A hospitalized 2-year-old child becomes extremely distressed when his mother leaves. Initially, he cries loudly, screams for his mother, refuses comfort from the nurse, and tries to follow her. Which phase of separation anxiety is the child demonstrating?

1. A

   Despair

2. B

   Detachment

3. C

   Protest

4. D

   Denial

Appeared in: AIIMS Jodhpur SNO-2023

Explanation

• The protest phase is the initial stage of separation anxiety, marked by loud crying, screaming, and active attempts to regain the caregiver.
• Children in this phase refuse comfort from others and may try to follow or call out for the parent.
• This phase is characterized by overt distress and is the most intense emotional response to separation.
• The scenario describes a 2-year-old who cries loudly, screams, refuses comfort, and tries to follow the mother, matching the protest phase.
• Bowlby's model describes protest as the first of three predictable stages: protest, despair, and detachment.

Why Other Options Were Wrong

• Option A: Despair is the second phase, where the child becomes withdrawn, quiet, and may appear hopeless after prolonged separation.
• Option B: Detachment is the third phase, where the child appears indifferent to the parent's return and may show interest in the environment or others.
• Option D: Denial is not a standard phase in the classic model of separation anxiety; it is not used to describe the stages of separation response in children.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Phases of separation anxiety in young children to guide bedside assessment, documentation, and the next nursing action.
• Recognizing the protest phase helps nurses provide appropriate emotional support and minimize trauma during hospitalization.
• Early intervention during the protest phase can prevent progression to despair or detachment, which are associated with worse emotional outcomes.
• What if? If the child had stopped crying and appeared withdrawn or apathetic after a prolonged absence, the answer would shift to the despair phase.

How to Approach the Question

• Identify the age and context: a 2-year-old hospitalized child separated from the mother.
• Focus on the described behaviors: loud crying, screaming, refusing comfort, trying to follow.
• Recall the classic stages of separation anxiety: protest, despair, detachment.
• Match the scenario's behaviors to the defining features of each phase.
• Eliminate options that do not fit the described behaviors or are not standard phases.

Concept Tested & Keywords

• Concept Tested: Phases of separation anxiety in young children
• Stem keywords: hospitalized 2-year-old, distressed when mother leaves, cries loudly, screams, refuses comfort, tries to follow
• Lead-in keywords: phase, separation anxiety
• Clinical cues: 2-year-old child
• Clinical cues: acute distress behaviors

Question ID

QYmZglBWldtbNo-sUcNBrt

Copy ID

Reference Book

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 3178-3180