noting the patient's age (4-year-old) and setting (hospitalized).
Identify the key behaviors described in the stem: 'refuses to eat' and 'crying for parents'.
Analyze these behaviors. Are they active and resistant, or passive and withdrawn?
Recall the three stages of separation anxiety: Protest, Despair, and Detachment.
Match the observed behaviors to the characteristics of each stage. The active crying and refusal to engage are classic signs of protest.
Evaluate the other options. 'Despair' involves hopelessness, 'Detachment' involves superficial adjustment, and 'Regression' is a behavior, not a stage. This confirms the initial choice.

Concept Tested & Keywords

Concept Tested: Stages of separation anxiety in a hospitalized child.
Stem keywords: 4-year-old child, hospitalized, refuses to eat, crying for parents
Lead-in keywords: Which stage
Clinical cues: The child's age (4 years old) places them in the preschooler category, where separation anxiety is still a significant concern.
Clinical cues: The behaviors 'crying for parents' and 'refusing to eat' are active, outward expressions of distress.

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E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) pp. 3176-3178, 2810-2812