Published online November 1, 2004
PEDIATRICS Vol. 114 No. 5 November 2004, pp. 1419-1424 (doi:10.1542/peds.2004-1721E)
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SUPPLEMENT ARTICLE

"Not Listening, Stubborn, and Problems With Sleeping"—Interpreting a Parent's Concerns at a 3-Year-Old's Health-Supervision Visit*

Key Words: behavioral screening • developmental delay • health-supervision visits • autistic spectrum disorders

The first 300 words of the full text of this article appear below.


   CASE
 
Max, a 3-year-old boy, is accompanied by his mother for a health-supervision visit. Two previously scheduled well-child visits have been postponed by parents because of busy work schedules. On this visit, Max's mother says that Max seems very healthy but that she is feeling frustrated by his "not listening," his stubbornness, and his lack of cooperation. Max refuses to fall asleep unless he is in his parents' bed and even then wakes up and disturbs his mother's sleep. The sleeping situation is particularly difficult because she and her husband both work long hours and commute to the Silicon Valley. This necessitates a "tag team" approach to parenting. Max's father takes him to child care (in a home-based program for 12 children) at 7:30 AM. The father returns home in the evening at 8 or 9 PM. Max's mother leaves home at 5 AM and picks Max up at 6 PM. She says that the hours and the commute are draining but unavoidable because of their house payments and the uncertainty of the economy. With tears in her eyes, she says that she feels terrible admitting it, but she finds it easier to deal with the demands of work than with Max.

During the physical examination, Max is squirmy but cooperative as long as the pediatrician keeps him distracted with a series of small toys. He plays with the wooden trains on the examination table and explores them closely, spinning their wheels. The physical examination is normal with 1 exception: Max is unwilling to interact with the examiner until she sits down, watches him explore the room, and comments on what he is doing without asking him questions. He then points to toys on the shelves he wants and takes them from her without making eye contact. Max's . . . [Full Text of this Article]

Martin T. Stein, MD

Professor of Pediatrics
University of California
San Diego, California

Meg Zweiback, RN, CPNP, MPH

Department of Family Health Care Nursing
School of Nursing
University of California
San Francisco, California